Quality of Health Care in Ghana: Mapping of Interventions and the Way Forward

Patient satisfaction with quality of care at out-patient departments in selected health facilities in Kumasi, Ghana

BACKGROUND

Health care is an indispensable element for economic growth and development of individuals and nations. Healthcare service quality is associated with patient satisfaction, ensuring the safety and security of patients, reducing mortality and morbidity, and improving the quality of life. Patient satisfaction with health service is linked to increased utilization following contendness with healthcare received from health providers. There is an increasing public perception of poor quality of care among patients visiting public health facilities in Ghana which translates into service dissatisfaction. Meanwhile, patient dissatisfaction will more likely result in poor utilization, disregard for medical advice, and treatment non-adherence. The study was conducted to assess patients' satisfaction with quality of care at the outpatient departments of selected health facilities in Kumasi, Ghana.

METHODS

An institutional-based analytical cross-sectional study was conducted among patients (aged ≥ 18 years) visiting outpatient departments of selected health facilities in Kumasi from October - December, 2019. A systematic sampling technique was adopted to collect quantitative information from 385 respondents using a structured questionnaire. At 95% confidence interval and 5% alpha level, two-level logistic regression models were performed. Model I estimated the crude associations and the effect of covariates was accounted for in Model II. The results were presented in odds ratio with a corresponding 95% confidence interval. All analysis were performed using STATA statistical software version 16.0.

RESULTS

Out of the 385 participants, 90.9% of the participants were satisfied with the services they received. Being married [AOR = 3.06, 95%CI = 1.07-8.74], agreeing that the facility is disability-friendly [AOR = 7.93, 95%CI = 2.07-14.43], facility has directional signs for navigation [AOR = 3.12, 95%=1.92-10.59] and the facility has comfortable and attractive waiting area [AOR = 10.02, 95%CI = 2.35-22.63] were associated with satisfaction with health service among patients. Spending more than 2 h at the health facility [AOR = 0.45, 95%CI = 0.04-0.93] and having perceived rude and irritating provider [AOR = 0.14, 95%CI = 0.04-0.51] had lower odds of satisfaction with health service received.

CONCLUSION

There is a high patient satisfaction with services received at out-patient departments which is influenced by a multiplicity of factors; being married, and agreeing that the facility is disability-friendly, has directional signs for navigation, and the waiting area is comfortable and attractive. The study findings call for the need to develop and implement health delivery interventions and strategies (i.e. patient-centered interventions, disability-friendly facilities, and sustainability and improvement of quality service) to improve and sustain patient satisfaction levels with health care service. These strategies must be directed towards addressing inequalities in infrastructural development and inputs needed for healthcare delivery in the health system.

Usability evaluation of electronic health records at the trauma and emergency directorates at the Komfo Anokye teaching hospital in the Ashanti region of Ghana

BACKGROUND

Electronic health records (EHRs) are currently gaining popularity in emerging economies because they provide options for exchanging patient data, increasing operational efficiency, and improving patient outcomes. This study examines how service providers at Ghana's Komfo Anokye Teaching Hospital adopt and use an electronic health records (EHRs) system. The emphasis is on identifying factors impacting adoption and the problems that healthcare personnel encounter in efficiently using the EHRs system.

METHOD

A quantitative cross-sectional technique was utilised to collect data from 234 trauma and emergency department staff members via standardised questionnaires. The participants were selected using the purposive sampling method. The Pearson Chi-square Test was used to examine the relationship between respondents' acceptability and use of EHRs.

RESULTS

The study discovered that a sizable number of respondents (86.8%) embraced and actively used the EHRs system. However, other issues were noted, including insufficient system training and malfunctions (35.9%), power outages (18.8%), privacy concerns (9.4%), and insufficient maintenance (4.7%). The respondents' comfortability in using the electronic health record system (X2=11.30, p=0.001), system dependability (X2=30.74, p=0.0001), and EHR's ability to reduce patient waiting time (X2=14.39, p=0.0001) were all strongly associated with their degree of satisfaction with the system. Furthermore, respondents who said elects increase patient care (X2= 75.59, p = 0.0001) and income creation (X2= 8.48, p = 0.004), which is related to the acceptability of the electronic health records system.

