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Hussien M. The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study. BMC Health Serv Res 2024; 24:614. [PMID: 38730420 PMCID: PMC11084123 DOI: 10.1186/s12913-024-11091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Patients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users' perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers. METHODS A community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval. RESULTS A typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0-10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091). CONCLUSIONS Service users' perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users' perceptions, with a special emphasis on improving health care providers' communication skills and removing facility-level access barriers.
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Affiliation(s)
- Mohammed Hussien
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Shure G, Gamachu M, Mitiku H, Deressa A, Eyeberu A, Mohammed F, Zakaria HF, Ayana GM, Birhanu A, Debella A, Mussa I. Patient satisfaction and associated factors among insured and uninsured patients in Deder General Hospital, eastern Ethiopia: a facility-based comparative cross-sectional study. Front Med (Lausanne) 2023; 10:1259840. [PMID: 38204483 PMCID: PMC10777387 DOI: 10.3389/fmed.2023.1259840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
Background Patient satisfaction is a crucial measure of healthcare quality, as dissatisfied patients are more likely to miss appointments, disregard treatment plans, and leave hospitals, leading to poor treatment outcomes. Therefore, the study aimed to compare levels of satisfaction with health services and associated factors among insured and uninsured patients in Deder General Hospital, eastern Ethiopia. Methods A comparative cross-sectional study with 532 participants was conducted from December 1-30, 2021. Data was collected through a structured questionnaire, analyzed using SPSS, and predictors assessed using a multivariate logistic regression model. Statistical significance was set at p < 0.05. Results Overall, patient satisfaction with health services was 65.6% (95% CI: 61.5-69.5), and the level of patient satisfaction with health services among insured and noninsured patients was 68.8% (95% CI: 62.8-74.4) and 62.4% (95% CI: 56.8-68.0), respectively. In the final model of multivariable analysis, factors such as educational status of secondary school (AOR = 4.90; 95% CI: 2.05-11.76), and a higher level (AOR = 3.08; 95% CI: 1.05-9.03), getting the entire prescribed drugs (AOR = 3.49; 95% CI: 1.43-8.54), getting some of the ordered drugs (AOR = 3.34; 95% CI: 1.61-6.94), paying less than 100 Ethiopian birrs (AOR = 4.85; 1.35-17.40) were significantly associated with patient satisfaction among insured patients. Whereas getting the entire and some prescribed drugs were (AOR = 6.28; 95% CI: 3.26-12.05), and (AOR = 3.40; 95% CI: 1.70-6.78) times more likely to be satisfied with the service among noninsured patients as compared to their counterparts, respectively. Conclusion The study found that about six in 10 patients in the study area were satisfied with healthcare services, with insurance patients reporting higher satisfaction. Factors such as receiving prescribed drugs, paying less than 100 Ethiopian birr, having a secondary school education, and having a higher education were associated with satisfaction.
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Affiliation(s)
- Giduma Shure
- Goro Muti Woreda Health Office, East Hararghe, Ethiopia
| | - Mulugeta Gamachu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Public Health, Rift Valley University, Harar, Ethiopia
| | - Habtamu Mitiku
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fethia Mohammed
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hamdi Fekredin Zakaria
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Getaneh MM, Bayked EM, Workneh BD, Kahissay MH. Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study. Front Public Health 2023; 11:1127755. [PMID: 37261241 PMCID: PMC10227519 DOI: 10.3389/fpubh.2023.1127755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Background The fundamental concept of community-based health insurance is to strengthen the healthcare financing system to access universal healthcare by reducing costly risk-coping strategies. The scheme's sustainability and the quality of services provided by it are highly dependent on the satisfaction of its beneficiaries. Despite beneficiaries' satisfaction being the key determinant for providing evidence for policy revision and decision-making, it has often been neglected. Therefore, the study investigated the community-based health insurance beneficiaries' satisfaction and associated factors in Legambo district, North-East Ethiopia. Methods The study was conducted in the Legambo district with a community-based cross-sectional study design from October to November 2019. The data were collected from 838 households that had been the beneficiaries of the scheme using multi-stage and systematic random sampling. Twelve trained data collectors were employed and gathered the data using a pre-tested, structured questionnaire. We ran descriptive, bivariate, and logistic regression analyses. A value of p less than 0.05 with a 95% CI was used in multivariate logistic regression to determine the association of variables with the beneficiaries' satisfaction. Results The overall satisfaction level of the beneficiaries of the scheme was 58.6% and was associated with the following factors: merchandize (AOR = 1.92, 95% CI = 1.02-3.63), living in rural areas (AOR = 1.52, 95% CI = 1.02-2.27), an early office opening time (AOR = 3.81, 95% CI = 2.04-7.10), a short time interval to use benefit packages (AOR = 4.85, 95% CI = 2.08-11.31), an inexpensive membership premium (AOR =10.58, 95% CI = 3.56-31.44), availability of laboratory services (AOR =2.95, 95% CI = 1.71-5.09), presence of referral services (AOR =1.93, 95% CI = 1.33-2.80), having immediate care at health facilities (AOR = 1.73, 95% CI = 1.01-2.97) and non-compulsory enrolment (AOR = 6.31, 95% CI = 1.64-24.20). Conclusion The beneficiaries' satisfaction with the scheme was suboptimal and found to be determined by occupation, residence, laboratory and referral services, immediate care, office opening time, time interval to use benefit packages, premium amount, and situation of enrollment, most of which are service-related variables. Thus, to improve the satisfaction level, the stakeholders that should work hard seem to be the health insurance agency (the insurer) and the health facilities (the provider or supplier).
