Women's access to health care in Ghana: effects of education, residence, lineage and self-determination

Access to a quality healthcare among prisoners - perspectives of health providers of a prison infirmary, Ghana

PURPOSE

The purpose of this paper is to explore the influence of health system factors on access to a quality healthcare among prisoners in Ghana.

DESIGN/METHODOLOGY/APPROACH

Data were gathered using different qualitative methods (interviews and participant observation) with staff of the James Camp Prison, Accra. Findings were analyzed using a framework method for the thematic analysis of the semi-structured interview data; and interpreted with the theoretical perspective of health systems thinking and innovation.

FINDINGS

The study concludes that health system factors such as inadequate funding for health services, lack of skilled personnel and a paucity of essential medical supplies and drugs negatively affected the quality of healthcare provided to inmates.

RESEARCH LIMITATIONS/IMPLICATIONS

The limited facilities available and the sample size (healthcare workers and prison administrators) impeded the achievement of varied views on the topic.

PRACTICAL IMPLICATIONS

The paper recommends the need for health policy makers and authorities of the Ghana Prison Service to collaborate and coordinate in a unified way to undertake policy analysis in an effort to reform the prisons healthcare system.

SOCIAL IMPLICATIONS

The national health insurance scheme was found to be the financing option for prisoners' access to free healthcare with supplementation from the Ghana Prison Service. The study recommends that policy makers and healthcare stakeholders should understand and appreciate the reality that the provision of a quality healthcare for prisoners is part of the entire system of healthcare service delivery in Ghana and as such should be given the needed attention.

ORIGINALITY/VALUE

This is one of few studies conducted on male only prisoners/prison in the context of Ghana. It recommends the need for an integrated approach to ensure that the entire healthcare system achieves set objectives in response to the primary healthcare concept.

Former Buruli Ulcer Patients' Experiences and Wishes May Serve as a Guide to Further Improve Buruli Ulcer Management

BACKGROUND

Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical disease frequently leading to permanent disabilities. The ulcers are treated with rifampicin and streptomycin, wound care and, if necessary surgical intervention. Professionals have exclusively shaped the research agenda concerning management and control, while patients' perspective on priorities and preferences have not explicitly been explored or addressed.

METHODOLOGY/PRINCIPAL FINDINGS

To get insight into patient perception of the management and control of Buruli ulcer a mixed methods research design was applied with a questionnaire and focus group discussions among former BU patients. Data collection was obtained in collaboration with a local team of native speakers in Ghana. A questionnaire was completed by 60 former patients and four focus group discussions were conducted with eight participants per group. Former patients positively evaluated both the effectiveness of the treatment and the financial contribution received for the travel costs to the hospitals. Pain experienced during treatment procedures, in particular wound care and the streptomycin injections, and the side-effects of the treatment were negatively evaluated. Former patients considered the development of preventive measures and knowledge on the transmission as priorities. Additionally, former patients asked for improved accessibility of health services, counselling and economic support.

CONCLUSIONS

These findings can be used to improve clinical management and to guide the international research agenda.

Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level

Introduction

A key element of the global drive to universal health coverage is ensuring access to needed health services for everyone, and to pursue this goal in an equitable way. This requires concerted efforts to reduce disparities in access through understanding and acting on barriers facing communities with the lowest utilisation levels. Financial barriers dominate the empirical literature on health service access. Unless the full range of access barriers are investigated, efforts to promote equitable access to health care are unlikely to succeed. This paper therefore focuses on exploring the nature and extent of non-financial access barriers.

Methods

We draw upon two structured literature reviews on barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda. One review analyses access barriers identified in published literature using qualitative research methods; the other in published literature using quantitative analysis of household survey data. We then synthesised the key qualitative and quantitative findings through a conjoint iterative analysis.

Results

Five dominant themes on non-financial access barriers were identified: ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education. The analysis highlighted that non-financial factors pose considerable barriers to access, many of which relate to the acceptability dimension of access and are challenging to address. Another key finding is that quantitative research methods, while yielding important findings, are inadequate for understanding non-financial access barriers in sufficient detail to develop effective responses. Qualitative research is critical in filling this gap. The analysis also indicates that the nature of non-financial access barriers vary considerably, not only between countries but also between different communities within individual countries.

Conclusions

To adequately understand access barriers as a basis for developing effective strategies to address them, mixed-methods approaches are required. From an equity perspective, communities with the lowest utilisation levels should be prioritised and the access barriers specific to that community identified. It is, therefore, critical to develop approaches that can be used at the district level to diagnose and act upon access barriers if we are to pursue an equitable path to universal health coverage.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-015-0181-z) contains supplementary material, which is available to authorized users.

Assessment of psychological barriers to cervical cancer screening among women in Kumasi, Ghana using a mixed methods approach

BACKGROUND

Cervical cancer is the leading cause of cancer death among women in Ghana, West Africa. The cervical cancer mortality rate in Ghana is more than three times the global cervical cancer mortality rate. Pap tests and visual inspection with acetic acid wash are widely available throughout Ghana, yet less that 3% of Ghanaian women get a cervical cancer screening at regular intervals.

OBJECTIVE

This exploratory study was to identify psychological barriers to cervical cancer screening among Ghanaian women with and without cancer using a mixed methods approach.

METHODS

Semi-structured interviews were conducted with 49 Ghanaian women with cancer and 171 Ghanaian women who did not have cancer.

RESULTS

The results of the quantitative analysis indicated that cancer patients where not more likely to have greater knowledge of cancer signs and symptoms than women without cancer. Analysis of the qualitative data revealed several psychological barriers to cervical cancer screening including, common myths about cervical cancer, misconceptions about cervical cancer screening, the lack of spousal support for screening, cultural taboos regarding the gender of healthcare providers, and the stigmatization of women with cervical cancer.

CONCLUSION

The results of this study can be used to inform the development of culturally relevant cervical cancer education interventions aimed at addressing the psychological barriers to cervical cancer screening perceived by Ghanaian women.