CONCLUSION

The study revealed that comfort, reliability, and improved care quality all had an impact on the EHRs system's acceptability and utilization. Challenges, including equipment malfunctions and power outages, were found. Continuous professional training was emphasized as a means of increasing employee confidence, as did the construction of a power backup system to combat disruptions. Patient data privacy was highlighted. In conclusion, this study highlights the relevance of EHRs system adoption and usability in healthcare. While the benefits are obvious, addressing obstacles through training, technical support, and infrastructure improvements is critical for increasing system effectiveness.

Factors influencing healthcare workers' and health system preparedness for the COVID-19 pandemic: A qualitative study in Ghana

Adequate preparedness of health systems, particularly healthcare workers (HCWs), to respond to COVID-19 is critical for the effective control of the virus, especially in low- and middle-income countries where health systems are overburdened. We examined Ghanaian HCWs' perceived preparedness to respond to the pandemic and the factors that shaped their preparedness and that of the health system. Semi-structured in-depth interviews were conducted with n = 26 HCWs responsible for the clinical management of COVID-19 patients and three administrators responsible for developing and implementing COVID-19 policies at the facility level. Interviews were conducted over the phone in English, transcribed, and analyzed using a thematic analysis approach. Generally, HCWs felt inadequately prepared to contain the spread of COVID-19 due to resource shortages and inadequate training. HCWs, similarly, perceived the health system to be unprepared due to insufficient clinical infrastructure and logistical challenges. The few who felt prepared identified readiness in managing high consequence infectious disease cases and pre-existing protocols as enablers of HCW preparedness. The health system and HCWs were unprepared to manage the COVID-19 pandemic due to inadequate training, logistical challenges, and weak clinical infrastructure. Interventions are urgently needed to improve the health system's preparedness for future pandemics.

Ethical implications of the widespread use of informal mHealth methods in Ghana

BACKGROUND

Informal mHealth is widely used by community health nurses in Ghana to extend healthcare delivery services to clients who otherwise might have been excluded from formal health systems or would experience significant barriers in their quest to access formal health services. The nurses use their private mobile phones or devices to make calls to their clients, health volunteers, colleagues or superiors. These phone calls are also reciprocal in nature. Besides, the parties exchange or share other health data and information through text messages, pictures, videos or voice clips. There are some ethical dimensions that are inherent in these practices that ought to be critically scrutinised by bioethicists.

OBJECTIVE

The author has argued in this paper that informal mHealth at large scale adoption in Ghana is associated with some bioethical challenges.

METHODS

This essay was largely based on an analysis of an empirical study published by Hampshire et al in 2021 on the use of informal mHealth methods in Ghana.

RESULTS

Widespread adoption of Informal mHealth in Ghana is associated with privacy invasion of both the nurses and their clients, breaches confidentiality of the parties, discredits the validity of informed consent processes and may predispose the nurses to some other significant aggregated harms.

CONCLUSION

The author affirms his partial support for a formalised adoption process of informal mHealth in Ghana but has reiterated that the current ethical challenges associated with informal mHealth in Ghana cannot escape all the debilitating bioethical challenges, even if it is formalised.

Pre-eclampsia training needs of midwives in a Ghanaian tertiary hospital: A cross-sectional study

AIM

This study aimed to assess the specific clinical and non-clinical training needs of midwives and determine their preferred approach to enhancing performance.

BACKGROUND

Pre-eclampsia remains one of the leading causes of maternal deaths in low and middle-income countries. Pre-eclampsia-related deaths may be due to reduced midwifery knowledge and inadequate management. Therefore, a training needs assessment is vital in identifying gaps in practice, especially, in poorly resourced settings for maximal use of training resources.

DESIGN

A hospital-based cross-sectional study.