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Affiliation(s)
- Melaknesh Minda Getaneh
- Department of Capacity Building and Operational Research, Ethiopian Pharmaceuticals Supply Services (EPSS), Dessie, Ethiopia
| | - Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Does Health System Responsiveness Differ between Insured and Uninsured Outpatients in Primary Health Care Facilities in Asagirt District, Ethiopia? A Cross-Sectional Study. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3857873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background. An effective designation of health facilities improves the facility’s ability to respond to patients’ legitimate expectations. Limited evidence exists regarding the association between health system responsiveness and financial fairness in Sub-Saharan Africa, particularly in Ethiopia. The purpose of the study was, therefore to evaluate the health system responsiveness among insured and uninsured outpatients in primary healthcare facilities and determine the association between health insurance and health system responsiveness among outpatients. Methods. A facility-based cross-sectional study was conducted between March 30 and April 30,2021. The study sampled 423 participants using a systematic random sampling technique, and the data was collected with structured and pretested questionnaires administered by interviewers. Responsiveness was measured using the short version of the World Health Organization’s multicountry responsiveness survey, which has seven dimensions including autonomy, communication, confidentiality, attention, dignity, choice, and amenities. Using quantile regression, a specific association between health insurance and the health system responsiveness index was examined, adjusting for sociodemographic, quality, and satisfaction-related factors. Results. Of a total of 417 outpatients, 70.74% had health insurance. There was no statistical difference in health system responsiveness among insured and uninsured outpatients. Possession of health insurance was not associated with responsiveness (−0.67; 95%CI: −1.59, 0.25). There was a statistically significant negative relationship between age and responsiveness (−1.33; 95% CI: −2.47, −0.19) among 30–39 year olds and (−1.66; 95% CI: −3.02, −0.32) among 40–49 year olds. However, there was a positive statistical association between responsiveness with urban residence (+1.33; 95%CI: 0.37, 2.29), perceived quality of healthcare (+2.96; 95%CI: 1.95, 4.05), and patient satisfaction (3; 95%CI: 1.94, 4.07). Conclusions. There was no difference in the responsiveness of the health system between insured and uninsured outpatients. All domains need further improvement, particularly those more closely related to patients’ concerns, such as waiting time to get service and choices of healthcare providers. Furthermore, health facility administrators and the government should enhance responsive healthcare services in parallel with quality improvement and patient satisfaction, based on feedback from service users for better performance.
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Hussien M, Azage M, Bayou NB. Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a community-based, cross-sectional study. BMJ Open 2022; 12:e063098. [PMID: 36253038 PMCID: PMC9577901 DOI: 10.1136/bmjopen-2022-063098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine how clients perceived the quality of healthcare they received and identify associated factors both at the individual and facility levels. DESIGN A community-based, cross-sectional study. SETTING Two rural districts of northeast Ethiopia, Tehulederie and Kallu. PARTICIPANTS 1081 rural households who had ever been enrolled in community-based health insurance and visited a health centre at least once in the previous 12 months. Furthermore, 194 healthcare providers participated in the study to provide cluster-level data. OUTCOME MEASURES The outcome variable of interest was the perceived quality of care, which was measured using a 17-item scale. Respondents were asked to rate the degree to which they agreed on 5-point response items relating to their experiences with healthcare in the outpatient departments of nearby health centres. A multilevel linear regression analysis was used to identify predictors of perceived quality of care. RESULTS The mean perceived quality of care was 70.28 (SD=8.39). Five dimensions of perceived quality of care were extracted from the factor analysis, with the patient-provider communication dimension having the highest mean score (M=77.84, SD=10.12), and information provision having the lowest (M=64.67, SD=13.87). Wealth status, current insurance status, perceived health status, presence of chronic illness and time to a recent health centre visit were individual-level variables that showed a significant association with the outcome variable. At the cluster level, the work experience of healthcare providers, patient volume and an interaction term between patient volume and staff job satisfaction also showed a significant association. CONCLUSIONS Much work remains to improve the quality of care, especially on information provision and access to care quality dimensions. A range of individual-level and cluster-level characteristics influence the perceived quality of care. For a better quality of care, it is vital to optimise the patient-provider ratio and enhance staff job satisfaction.
