1
|
Agyemang-Duah W, Oduro MS, Peprah P, Adei D, Nkansah JO. The role of gender in health insurance enrollment among geriatric caregivers: results from the 2022 informal caregiving, health, and healthcare survey in Ghana. BMC Public Health 2024; 24:1566. [PMID: 38862957 PMCID: PMC11165831 DOI: 10.1186/s12889-024-18930-y] [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: 11/24/2023] [Accepted: 05/23/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Female informal caregivers of older adults experience a higher burden of physical and mental health problems compared to their male counterparts due to the greater intensity of care they provide. This is likely to result in an imbalance in health needs, including health insurance enrollment, between male and female informal caregivers of older adults. However, to date, no study is available on the role of gender in health insurance enrollment among informal caregivers of older adults in Ghana. This study examines the association between gender and health insurance enrollment among informal caregivers of older adults in Ghana. METHODS Cross-sectional data from the Informal Caregiving, Health, and Healthcare Survey among caregivers of older adults aged 50 years or above (N = 1,853 and mean ages = 39.15 years and 75.08 years of informal caregivers and their care recipients, respectively) in Ghana were analyzed. A binary logit regression model was used to estimate the association between gender and health insurance enrollment. All statistical inferences were made at the 5% significance level. RESULTS The final Model (3) showed that female informal caregivers were 2.70 times significantly more likely to enrol in a health insurance scheme than their male counterparts (AOR: 2.70, 95% CI: 2.09-3.48, p-value = 0.001). Apart from gender, the results revealed that participants aged 55-64 years (AOR = 2.38, 95%CI: 1.29-4.41, p-value = 0.006), with tertiary education (AOR: 3.62, 95% CI: 2.32-5.66, p-value = 0.001) and living with the care recipients (AOR: 1.50, 95% CI: 1.14-1.98, p-value = 0.003) were significantly more likely to enrol in a health insurance scheme than their counterparts. The findings further showed that those who earned between GH¢1000 and 1999 (US$99.50-198.50) monthly (AOR: 0.70, 95% CI: 0.52-0.95, p-value = 0.022) and were affiliated with African traditional religion (AOR: 0.30, 95%CI: 0.09-0.99, p-value = 0.048) were significantly less likely to enrol in a health insurance scheme than their counterparts. CONCLUSION Gender was a significant predictor of health insurance enrollment among informal caregivers of older adults. This finding contributes to the empirical debates on the role of gender in health insurance enrollment among informal caregivers of older adults. Policymakers need to develop gender-specific measures to address gender gaps in health insurance enrollment among informal caregivers of older adults in Ghana. Such health policies and programs should consider other significant demographic and socioeconomic factors associated with health insurance enrolment among informal caregivers of older adults in Ghana.
Collapse
Affiliation(s)
- Williams Agyemang-Duah
- Department of Geography and Planning, Queen's University, Kingston, ON, K7L 3N6, Canada.
| | - Michael Safo Oduro
- Pfizer Research and Development, PSSM Data Sciences, Groton, CT, 06340, USA
| | - Prince Peprah
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Dina Adei
- Department of Planning, Kwame Nkrumah University of Science and Technology, Private Mail Bag, Kumasi, Ghana
| | | |
Collapse
|
2
|
Ottie-Boakye D, Bawah AA, Dodoo ND, Anarfi JK. Prevalence, perceptions and associated factors of health insurance enrollment among older persons in selected cash grant communities in Ghana: a cross-sectional mixed method. BMC Geriatr 2024; 24:439. [PMID: 38762460 PMCID: PMC11102239 DOI: 10.1186/s12877-024-05037-7] [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: 08/22/2023] [Accepted: 05/02/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Universal Health Coverage has been openly recognized in the United Nations health-related Sustainable Development Goals by 2030, though missing under the Millennium Development Goals. Ghana implemented the National Health Insurance Scheme programme in 2004 to improve financial access to healthcare for its citizens. This programme targeting low-income individuals and households includes an Exempt policy for older persons and indigents. Despite population ageing, evidence of the participation and perceptions of older persons in the scheme in cash grant communities is unknown. Hence, this paper examined the prevalence, perceptions and factors associated with health insurance enrollment among older persons in cash grant communities in Ghana. METHODS Data were from a cross-sectional household survey of 400 older persons(60 + years) and eight FGDs between 2017 and 2018. For the survey, stratified and simple random sampling techniques were utilised in selecting participants. Purposive and stratified sampling techniques were employed in selecting the focus group discussion participants. Data analyses included descriptive, modified Poisson regression approach tested at a p-value of 0.05 and thematic analysis. Stata and Atlas-ti software were used in data management and analyses. RESULTS The mean age was 73.7 years. 