SETTING

The largest tertiary hospital in Ghana.

METHODS

An online version of the validated WHO Hennessy-Hicks Training Needs Analysis questionnaire was used to assess midwives' training needs on the management of pre-eclampsia. The tool has good psychometric properties and was used to assess 1) midwives' confidence in performing tasks, 2) the importance of the task to their role and 3) their preferred performance improvement approach. Data analysis adhered to the guidelines specified in the Hennessy-Hicks Training Needs Analysis Questionnaire and the priority training requirements of the midwives were assessed through descriptive statistics and a series of independent t-tests.

RESULTS

Among the 250 midwives who responded, most possessed 1-5 years of experience (74.7 %). All 28 tasks were viewed by midwives as essential responsibilities in pre-eclampsia management. Midwives had the greatest need for training in research/audit and clinical skills domains respectively (p < 0.001, 95 % confidence interval: 1.08-1.47, Cohen's-D = 1.27; and p < 0.001, 95 % confidence interval: 0.69-1.06, Cohen's-D = 0.87). The foremost primary training necessity, as recognised by midwives, was undertaking health promotion activities, including antenatal health education (MD= 0.43, 95 % confidence interval: 0.29-0.57). Training courses were identified as the preferred approach to address training needs and improve overall proficiency.

CONCLUSION

Midwives in Ghana require comprehensive training covering research and clinical-based competencies to improve pre-eclampsia management. Considering the pivotal role of Ghanaian midwives in safeguarding maternal well-being, there is a compelling need to enhance the calibre of midwifery services. These findings can guide stakeholders in countries with comparable healthcare contexts in creating effective, resource-efficient training programs that avoid counterproductivity, ultimately supporting national initiatives to enhance pre-eclampsia management and the quality of care.

The burden and predictors of late antenatal booking in a rural setting in Ghana

AIM

The aim of the study was to determine the prevalence and key predictors of late booking among pregnant women accessing antenatal care services in a rural district of Ghana.

DESIGN

Cross-sectional study.

METHODS

Data on demographic characteristics, knowledge of accessing antenatal care services and booking gestation were collected from 163 randomly selected pregnant women accessing accessing antenatal care in rural Ghana from 1 March 2022 to 30 April 2022 using a structured questionnaire. The chi-square and logistic regression were used to explore associations between exposure and dependent variables.

RESULTS

The prevalence of late accessing antenatal care booking among study participants was 44.8% (73/163). About 79.1% (129/163) of them had adequate knowledge of accessing antenatal care services. Maternal age of 35-49 years (AOR: 8.53, 95% CI: 2.41-30.12), participants whose partners had no formal education (AOR: 3.43, 95% CI: 1.03-11.39) and participants with adequate knowledge about accessing antenatal care services (AOR: 0.21, 95% CI: 0.07-0.62) were associated with late booking for accessing antenatal care services among study participants.

Effects of computerized decision support on maternal and neonatal health-worker performance in the context of combined implementation with performance-based incentivisation in Upper East Region, Ghana: a qualitative study of professional perspectives

BACKGROUND

Computerized decision support systems (CDSS) and performance-based incentives (PBIs) can improve health-worker performance. However, there is minimal evidence on the combined effects of these interventions or perceived effects among maternal and child healthcare providers in low-resource settings. We thus aimed to explore the perceptions of maternal and child healthcare providers of CDSS support in the context of a combined CDSS-PBI intervention on performance in twelve primary care facilities in Ghana's Upper East Region.

METHODS

We conducted a qualitative study drawing on semi-structured key informant interviews with 24 nurses and midwives, 12 health facility managers, and 6 district-level staff familiar with the intervention. We analysed data thematically using deductive and inductive coding in NVivo 10 software.

RESULTS

Interviewees suggested the combined CDSS-PBI intervention improved their performance, through enhancing knowledge of maternal health issues, facilitating diagnoses and prescribing, prompting actions for complications, and improving management. Some interviewees reported improved morbidity and mortality. However, challenges described in patient care included CDSS software inflexibility (e.g. requiring administration of only one intermittent preventive malaria treatment to pregnant women), faulty electronic partograph leading to unnecessary referrals, increased workload for nurses and midwives who still had to complete facility forms, and power fluctuations affecting software.