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Affiliation(s)
- Mohammed Hussien
- Health Systems Management and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Muluken Azage
- Environmental Health, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
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Otieno P, Angeles G, Quiñones S, van Halsema V, Novignon J, Palermo T. Health services availability and readiness moderate cash transfer impacts on health insurance enrolment: evidence from the LEAP 1000 cash transfer program in Ghana. BMC Health Serv Res 2022; 22:599. [PMID: 35509055 PMCID: PMC9066897 DOI: 10.1186/s12913-022-07964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expanding health insurance coverage is a priority under Sustainable Development Goal 3. To address the intersection between poverty and health and remove cost barriers, the government of Ghana established the National Health Insurance Scheme (NHIS). Government further linked NHIS with the Livelihood Empowerment Against Poverty (LEAP) 1000 cash transfer program by waiving premium fees for LEAP 1000 households. This linkage led to increased NHIS enrolment, however, large enrolment gaps remained. One potential reason for failure to enroll may relate to the poor quality of health services. METHODS We examine whether LEAP 1000 impacts on NHIS enrolment were moderated by health facilities' service availability and readiness. RESULTS We find that adults in areas with the highest service availability and readiness are 18 percentage points more likely to enroll in NHIS because of LEAP 1000, compared to program effects of only 9 percentage points in low service availability and readiness areas. Similar differences were seen for enrolment among children (20 v. 0 percentage points) and women of reproductive age (25 v. 10 percentage points). CONCLUSIONS We find compelling evidence that supply-side factors relating to service readiness and availability boost positive impacts of a cash transfer program on NHIS enrolment. Our work suggests that demand-side interventions coupled with supply-side strengthening may facilitate greater population-level benefits down the line. In the quest for expanding financial protection towards accelerating the achievement of universal health coverage, policymakers in Ghana should prioritize the integration of efforts to simultaneously address demand- and supply-side factors. TRIAL REGISTRATION This study is registered in the International Initiative for Impact Evaluation's (3ie) Registry for International Development Impact Evaluations ( RIDIE-STUDY-ID-55942496d53af ).
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Affiliation(s)
- Peter Otieno
- African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya
| | - Gustavo Angeles
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, 400 Meadowmont Circle CB #3446, Chapel Hill, NC, USA
| | - Sarah Quiñones
- Department of Epidemiology and Environmental Health, University at Buffalo, SUNY, 270 Farber Hall, Buffalo, NY, USA
| | | | - Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo, SUNY, 270 Farber Hall, Buffalo, NY, USA.
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Lohmann J, Brenner S, Koulidiati JL, Somda SMA, Robyn PJ, De Allegri M. No impact of performance-based financing on the availability of essential medicines in Burkina Faso: A mixed-methods study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000212. [PMID: 36962391 PMCID: PMC10021144 DOI: 10.1371/journal.pgph.0000212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
Access to safe, effective, and affordable essential medicines (EM) is critical to quality health services and as such has played a key role in innovative health system strengthening approaches such as Performance-based Financing (PBF). Available literature indicates that PBF can improve EM availability, but has not done so consistently in the past. Qualitative explorations of the reasons are yet scarce. We contribute to expanding the literature by estimating the impact of PBF on EM availability and stockout in Burkina Faso and investigating mechanisms of and barriers to change. The study used an explanatory mixed methods design. The quantitative study component followed a quasi-experimental design (difference-in-differences), comparing how EM availability and stockout had changed three years after implementation in 12 PBF and in 12 control districts. Qualitative data was collected from purposely selected policy and implementation stakeholders at all levels of the health system and community, using in-depth interviews and focus group discussions, and explored using deductive coding and thematic analysis. We found no impact of PBF on EM availability and stockouts in the quantitative data. Qualitative narratives converge in that EM supply had increased as a result of PBF, albeit not fully satisfactorily and sustainably so. Reasons include persisting contextual challenges, most importantly a public medicine procurement monopoly; design challenges, specifically a disconnect and disbalance in incentive levels between service provision and service quality indicators; implementation challenges including payment delays, issues around performance verification, and insufficient implementation of activities to strengthen stock management skills; and concurrently implemented policies, most importantly a national user fee exemption for children and pregnant women half way through the impact evaluation period. The case of PBF and EM availability in Burkina Faso illustrates the difficulty of incentivizing and effecting holistic change in EM availability in the presence of strong contextual constraints and powerful concurrent policies.