59.3% were females, 56.5% resided in rural communities, while 34.5% had no formal education. Two-thirds were into agriculture. Three-fourth had non-communicable diseases. Health insurance coverage was 60%, and mainly achieved as Exempt by age. Being a female [Adjusted Prevalence Ratio (APR) 1.29, 95%CI:1.00-1.67], having self-rated health status as bad [APR = 1.34, 95%CI:1.09-1.64] and hospital healthcare utilisation [APR = 1.49, 95%CI:1.28-1.75] were positively significantly associated with health insurance enrollment respectively. Occupation in Agriculture reduced insurance enrollment by 20.0%. Cited reasons for poor perceptions of the scheme included technological challenges and unsatisfactory services. CONCLUSION Health insurance enrollment among older persons in cash grant communities is still not universal. Addressing identified challenges and integrating the views of older persons into the programme have positive implications for securing universal health coverage by 2030.
Collapse
Affiliation(s)
- Doris Ottie-Boakye
- School of Public Health, College of Health Sciences, University of Ghana, Box LG 13, Legon, Accra, Ghana.
| | - Ayagah Agula Bawah
- Regional Institute for Population Studies, University of Ghana-Legon, Box LG 96, Accra, Ghana
| | - Naa Dodua Dodoo
- African Institute for Development Policy (AFIDEP), City Centre, Box 31024, Lilongwe 3, Malawi
| | - J K Anarfi
- Regional Institute for Population Studies, University of Ghana-Legon, Box LG 96, Accra, Ghana
| |
Collapse
|
3
|
Osei Afriyie D, Masiye F, Tediosi F, Fink G. Confidence in the health system and health insurance enrollment among the informal sector population in Lusaka, Zambia. Soc Sci Med 2023; 321:115750. [PMID: 36801748 DOI: 10.1016/j.socscimed.2023.115750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/29/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND To improve equitable access to quality essential services and reduce financial hardship, low-and-middle-income countries are increasingly relying on prepayment strategies such as health insurance schemes. Among the informal sector population, confidence in the health system to provide effective treatment and trust in institutions can play an important role in health insurance enrollment. The objective of this study was to examine the extent to which confidence and trust affect enrollment into the recently introduced Zambia National Health insurance. METHODS We conducted a regionally representative cross-sectional household survey in Lusaka, Zambia collecting information on demographics, health expenditure, ratings of last health facility visit, health insurance status and confidence in the health system. We used multivariable logistic regression to assess the association between enrollment and confidence in the private and public health sector as well as trust in the government in general. RESULTS Of the 620 respondents interviewed, 70% were enrolled or planning to enroll in the health insurance. Only about one-fifth of respondents were very confident that they would receive effective care in the public health sector 'if they became sick tomorrow' while 48% were very confident in the private health sector. While confidence in the public system was only weakly associated with enrollment, confidence in the private health sector was strongly associated with enrollment (Adjusted odds ratio (AOR) 3.40 95% CI 1.73 - 6.68). No association was found between enrollment and trust in government or perceived government performance. CONCLUSIONS Our results suggest that confidence in the health system, particularly in the private health sector, is strongly associated with health insurance enrollment. Focusing on achieving high quality of care across all levels of the health system may be an effective strategy to increase enrollment in health insurance.
Collapse
Affiliation(s)
- Doris Osei Afriyie
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Felix Masiye
- University of Zambia, Department of Economics, Lusaka, Zambia.