CONCLUSION

Combining CDSS and PBI interventions has potential to improve maternal and child healthcare provision in low-income settings. However, user perspectives and context must be considered, along with allowance for revisions, when designing and implementing CDSS and PBIs interventions.

A qualitative document analysis of policies influencing preeclampsia management by midwives in Ghana

BACKGROUND

Preeclampsia is a global issue that causes significant morbidity and mortality in low- and middle-income countries (LMICs). The care women with preeclampsia receive in LMICs is below the standard experienced by women in westernised countries due to multiple interacting factors. A review of policy factors influencing the management of preeclampsia in Ghana is needed.

AIM

This study focuses on the midwife's role and scope of practice concerning preeclampsia management. The study aimed to explore the congruence between Ghanaian preeclampsia guidelines and international best practice recommendations for midwifery practice. The study also aimed to describe how recommendations are incorporated into Ghanaian guidelines.

METHOD/DESIGN

This study was a qualitative document analysis of national and tertiary hospital policies related to midwives' scope of practice in Ghana. Altheide's five-step process (sampling, data collection, data coding and organisation, data analysis and report) was used to systematically source and analyse the content of written documents.

RESULTS

The findings illustrated several recommendation shortcomings in Ghanaian documents at the national and tertiary hospital levels. The content of Ghanaian preeclampsia management guidelines was not comprehensive, contained conflicting information, and was not backed by research evidence. The standards of practice for midwives were consistent at both the national and tertiary hospital levels. Midwives had limited roles in detection, management, stabilisation, and referral of women with preeclampsia.

CONCLUSION

Uniform guidelines incorporating international recommendations are urgently needed to improve multi-professional collaboration, solidify midwives' roles, and optimise maternal and fetal outcomes.

Midwives' strategies for coping with barriers to providing quality maternal and neonatal care: a Glaserian grounded theory study

Background

Midwives face direct and indirect barriers in their workplaces that have negative consequences on their ability to provide quality care to women and neonates, however, they still carry on with their duties. This study aimed at investigating the coping strategies that Ghanaian midwives adopt to be able to complete their work.

Methods

Glaserian Grounded theory was used in this study. Data were collected through non-participant observations and semi-structured interviews. The study participants included 29 midwives who worked in labour/birthing environments and a pharmacist, a social worker, a national Health Insurance Scheme manager and a health services manager.

Findings

The midwives’ motivation due to their strong desire to save the lives of women and neonates and their strong affection for the midwifery profession was identified to help them cope with the barriers that they faced in their workplaces. The midwives’ motivation was found to spur actions such as improvising, taking control of the birthing process and the birthing environment and the maintenance of social and professional networks to help them to complete their duties.

Conclusion

Ghanaian midwives face myriad barriers in their workplaces; however, they are able to adopt coping strategies that enable them to complete their duties. The provision of care resources for maternity services in the country will reduce the barriers that the midwives face and improve the quality of maternal and neonatal care. In the short term however, pre and post midwifery educational programmes should focus on developing resilience in the midwifery workforce to help midwives cope more effectively with the challenges that they face in their workplaces.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07049-0.

Is quality maternal healthcare all about successful childbirth? Views of mothers in the Wa Municipality, Ghana

Introduction

In spite of the countless initiatives of the Ghana government to improve the quality of maternal healthcare, Upper West Region still records poor childbirth outcomes. This study, therefore, explored women’s perception of the quality of maternal healthcare they receive in the Wa Municipality of the Upper West Region of Ghana.

Materials and methods

This is a qualitative cross-sectional study of 62 women who accessed maternal healthcare in the Wa Municipality of Ghana. We analysed the transcripts using the analytic inductive technique. An inter-coding technique (testing for inter-coding agreement) was employed. The iterative coding process resulted in a coding scheme with four main themes. We used peer-debriefing technique in ensuring credibility and trustworthiness.