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Affiliation(s)
- Julia Lohmann
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany
| | - Stephan Brenner
- Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany
| | - Jean-Louis Koulidiati
- Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany
| | - Serge M A Somda
- Centre MURAZ, Bobo-Dioulasso, Burkina Faso
- UFR/SEA, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Paul Jacob Robyn
- Health, Nutrition and Population Global Practice, World Bank, Washington, DC, United States of America
| | - Manuela De Allegri
- Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany
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Hailie MT, Hassen SL, Temesgen MM. Client satisfaction on community based health insurance scheme and associated factors at Boru Meda Hospital, Northeast, Ethiopia: institutional based cross-sectional study. BMC Health Serv Res 2021; 21:1287. [PMID: 34847939 PMCID: PMC8630846 DOI: 10.1186/s12913-021-07223-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background Community-based health insurance systems are usually voluntary and characterized by community members pooling funds and protecting themselves against the high costs of seeking medical care and treatment for illness. Client satisfaction with health service provision during the implementation of health insurance schemes has often been neglected. This study aimed to determine client satisfaction with the community-based health insurance scheme and associated factors. Methods An institutional-based cross-sectional study design was applied from February 22–March 11 /2019. A total of 420 study participants were included in the study using a systematic random sampling technique. Data were collected using a pretested semi-structured interviewer-administered questionnaire with a patient exit interview. Bivariate and multivariate logistic regression analyses were used to identify factors associated with Community-based Health Insurance of client satisfaction. Statistical significance was decided at a p-value less than 0.05. Result A total of 420 community-based health insurance clients of health service users participated in the study with a 100% response rate. The overall client satisfaction was 80% at 95% Cl (76.1, 83.9), respondents who have perceived that partially or none availability of prescribing drugs were 0.09 times less likely satisfied as compared to full availability of prescribing drugs (AOR =0.09; 95% Cl: (0.04, 0.19)). Besides, study participants waiting time to consult service providers within 30 min were more satisfied than those who were delayed 60 min and above (AOR =3.16; 95% Cl: (1.19, 8.41)). Conclusion Community-based health insurance client satisfaction provided in the present study was 80% indicating low proportion. Full availability of prescribing drugs, clients renewed their community-based health insurance membership, and preference of clients to use the hospital for future health care need were positively associated with client satisfaction while the perception of waiting time before physician consultation negatively affected client’s satisfaction. Therefore, the hospital management members and service providers need to give attention to reduce waiting time preceding consultation, improve drug availability, and sustain the hospital preference by the client.
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Affiliation(s)
- Mulugeta Tasew Hailie
- Amhara Public Health Institute, Planning, Monitoring, and Evaluation Directorate, Dessie, Ethiopia.
| | - Seid Legesse Hassen
- Amhara Public Health Institute, Research and Technology Transfer Directorate, Dessie, Ethiopia
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Amani PJ, Tungu M, Hurtig AK, Kiwara AD, Frumence G, San Sebastián M. Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study. Int J Equity Health 2020; 19:179. [PMID: 33046058 PMCID: PMC7549195 DOI: 10.1186/s12939-020-01270-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients' expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population. METHODS A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors. RESULTS A total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (- 1; 95% CI: - 1.45, - 0.45) and inpatient (- 2; 95% CI: - 2.69, - 1.30) care. CONCLUSION The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.
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Affiliation(s)
- Paul Joseph Amani
- Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden.
| | - Malale Tungu
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna-Karin Hurtig
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
| | - Angwara Denis Kiwara
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Miguel San Sebastián
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
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Mitiku Kebede K, Geberetsadik SM. Household satisfaction with community-based health insurance scheme and associated factors in piloted Sheko district; Southwest Ethiopia. PLoS One 2019; 14:e0216411. [PMID: 31083706 PMCID: PMC6513074 DOI: 10.1371/journal.pone.0216411] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Community-based health insurance (CBHI) scheme is an emerging strategy for providing financial protection against health-related poverty. It is being piloted in the Sheko district, but community satisfaction with the scheme has not yet studied. Therefore, this study aimed to assess the level of household's satisfaction to CBHI scheme and associated factors in a piloted Sheko district; southwest Ethiopia. METHODS A community-based cross-sectional study was conducted in Sheko district from March to April 2018. Data was collected on 528 households by using simple random sampling method. Trained data collectors gathered the data using a pre-tested and structured questionnaire. Descriptive statistics, bivariate and multivariable logistic regression analyses were performed. To determine the independent predictors of household's satisfaction to CBHI, a cut point of p values < 0.05 were used. RESULTS This study showed that more than half (54.7%) of the households were satisfied with the CBHI scheme. Satisfaction to CBHI was positively associated with adequate knowledge of CBHI benefit packages (AOR = 2.29, 95% CI = 1.55-3.38), type of health facility visit (AOR = 1.93, 95% CI = 1.09-3.39), laboratory service provision (AOR = 2.07, 95% CI = 1.15-373) and length of enrollment (AOR = 1.53, 95% CI = 1.01-2.32). CONCLUSIONS Household's satisfaction to CBHI scheme was moderate. Modifiable factors, including adequate knowledge of CBHI benefit packages, type of health facility visit, laboratory service provision, and length of enrollment were independent determinants of satisfaction. In order to augment enrollee's satisfaction to CBHI, efforts should be given to improving their knowledge of CBHI benefit packages through education and information campaigns. Furthermore, due consideration should also be given to improving the quality of health services.