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| |
Collapse
|
4
|
The Problem of Antimalarial-Drug Abuse by the Inhabitants of Ghana. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020257. [PMID: 36837460 PMCID: PMC9960956 DOI: 10.3390/medicina59020257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023]
Abstract
Introduction: Malaria is still a huge social and economic health problem in the world. It especially affects the developing countries of Africa. A particular problem is the misuse and abuse of over-the-counter antimalarials. This problem could lead to the emergence of drug-resistant strains and the subsequent elimination of more antimalarials from the list of effective antimalarials in Ghana. Methods: During the implementation of the study, an original questionnaire was used to collect data among Ghanaians on their knowledge of malaria, attitude towards antimalarials and their use of antimalarials. Results: The proportion in the analyzed subgroups was compared using the chi-square test. The analysis was conducted using TIBCO Software Inc., Krakow, Poland (2017) and Statistica (data analysis software system), version 13. In total, 86.29% of respondents knew the symptoms of malaria (p = 0.02) and 57.2% knew the cause of malaria (p < 0.001). Respondents with higher education were significantly more likely to know the symptoms of malaria (96%) p < 0.001. In the study group, only 74.59% of the respondents consulted medical personnel before taking the antimalarial drug (p = 0.51) and only 14.2% of the remaining respondents performed a rapid diagnostic test for malaria. Conclusions: The awareness of Accra and Yendi native inhabitants about the causes and symptoms of malaria and alternative ways of prevention is quite high. People's education very significantly influences the way Accra residents deal with suspected malaria. Widespread public education and awareness and accessibility to places where antimalarial drugs are sold play a very important role in the proper use of antimalarial drugs.
Collapse
|
5
|
Njie H, Wangen KR, Chola L, Gopinathan U, Mdala I, Sundby JS, Ilboudo PGC. Willingness to pay for a National Health Insurance Scheme in The Gambia: a contingent valuation study. Health Policy Plan 2022; 38:61-73. [PMID: 36300926 PMCID: PMC9849717 DOI: 10.1093/heapol/czac089] [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: 11/16/2021] [Revised: 10/02/2022] [Accepted: 10/26/2022] [Indexed: 01/22/2023] Open
Abstract
In pursuit of universal health coverage, many low- and middle-income countries are reforming their health financing systems and introducing health insurance schemes. As part of these reforms, lawmakers in The Gambia enacted 'The National Health Insurance Bill, 2021'. The Act will establish a National Health Insurance Scheme (NHIS) that pays for the cost of healthcare services for its members. This study assessed Gambians' willingness to pay (WTP) for a NHIS. Using multistage sampling design with no replacement, head/co-head of households were presented with a hypothetical health insurance scheme from July to August 2020. Their WTP and factors influencing WTP were elicited using a contingent valuation method. Descriptive statistics were used to describe sample characteristics. Lopez-Feldman's modified ordered probit model and linear regression were applied to estimate respondents' WTP as well as identify factors that influence their WTP. More than 90% of the respondents-677 (94.4%) were willing to join and pay for the scheme. Half of these respondents-398 (58.8%) agreed to pay the first bid of US dollars (US$) 20.78 or Gambian dalasi (GMD) 1000. The average WTP was estimated at US$23.27 (GMD1119.82), whereas average maximum amount to pay was US$26.01 (GMD1251.16). Results of the two models together showed that gender, level of education and household income were statistically significant, with the latter showing negative influence on WTP. The study found that Gambians were largely receptive to the scheme and have stated their willingness to contribute. Our findings can inform policymakers in The Gambia and other sub-Saharan countries when establishing contribution rates and exemption criteria during social health insurance scheme implementation.