Results

Logistics and equipment; referral service; empathic service delivery; inadequacy of care providers; affordability of service; satisfaction with services received; as well as experience and service delivery were the parameters used by the women in assessing quality maternity care. A number of gaps were reported in the healthcare system including limited healthcare providers, limited beds and inefficient referral system. Conversely, some of them reported that some healthcare providers offered empathetic healthcare. Contrary views were expressed with respect to satisfaction with maternity care.

Conclusion

Government and all stakeholders seeking to enhance quality of maternal health and accelerate the attainment of the third Sustainable Development Goal need to reconsider the financing of service delivery at health institutions. Indeed, our findings have illustrated that routine workshops on empathetic healthcare are required in efforts to increase the rate of facility-based childbirth, and thereby subside maternal mortality and all adverse pregnancy outcomes.

Perspectives and practices of healthcare providers and caregivers on healthcare-associated infections in the neonatal intensive care units of two hospitals in Ghana

Healthcare-associated infections (HAIs) remain a serious threat to patient safety worldwide, particularly in low- and middle-income countries. Reducing the burden of HAIs through the observation and enforcement of infection prevention and control (IPC) practices remains a priority. Despite growing emphasis on HAI prevention in low- and middle-income countries, limited evidence is available to improve IPC practices to reduce HAIs. This study examined the perspectives of healthcare providers (HPs) and mothers in the neonatal intensive care unit on HAIs and determined the major barriers and facilitators to promoting standard IPC practices. This study draws on data from an ethnographic study using 38 in-depth interviews, four focus group discussions and participant observation conducted among HPs and mothers in neonatal intensive care units of a secondary- and tertiary-level hospital in Ghana. The qualitative data were analysed using a grounded theory approach, and NVivo 12 to facilitate coding. HPs and mothers demonstrated a modest level of understanding about HAIs. Personal, interpersonal, community, organizational and policy-level factors interacted in complex ways to influence IPC practices. HPs sometimes considered HAI concerns to be secondary in the face of a heavy clinical workload, a lack of structured systems and the quest to protect professional authority. The positive attitudes of some HPs, and peer interactions promoted standard IPC practices. Mothers expressed interest in participation in IPC activities. It however requires systematic efforts by HPs to partner with mothers in IPC. Training and capacity building of HPs, provision of adequate resources and improving communication between HPs and mothers were recommended to improve standard IPC practices. We conclude that there is a need for institutionalizing IPC policies and strengthening strategies that acknowledge and value mothers' roles as caregivers and partners in IPC. To ensure this, HPs should be better equipped to prioritize communication and collaboration with mothers to reduce the burden of HAIs.

Utilization of the Ghana National Health Insurance Scheme and its association with patient perceptions on healthcare quality

OBJECTIVE

To determine the association between the utilization of the Ghana National Health Insurance Scheme (NHIS) and patient perceptions of quality of care.

METHODS

Ghana Demographic and Health Survey (GDHS) 2014 had 19 questions on perceptions of quality of care received during the last reported health visit (n = 4332). These questions were summarized into an overall 100-point perception score using item response theory (IRT). Patients were divided into three utilization categories: those paying with their NHIS card fully, those paying with their card and out-of-pocket (OOP), and those paying fully OOP. A multiple linear regression model was used to measure the association between NHIS utilization and overall perception.

RESULTS

In general, NHIS utilization was negatively associated with overall perception, and the difference across utilization categories was higher among private facility users than public facility users. Among private facilities, those who paid fully with NHIS reported five points lower than those who paid fully OOP (P = 0.005). Among public facilities, the difference is only 1.7 (P = 0.4342).

CONCLUSION

NHIS utilization was a negative predictor for patient perceptions, but the differences are more nuanced according to type of facility. Future GDHS rounds should continue measuring perceptions in aid of policy to improve service delivery under the NHIS.