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Affiliation(s)
- Kindie Mitiku Kebede
- Department of Public Health, College of Health Sciences, Mizan -Tepi University, Mizan-Teferi, Ethiopia
- * E-mail:
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Andoh-Adjei FX, Nsiah-Boateng E, Asante FA, Spaan E, van der Velden K. Perception of quality health care delivery under capitation payment: a cross-sectional survey of health insurance subscribers and providers in Ghana. BMC FAMILY PRACTICE 2018; 19:37. [PMID: 29514594 PMCID: PMC5842640 DOI: 10.1186/s12875-018-0727-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/01/2018] [Indexed: 12/02/2022]
Abstract
BACKGROUND Ghana introduced capitation payment method in 2012 but was faced with resistance for its perceived poor quality of care. This paper assesses National Health Insurance Scheme subscribers and care providers' perception of quality of care under the capitation payment method. METHODS This is a cross-sectional survey of subscribers and care providers perception of quality of care in three administrative regions of Ghana using a 5-point Likert scale for the assessment based on a set of quality of care measures. We performed descriptive analysis to determine average perception of quality of care scores for each of the measures used. Bivariate and multivariate analyses were also performed to examine relationships between respondent's characteristics and their perception of quality of care. RESULTS In general, subscribers expressed positive perception about the quality of care though subscribers in Ashanti were less positive compared to those in the Central region. A chi-square analysis, however, showed significant differences in subscribers' perception of quality of care by occupation (p = 0.002), region (p = 0.007) length of NHIS membership (p = 0.006), and age (p = 0.014). Multivariate logistic regression analysis also showed that different factors, other than region of residence, were significantly associated with perceived good quality of care. Analysis of health care providers' responses also showed significant differences in their perception of quality of care by region (p = 0.001). Multivariate logistic model showed that health care providers in the Volta region (OR = 0.14, 95% CI: 0.03-0.58) were significantly less likely to perceive quality of care as good compared to those in the Ashanti region. CONCLUSION Subscribers and care providers across the three regions have relatively good perception of the quality of health care in general though subscribers in Ashanti were less positive than those in the Central region. It is, therefore, plausible that capitation payment may have influenced the relatively low perception of quality of care in the Ashanti region.
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Affiliation(s)
| | | | - Felix Ankomah Asante
- Institute of Statistical, Social and Economic Research (ISSER) University of Ghana, Legon-Accra, Ghana
| | - Ernst Spaan
- Radboud Institute for Health Science, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Koos van der Velden
- Radboud Institute for Health Science, Department for Primary and Community Health, Radboud University Medical Centre, Nijmegen, Netherlands
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Duku SKO, Nketiah-Amponsah E, Janssens W, Pradhan M. Perceptions of healthcare quality in Ghana: Does health insurance status matter? PLoS One 2018; 13:e0190911. [PMID: 29338032 PMCID: PMC5770037 DOI: 10.1371/journal.pone.0190911] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/22/2017] [Indexed: 11/19/2022] Open
Abstract
This study's objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare for both the insured and uninsured.
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Affiliation(s)
- Stephen Kwasi Opoku Duku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Faculty of Economics and Business Administration, Free University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | | | - Wendy Janssens
- Faculty of Economics and Business Administration, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Menno Pradhan
- Faculty of Economics and Business Administration, Free University of Amsterdam, Amsterdam, The Netherlands
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13
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Duku SKO, Asenso-Boadi F, Nketiah-Amponsah E, Arhinful DK. Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana. HEALTH ECONOMICS REVIEW 2016; 6:43. [PMID: 27624462 PMCID: PMC5021654 DOI: 10.1186/s13561-016-0122-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Utilization of healthcare in Ghana's novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme's financial sustainability. This paper investigates the presence of adverse selection by assessing the effect of healthcare utilization and frequency of use on NHIS renewal. METHOD Routine enrolment and utilization data from 2008 to 2013 in two regions in Ghana was analyzed. Pearson Chi-square test was performed to test if the proportion of insured who utilize healthcare in a particular year and renew membership the following year is significantly different from those who utilize healthcare and drop-out. Logistic regressions were estimated to examine the relationship between healthcare utilization and frequency of use in previous year and NHIS renewal in current year. RESULTS We found evidence suggestive of the presence of adverse selection in the NHIS. Majority of insured who utilized healthcare renewed their membership whiles most of those who did not utilize healthcare dropped out. The likelihood of renewal was significantly higher for those who utilize healthcare than those who did not and also higher for those who make more health facility visits. CONCLUSION The NHIS claims bill is high because high risk individuals who self-select into the scheme makes more health facility visits and creates financial sustainability problems. Policy makers should adopt pragmatic ways of enforcing mandatory enrolment so that low risk individuals remain enrolled; and sustainable ways of increasing revenue whiles ensuring that the societal objectives of the scheme are not compromised.