Collapse
Affiliation(s)
- Hassan Njie
- *Corresponding author. Department of Community Medicine and Global Health, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway. E-mail:
| | - Knut Reidar Wangen
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, Oslo 0317, Norway
| | - Lumbwe Chola
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, Oslo 0317, Norway,Norwegian Institute of Public Health, Sandakerveien 24c, Bygg D, Oslo 0473, Norway
| | - Unni Gopinathan
- Norwegian Institute of Public Health, Sandakerveien 24c, Bygg D, Oslo 0473, Norway
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Postboks 1130 Blindern, Oslo 0318, Norway
| | - Johanne S Sundby
- Department of Community Medicine and Global Health, University of Oslo, Postboks 1130 Blindern 0318, Oslo, Norway
| | - Patrick G C Ilboudo
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi 0318, Kenya
| |
Collapse
|
6
|
The Mediating Effect of Healthcare Utilization on Livelihood Empowerment against Poverty (LEAP) and Health Security of Older Adults in Ghana: A Case Study on the Ga-West Municipality in Accra, Ghana. Healthcare (Basel) 2022; 10:healthcare10020370. [PMID: 35206984 PMCID: PMC8872544 DOI: 10.3390/healthcare10020370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
The concept of health security has aroused several interpretations because of theoretical technique indifferences or academic methodology. The focus has been on human security, old age health security (OAHS), whereas there remain issues of low healthcare utilization by older people from rural Ghana while there are social assistance programs. The study aimed at investigating the mediating effect of healthcare utilization on Livelihood Empowerment against Poverty (LEAP) and old age health security OAHS. With purposive sampling technique, participants were selected to participate in the study with standardized quantitative questionnaire to measure the variables involved in the study and a regression technique to analyze the data. The result of the mediation analysis showed a partial mediation between LEAP and Healthcare Utilization (HU) was found to have bridged the gap between the LEAP and OAHS. The LEAP policy also caused an increase in Health Utilization and, subsequently, an increase in old age health security (OAHS). The study is essential to help the National Health Insurance Authority NHIA in restructuring health care premiums to incite utilization of health facilities by the aged.
Collapse
|
7
|
Osei Afriyie D, Krasniq B, Hooley B, Tediosi F, Fink G. Equity in health insurance schemes enrollment in low and middle-income countries: A systematic review and meta-analysis. Int J Equity Health 2022; 21:21. [PMID: 35151323 PMCID: PMC8841076 DOI: 10.1186/s12939-021-01608-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/10/2021] [Indexed: 01/11/2023] Open
Abstract
Background Ensuring access to essential quality health services and reducing financial hardship for all individuals regardless of their ability to pay are the main goals of universal health coverage. Various health insurance schemes have been recently implemented in low- and middle-income countries (LMICs) to achieve both of these objectives. We systematically reviewed all available literature to assess the extent to which current health insurance schemes truly reach the poor and underserved populations in LMICs. Methods In the systematic review, we searched on PubMed, Web of Science, EconLit and Google Scholar to identify eligible studies which captured health insurance enrollment information in LMICs from 2010 up to September 2019. Two authors independently selected studies, extracted data, and appraised included studies. The primary outcome of interest was health insurance enrollment of the most vulnerable populations relative to enrollment of the best-off subgroups. We classified households both with respect to their highest educational attainment and their relative wealth and used random-effects meta-analysis to estimate average enrollment gaps. Results 48 studies from 17 countries met the inclusion criteria. The average enrollment rate into health insurance schemes for vulnerable populations was 36% with an inter-quartile range of 26%. On average, across countries, households from the wealthiest subgroup had 61% higher odds (95% CI: 1.49 to 1.73) of insurance enrollment than households in the poorest group in the same country. Similarly, the most educated groups had 64% (95% CI: 1.32 to 1.95) higher odds of enrollment than the least educated groups. Conclusion The results of this study show that despite major efforts by governments, health insurance schemes in low-and middle-income countries are generally not reaching the targeted underserved populations and predominantly supporting better-off population groups. Current health insurance designs should be carefully scrutinized, and the extent to which health insurance can be used to support the most vulnerable populations carefully re-assessed by countries, which are aiming to use health insurance schemes as means to reach their UHC goals. Furthermore, studies exploring best practices to include vulnerable groups in health insurance schemes are needed. Registration Not available Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01608-x.
Collapse
|
8
|
Socio-economic and technological aspects of mental health of older persons: the role of strong and weak ties in Ghana. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x21001859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Research indicates that social capital can influence the extent to which socio-economic status (SES) and information and communications technology (ICT) affect mental health. This study uses empirical data to examine the veracity of this claim by examining the effect of SES and ICT use on the mental health of older persons in Ghana, as well as the moderating role of bonding (i.e. strong ties) and bridging (i.e. weak ties) social capital in these associations. Data were drawn from 409 older persons from four regions in Ghana as part of a broader cross-sectional survey. Ordinal logistic regression analyses showed that SES and ICT use had positive associations with mental health after adjusting for other socio-demographic factors. Bridging social capital modified the association between SES and mental health positively. Bonding social capital also moderated the relations between ICT use on mental health positively. We argue that the prevalent nature of resources embedded in strong ties and the diversity of support that emerge from weak ties account for the difference in their influence observed in this study. Thus, while advances in socio-economic and technological conditions can enhance older persons’ mental health, equal attention must be paid to the characteristics of their strong and weak ties as they possess the resources to make socio-technological policies even more meaningful.