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Affiliation(s)
- Stephen Kwasi Opoku Duku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Faculty of Economics and Business Administration, Free University of Amsterdam, De Boelelaan 1105, 1081HV Amsterdam, The Netherlands
- Ghana Health Service, Accra, Ghana
| | | | | | - Daniel Kojo Arhinful
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Badacho AS, Tushune K, Ejigu Y, Berheto TM. Household satisfaction with a community-based health insurance scheme in Ethiopia. BMC Res Notes 2016; 9:424. [PMID: 27576468 PMCID: PMC5004312 DOI: 10.1186/s13104-016-2226-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 08/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-based health insurance (CBHI) schemes are an emerging tool for providing financial protection against health-related poverty. In Ethiopia, CBHI is being piloted in 13 districts, but community experience and satisfaction with the scheme have yet to be studied. Therefore, this study aimed to assess the experiences and satisfaction of households enrolled in a pilot CBHI scheme. METHODS A community-based cross-sectional study method was used in one pilot district in South Ethiopia. Data were collected in March and April 2014. 386 households enrolled in the CBHI scheme were sampled by simple random sampling. Data were collected by trained data collectors using a pre-tested structured questionnaire. Descriptive statistics and bivariate and multiple linear regression analyses were performed. P values less than 0.05 and 95 % confidence intervals were used to determine associations between independent and dependent variables. RESULTS The study revealed that overall household satisfaction with CBHI was 91.38 %. Moreover, there was a significant association between health service provision and CBHI members' satisfaction scores. For instance, household heads that strongly disagreed with laboratory services provision had an average 0.878 decrease in CBHI satisfaction score compared to household heads that strongly agreed. CBHI process- and management-related factors were also significantly associated with satisfaction. CONCLUSIONS Satisfaction with CBHI was high. Age, family size, laboratory services provision, health services provider friendliness, CBHI offices opening times, membership card collection process, and time interval to use of services were significant predictors of satisfaction with CBHI.
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Affiliation(s)
- Abebe Sorsa Badacho
- School of Public Health, College of Health Sciences, Wolaita Sodo University, P.O. Box 138, Sodo, Ethiopia
| | - Kora Tushune
- Department of Health Services Management, College of Public Health and Medicine, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Yohannes Ejigu
- Department of Health Services Management, College of Public Health and Medicine, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Tezera Moshago Berheto
- School of Public Health, College of Health Sciences, Wolaita Sodo University, P.O. Box 138, Sodo, Ethiopia
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Alhassan RK, Nketiah-Amponsah E, Spieker N, Arhinful DK, Rinke de Wit TF. Perspectives of frontline health workers on Ghana's National Health Insurance Scheme before and after community engagement interventions. BMC Health Serv Res 2016; 16:192. [PMID: 27236330 PMCID: PMC4884385 DOI: 10.1186/s12913-016-1438-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Barely a decade after introduction of Ghana's National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services. However, sustainability of the scheme is increasingly threatened by concerns on quality of health service delivery in NHIS-accredited health facilities coupled with stakeholders' discontentment with the operational and administrative challenges confronting the NHIS. The study sought to ascertain whether or not Systematic Community Engagement (SCE) interventions have a significant effect on frontline health workers' perspectives on the NHIS and its impact on quality health service delivery. METHODS The study is a randomized cluster trial involving clinical and non-clinical frontline health workers (n = 234) interviewed at baseline and follow-up in the Greater Accra and Western regions of Ghana. Individual respondents were chosen from within each intervention and control groupings. Difference-in-difference estimations and propensity score matching were performed to determine impact of SCE on staff perceptions of the NHIS. The main outcome measure of interest was staff perception of the NHIS based on eight (8) factor-analyzed quality service parameters. RESULTS Staff interviewed in intervention facilities appeared to perceive the NHIS more positively in terms of its impact on "availability and quality of drugs (p < 0.05)" and "workload on health staff/infrastructure" than those interviewed in control facilities (p < 0.1). Delayed reimbursement of service providers remained a key concern to over 70 % of respondents in control and intervention health facilities. CONCLUSION Community engagement in quality service assessment is a potential useful strategy towards empowering communities while promoting frontline health workers' interest, goodwill and active participation in Ghana's NHIS.
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Affiliation(s)
- Robert Kaba Alhassan
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands.
| | | | | | - Daniel Kojo Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Tobias F Rinke de Wit
- PharmAccess Foundation, Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
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Attitudes of health care professionals towards Mutual Health Organizations: evidence from two regions in the Northwest Province of Cameroon. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0716-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Yé M, Diboulo E, Kagoné M, Sié A, Sauerborn R, Loukanova S. Health worker preferences for performance-based payment schemes in a rural health district in Burkina Faso. Glob Health Action 2016; 9:29103. [PMID: 26739784 PMCID: PMC4703797 DOI: 10.3402/gha.v9.29103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/16/2015] [Accepted: 10/16/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND One promising way to improve the motivation of healthcare providers and the quality of healthcare services is performance-based incentives (PBIs) also referred as performance-based financing. Our study aims to explore healthcare providers' preferences for an incentive scheme based on local resources, which aimed at improving the quality of maternal and child health care in the Nouna Health District. DESIGN A qualitative and quantitative survey was carried out in 2010 involving 94 healthcare providers within 34 health facilities. In addition, in-depth interviews involving a total of 33 key informants were conducted at health facility levels. RESULTS Overall, 85% of health workers were in favour of an incentive scheme based on the health district's own financial resources (95% CI: [71.91; 88.08]). Most health workers (95 and 96%) expressed a preference for financial incentives (95% CI: [66.64; 85.36]) and team-based incentives (95% CI: [67.78; 86.22]), respectively. The suggested performance indicators were those linked to antenatal care services, prevention of mother-to-child human immunodeficiency virus transmission, neonatal care, and immunization. CONCLUSIONS The early involvement of health workers and other stakeholders in designing an incentive scheme proved to be valuable. It ensured their effective participation in the process and overall acceptance of the scheme at the end. This study is an important contribution towards the designing of effective PBI schemes.
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Affiliation(s)
- Maurice Yé
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso;
| | - Eric Diboulo
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Svetla Loukanova
- Department of General Practice and Health Services Research, University of Heidelberg Hospital, Heidelberg, Germany
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18
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Alhassan RK, Duku SO, Janssens W, Nketiah-Amponsah E, Spieker N, van Ostenberg P, Arhinful DK, Pradhan M, Rinke de Wit TF. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana. PLoS One 2015; 10:e0140109. [PMID: 26465935 PMCID: PMC4605650 DOI: 10.1371/journal.pone.0140109] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 09/22/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. PURPOSE To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. METHODS This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. RESULTS Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. CONCLUSION There is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana's healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes.
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Affiliation(s)
- Robert Kaba Alhassan
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Legon, Accra, Ghana
- University of Amsterdam (UvA), Amsterdam, Netherlands
| | - Stephen Opoku Duku
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Legon, Accra, Ghana
- Department of Development Economics, Vrije University (VU), Amsterdam, Netherlands
| | - Wendy Janssens
- Department of Development Economics, Vrije University (VU), Amsterdam, Netherlands
| | | | | | | | - Daniel Kojo Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana, Legon, Accra, Ghana
| | - Menno Pradhan
- Department of Development Economics, Vrije University (VU), Amsterdam, Netherlands
| | - Tobias F. Rinke de Wit
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands
- PharmAccess Foundation, Amsterdam, Netherlands
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Ahiabu MA, Tersbøl BP, Biritwum R, Bygbjerg IC, Magnussen P. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana. Health Policy Plan 2015; 31:250-8. [PMID: 26045328 PMCID: PMC4748131 DOI: 10.1093/heapol/czv048] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/13/2022] Open
Abstract
Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and 'no malaria drug' on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support of rational drug use.
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Affiliation(s)
- Mary-Anne Ahiabu
- Disease Control and Prevention Department, Ghana Health Service, Ministry of Health, P. O. Box KB 493, Accra, Ghana, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark,
| | - Britt P Tersbøl
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark
| | - Richard Biritwum
- Department of Community Health, College of Health Sciences, University of Ghana P. O. Box KB 4236, Accra, Ghana and
| | - Ib C Bygbjerg
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark
| | - Pascal Magnussen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark, Centre for Medical Parasitology, University of Copenhagen, CSS Building 22/23, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen K, Denmark
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20
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Ridde V, Turcotte-Tremblay AM, Souares A, Lohmann J, Zombré D, Koulidiati JL, Yaogo M, Hien H, Hunt M, Zongo S, De Allegri M. Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso. Implement Sci 2014; 9:149. [PMID: 25304365 PMCID: PMC4201720 DOI: 10.1186/s13012-014-0149-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/19/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications. METHODS/DESIGN The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods. DISCUSSION Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.