Collapse
|
9
|
Shatilwe JT, Kuupiel D, Mashamba-Thompson TP. Evidence on access to healthcare information by women of reproductive age in low- and middle-income countries: Scoping review. PLoS One 2021; 16:e0251633. [PMID: 34086686 PMCID: PMC8177524 DOI: 10.1371/journal.pone.0251633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background A majority of women of reproductive age in low- and middle-income countries (LMICs) are not able to access healthcare information due to different factors. This scoping review aimed to map the literature on access to healthcare information by women of reproductive age in LMICs. Methods The literature search was conducted through the following databases: Google Scholar, Science Direct, PubMed, EBSCOhost (Academic search complete, CINAHL with full text, MEDLINE with full text, MEDLINE, and PsycINFO), Emerald, Embase, published and peer-reviewed journals, organizational projects, reference lists, and grey literature. Results A total of 377 457 articles were identified from all the databases searched. Of these, four articles met inclusion criteria after full article screening and were included for data extraction. The themes that emerged from our study are as follows: accessibility, financial accessibility/affordability, connectivity, and challenges. This study demonstrated that there are minimal interventions that enable women of reproductive age to access healthcare information in terms of accessibility, financial accessibility, and connectivity. Conclusion The findings of the study revealed poor access and utilization of healthcare information by women of reproductive age. We, therefore, recommend primary studies in other LMICs to determine the accessibility, financial accessibility, connectivity, and challenges faced by women of reproductive age in LMICs.
Collapse
Affiliation(s)
- Joyce Twahafifwa Shatilwe
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
10
|
Yamson P, Tetteh J, DeGraft-Amoah D, Quansah H, Mensah G, Biritwum R, Yawson AE. Unmet Needs of Healthcare Services and Associated Factors among a Cohort of Ghanaian Adults: A Nationally Stratified Cross-Sectional Study Design. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211028172. [PMID: 34180280 PMCID: PMC8243108 DOI: 10.1177/00469580211028172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
We estimated the prevalence of unmet needs of healthcare services (UNHS) and its associated factors among a cohort of older Ghanaian adults. World Health Organization (WHO) Study on Global AGEing and Adult Health for Ghana was used with a total of 4735 participants. Logistics regression analysis was performed using Stata 16 to assess associated factors. The overall UNHS was 3.7% (95% CI = 2.7-4.8) and the prevalence was significantly high amongst older adults aged 60 to 69 years (5.9%). Could not afford the healthcare (56.4%) was the main contender for UNHS. UNHS was influenced by; those aged 60 to 69 years [OR (95% CI) = 1.86 (1.19-2.91)]; no formal educational [aOR (95% CI) = 4.71 (1.27-17.38)], and no NHIS [OR (95% CI) = 1.78 (1.03-3.09)]. Participants needed care for joint pain (25.4%), and communicable diseases (19.1%). The inability to access healthcare was relatively higher for older adults more advanced in age, with low education, and for those without health insurance. Health system strengthening including financial protection by expanding the National Health Insurance Scheme to all Ghanaians in line with Ghana's Universal Health Coverage Roadmap would reduce the unmet healthcare needs of older adults.
Collapse
Affiliation(s)
- Phaedra Yamson
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - John Tetteh
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Daniel DeGraft-Amoah
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Henry Quansah
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - George Mensah
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Richard Biritwum
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| |
Collapse
|
11
|
Alkodaymi MS, Shaar BA, Fawzy NA, Alhabbbash R, Senjab A, AlSaoud R. Knowledge, perception, and attitudes of Universal Health Coverage policies among Alfaisal University students in Saudi Arabia. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:348. [PMID: 33575384 PMCID: PMC7871921 DOI: 10.4103/jehp.jehp_767_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Saudi Arabia aims to achieve Universal Health Coverage (UHC) by a combination of free public healthcare and mandatory cooperative health insurance. To ensure the effectiveness of UHC policies, every individual should have a strong knowledge of their health-care rights and the system that guarantees it. OBJECTIVES The aim of this study is to measure the knowledge of Alfaisal students and record their perceptions and attitudes about Saudi Arabia's basic health-care coverage structure and UHC policies. MATERIALS AND METHODS A cross-sectional survey was developed with 22 items measuring knowledge and 7 items evaluating perception and attitudes and distributed through E-mail with a consecutive sampling method at Alfaisal University to achieve the required calculated sample size for March-April of 2020. The accumulated data were organized, tabulated, and statistically analyzed using SPSS software. Comparison between two groups and more was made using the Chi-square test. RESULTS Students' self-reported knowledge on the three main knowledge questions ranged from 30.6% to 57.7%, with medical students admitting to similar or worse knowledge compared to their colleagues from other colleges. About 57.3% of our respondents believe the Saudi system provides effective and sufficient healthcare to all, but only 42.7% believe that the system provides financial protection to all. CONCLUSION The study showed a low level of knowledge about Saudi Arabia's UHC policies among Alfaisal students, especially among medical students, with a generally positive perception and attitudes toward them, although with some serious misconceptions that should be addressed.
Collapse
Affiliation(s)
| | - Bader Abou Shaar
- Academic Department, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Nader Ashraf Fawzy
- Academic Department, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rola Alhabbbash
- Academic Department, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdulrahman Senjab
- Academic Department, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rawan AlSaoud
- Academic Department, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Gyasi RM, Phillips DR, Buor D. The Role of a Health Protection Scheme in Health Services Utilization Among Community-Dwelling Older Persons in Ghana. J Gerontol B Psychol Sci Soc Sci 2020; 75:661-673. [PMID: 29982726 DOI: 10.1093/geronb/gby082] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This study examines the relationships between National Health Insurance Scheme (NHIS) enrollment and the frequency and "timing" of health services utilization among community-dwelling older Ghanaians. It also investigates whether the NHIS policy has improved equity in access to health care in later life. METHODS Cross-sectional data were derived from an Ageing, Health, Psychological Wellbeing and Health-seeking Behavior Study collected between August 2016 and January 2017 (N = 1,200). Descriptive and bivariate analyses described the sample. Generalized Poisson and logit regression models, respectively estimated the predictors of frequency of health services utilization and time from onset of illness to health facility use and during last illness episode. RESULTS Older persons with active NHIS membership frequently used health facilities (β = 0.237, standard error [SE] = 0.0957, p ˂ .005), but the association was largely a function of health-related factors. The NHIS enrollees were more likely to attend health facility earlier (β = 1.347, SE = 0.3437, p ˂ .001) compared with nonenrollees, after adjusting for theoretically relevant covariates. Moreover, given the NHIS enrollment, the rich (eβ = 2.149, SE = 0.240, p ˂ .005), social support recipients (eβ = 1.366, SE = 0.162, p ˂ .05) and those living with relevant others (eβ = 2.699, SE = 0.175, p ˂ .001) were more likely to consume health services. DISCUSSION Ghana's NHIS policy generally increases health services utilization but at present lacks the capability to improve equitable access to health care, especially between poor and nonpoor older adults. This may hamper the progress toward universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.