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Affiliation(s)
- Valéry Ridde
- University of Montreal Hospital Research Center (CRCHUM), 850 Saint-Denis, 3rd Floor, Montréal, QC, H2X 0A9, Canada.
- University of Montreal School of Public Health, 7101 Avenue du Parc, 3rd Floor, Montréal, QC H3N 1X9, Canada.
| | - Anne-Marie Turcotte-Tremblay
- University of Montreal Hospital Research Center (CRCHUM), 850 Saint-Denis, 3rd Floor, Montréal, QC, H2X 0A9, Canada.
- University of Montreal School of Public Health, 7101 Avenue du Parc, 3rd Floor, Montréal, QC H3N 1X9, Canada.
| | - Aurélia Souares
- Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
| | - Julia Lohmann
- Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
| | - David Zombré
- University of Montreal Hospital Research Center (CRCHUM), 850 Saint-Denis, 3rd Floor, Montréal, QC, H2X 0A9, Canada.
- University of Montreal School of Public Health, 7101 Avenue du Parc, 3rd Floor, Montréal, QC H3N 1X9, Canada.
| | - Jean Louis Koulidiati
- Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
| | - Maurice Yaogo
- AFRICSanté & Université Catholique de l'Afrique de l'Ouest - Unité Universitaire de Bobo-Dioulasso, 01 BP 298, Bobo-Dioulasso, Burkina Faso.
| | - Hervé Hien
- Centre MURAZ, 01 BP, Bobo-Dioulasso, Burkina Faso.
- Institut de recherche en sciences de la santé (IRSS) du CNRST, 03 BP 7192 03, Ouagadougou, Burkina Faso.
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, 2nd Floor, Montréal, QC H3G 1Y5, Canada.
| | - Sylvie Zongo
- Institut des Sciences des Sociétés (INSS-CNRST), 03 BP 7047, Ouagadougou, Burkina Faso.
| | - Manuela De Allegri
- Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
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Robyn PJ, Bärnighausen T, Souares A, Traoré A, Bicaba B, Sié A, Sauerborn R. Provider payment methods and health worker motivation in community-based health insurance: a mixed-methods study. Soc Sci Med 2014; 108:223-36. [PMID: 24681326 DOI: 10.1016/j.socscimed.2014.01.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/16/2014] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
In a community-based health insurance (CBHI) introduced in 2004 in Nouna health district, Burkina Faso, poor perceived quality of care by CBHI enrollees has been a key factor in observed high drop-out rates. The poor quality perceptions have been previously attributed to health worker dissatisfaction with the provider payment method used by the scheme and the resulting financial risk of health centers. This study applied a mixed-methods approach to investigate how health workers working in facilities contracted by the CBHI view the methods of provider payment used by the CBHI. In order to analyze these relationships, we conducted 23 in-depth interviews and a quantitative survey with 98 health workers working in the CBHI intervention zone. The qualitative in-depth interviews identified that insufficient levels of capitation payments, the infrequent schedule of capitation payment, and lack of a payment mechanism for reimbursing service fees were perceived as significant sources of health worker dissatisfaction and loss of work-related motivation. Combining qualitative interview and quantitative survey data in a mixed-methods analysis, this study identified that the declining quality of care due to the CBHI provider payment method was a source of significant professional stress and role strain for health workers. Health workers felt that the following five changes due to the provider payment methods introduced by the CBHI impeded their ability to fulfill professional roles and responsibilities: (i) increased financial volatility of health facilities, (ii) dissatisfaction with eligible costs to be covered by capitation; (iii) increased pharmacy stock-outs; (iv) limited financial and material support from the CBHI; and (v) the lack of mechanisms to increase provider motivation to support the CBHI. To address these challenges and improve CBHI uptake and health outcomes in the targeted populations, the health care financing and delivery model in the study zone should be reformed. We discuss concrete options for reform based on the study findings.
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Affiliation(s)
- Paul Jacob Robyn
- University of Heidelberg, Institute of Public Health, Germany; The World Bank, Washington, DC, USA.
| | - Till Bärnighausen
- Harvard School of Public Health, Department of Global Health and Population, USA; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa
| | - Aurélia Souares
- University of Heidelberg, Institute of Public Health, Germany
| | - Adama Traoré
- Nouna Health Research Centre, Ministry of Health, Burkina Faso
| | - Brice Bicaba
- Nouna Health Research Centre, Ministry of Health, Burkina Faso; Nouna Health District, Ministry of Health, Burkina Faso
| | - Ali Sié
- Nouna Health Research Centre, Ministry of Health, Burkina Faso
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