Collapse
Affiliation(s)
- Razak M Gyasi
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong.,Centre for Social Policy and Social Change, Lingnan University, Tuen Mun, Hong Kong
| | - David R Phillips
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong
| | - Daniel Buor
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
13
|
Dake FAA, van der Wielen N. Towards universal access to healthcare for older adults: an assessment of the old-age exemption policy under Ghana's National Health Insurance Scheme. Int J Equity Health 2020; 19:38. [PMID: 32183844 PMCID: PMC7077146 DOI: 10.1186/s12939-020-1156-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background Despite calls for governments to provide universal health coverage for all, social health insurance programmes (SHI) that specifically target older adults continue to be largely absent in many African countries. Only a few African countries have implemented SHI programmes that include specific provisions for older adults. Ghana’s National Health Insurance Scheme (NHIS) is one of the few programmes in Africa that exempts older adults from paying premiums for health insurance. This study examined socio-demographic factors associated with old-age premium exemption under Ghana’s NHIS. Methods The study used data from the seventh round of the Ghana Living Standards Survey (GLSS 7) conducted in 2017. Descriptive statistics and binary logistic regression were used in analysing data from a sample of 1532 older adults aged 70 years and older. Results The results reveal that only about 43% of older adults who were enrolled on the NHIS at the time of the survey acquired their membership through the old-age exemption policy. Additionally, increasing age was associated with higher odds of reporting exemption from paying premiums for health insurance. Also, older adults who are living in rural areas were more likely to pay premiums rather than being exempt as compared to their counterparts living in urban areas. Conclusions These findings indicate that the old-age exemption policy is not achieving the intended goal of providing financial risk protection for some older adults. Additionally, the policy is not reaching those who need it most, particularly those living in rural areas. Specific targeting is required for older adults living in rural areas who are less likely to benefit from the old-age exemption policy in spite of being eligible.
Collapse
Affiliation(s)
- Fidelia A A Dake
- Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon, Accra, Ghana.
| | | |
Collapse
|
14
|
Lloyd-Sherlock P, Amoakoh-Coleman M. A critical review of intervention and policy effects on the health of older people in sub-Saharan Africa. Soc Sci Med 2020; 250:112887. [PMID: 32135461 DOI: 10.1016/j.socscimed.2020.112887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/20/2022]
Abstract
This paper provides a critical review of publications containing information about specific health effects on older adults of interventions and policies in sub-Saharan Africa. Interventions and policies fell into the following categories: testing or treating HIV, the provision of pensions, screening for non-communicable diseases (NCDs), health service financing and interventions related to visual conditions. The review finds that the relevant literature is very limited relative to the size of older populations in the region. Conditions of particular relevance to older adults, such as NCDs, are under-represented and most studies treat older people as a single category, typically including all adults aged 50 and over. The paper concludes that evidence about the health effects of interventions and policies on the region's rapidly growing older populations remains minimal, and that this both reflects and reinforces a bias against older people in health policy.
Collapse
Affiliation(s)
- Peter Lloyd-Sherlock
- School of International Development, University of East Anglia, Earlham Road, Norwich, NR4 7HT, UK.
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| |
Collapse
|
15
|
Shatilwe JT, Mashamba-Thompson TP. Mapping evidence on access to healthcare information by women of reproductive age in low-and-middle-income countries: scoping review protocol. Syst Rev 2019; 8:328. [PMID: 31843003 PMCID: PMC6913006 DOI: 10.1186/s13643-019-1203-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research shows that there are inadequate interventions in resource-limited settings that could enable women of reproductive age to access and use health services in those settings. The main objective of this scoping review is to map the evidence on access to healthcare information by women of reproductive age in LMICs. METHOD AND ANALYSIS The primary search will include Google Scholar, Science Direct, PubMed, EBSCOhost (Academic search complete, CINAHL with full text, MEDLINE with full text, MEDLINE), Emerald, Embase, CDSR, PsycINFO, published and peer review journals, organisational projects, conference papers, reference list, grey literature sources, as well as reports related to this objective will be included in the study. Identified keywords will be used to search articles from the studies. The articles and abstracts will be screened by two independent reviewers (JS and TPMT). Inclusion and exclusion criteria will be considered to guide the screening. A thematic content analysis will be used to present the narrative account of the reviews, using NVivo computer software (version 11). DISCUSSIONS The scoping review will focus on women of reproductive age in LMICs. We anticipate finding relevant literature on the interventions aimed at accessing health care services in LMICs. The study findings will help reveal research gaps to guide future research. SCOPING REVIEW REGISTRATION Not registered with PROSPERO (not needed). PROTOCOL AND REGISTRATION This scoping review was not registered.
Collapse
Affiliation(s)
- Joyce T Shatilwe
- Displine of Public Health Medicine and School of Nursing, University of KwaZulu-Natal, Durban, South Africa.
| | - Tivani P Mashamba-Thompson
- Displine of Public Health Medicine and School of Nursing, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|