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Doku AK, Tetteh J, Edzeame J, Peters RJG, Agyemang C, Otchi EH, Yawson AE. The Ghana heart initiative - a health system strengthening approach as index intervention model to solving Ghana's cardiovascular disease burden. Front Public Health 2024; 12:1330708. [PMID: 38694980 PMCID: PMC11061415 DOI: 10.3389/fpubh.2024.1330708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
Cardiovascular diseases (CVD) are the leading cause of death worldwide, with 80% of these deaths occurring in low-middle income countries (LMICs). In Ghana and across Africa, CVDs have emerged as the leading causes of death primarily due to undetected and under treated hypertension, yet less than 5% of resources allocated to health in these resource-poor countries go into non-communicable diseases (NCD) including CVD prevention and management. Consequently, most countries in Africa do not have contextually appropriate and sustainable health system framework to prevent, detect and manage CVD to achieve Universal Health Coverage (UHC) in CVD care through improved Primary Health Care (PHC) with the aim of achieving Sustainable Development Goals (SDG) in CVD/NCD. In view of this, the Ghana Heart Initiative (GHI) was envisaged as a national strategy to address the identified gaps using a health system and a population-based approach to reduce the national burden of CVDs. The GHI intervention includes the development of guidelines and training manuals; training, equipment support, establishment of a national call/support center, and improvement in the national data capturing system for CVDs and NCD, management of Hypertension, Deep Vein Thrombosis (DVT) and Heart Failure (HF). Following the implementation of the GHI concept, a national CVD Management Guideline was developed and 300-health facilities across the different levels of care including one teaching hospital, was also supported with basic life-saving equipment. In addition, more than 1,500 healthcare workers also reported improvement in their knowledge and skills in the management and treatment of CVD-related cases in their health facilities. These are key contributions to strengthening the health system for CVD care and learning lessons for scale up.
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Affiliation(s)
- Alfred K. Doku
- University of Ghana Medical School, Accra, Ghana
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherland
| | - John Tetteh
- Department of Community Health, Medical School, University of Ghana, Accra, Ghana
| | - Juliette Edzeame
- Deutsche Gesellschaft fur Internationale Zusammenarbeit, Accra, Ghana
| | - Ron J. G. Peters
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherland
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elom Hillary Otchi
- Accra College of Medicine, Accra, Ghana
- Korle Bu Teaching Hospital, Accra, Ghana
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Otchi EH, Hinchcliff R, Greenfield D. A beacon to guide others: improving chronic disease management through targeted, evidence-based primary healthcare quality measures. Int J Qual Health Care 2024; 36:mzae014. [PMID: 38401172 DOI: 10.1093/intqhc/mzae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024] Open
Affiliation(s)
- Elom Hillary Otchi
- Quality Management Unit (QMU), Korle Bu Teaching Hospital (KBTH), Accra KB 755, +233, Ghana
- Community Health Department, Family Health Medical School, Box TS 669, Teshie-Accra +233, Ghana
| | - Reece Hinchcliff
- School of Applied Psychology, Griffith Health Griffith University | Southbank Campus, Building S07, 226 Grey Street South Bank, Brisbane 4101, Australia
| | - David Greenfield
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales 2502, Australia
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Hooley B, Otchi EH, Mayeden S, Yawson AE, Awoonor-Williams K, Tediosi F. Examining the Utilization of Social Capital by Ghanaians When Seeking Care for Chronic Diseases: A Personal Network Survey. Int J Public Health 2023; 68:1605891. [PMID: 38179319 PMCID: PMC10764420 DOI: 10.3389/ijph.2023.1605891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives: With limited social security and health protection in Ghana, intergenerational support is needed by those living with NCDs, who incur recurrent costs when seeking NCD care. We measured the level of informal support received by NCD patients and identified factors that influence support provision. Methods: We surveyed 339 NCD patients from three hospitals in Ghana, who listed their social ties and answered questions about their relationship and support frequency. We analyzed the relationship between social support, demographic and health information, characteristics of social ties, and network characteristics. Results: Participants described 1,371 social ties. Nearly 60% of respondents reported difficulties in their usual work or household duties due to chronic illness, which was also the strongest predictor of support. Patients with higher wellbeing reported less social support, while older age and having co-habitant supporters were negatively associated with support, indicating caregiver burnout. Conclusion: Ghanaian NCD patients receive support from various caregivers who may not be able to handle the increasing healthcare and social needs of an aging population. Policies should therefore enhance resource pooling and inclusiveness for old age security.
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Affiliation(s)
- Brady Hooley
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Elom Hillary Otchi
- Korle Bu Teaching Hospital, Accra, Ghana
- Accra College of Medicine, Accra, Ghana
| | | | - Alfred Edwin Yawson
- Korle Bu Teaching Hospital, Accra, Ghana
- Medical School, University of Ghana, Accra, Ghana
| | - Koku Awoonor-Williams
- Department of Policy, Planning, Monitoring and Evaluation, Ghana Health Service, Accra, Ghana
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
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Otchi EH, Gyawu N, Buckle G. Model for building quality resilient health facility. Front Public Health 2023; 11:1269330. [PMID: 38106891 PMCID: PMC10722193 DOI: 10.3389/fpubh.2023.1269330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023] Open
Abstract
The AfIHQSA Model is the model for building quality resilient health systems. It is proposed as a compliment to and in many instances as an alternative to the many other existing in ensuring a systematic and a sustained approach to improving outcomes in African health systems. It seeks to bring the necessary transformation to healthcare quality and patient safety and facilitate the attainment of desired outcomes. The model is unique in its iterative nature and how it places premium on sustaining the gains of improvement. The authors are concerned about the lack of sustainability of the many quality improvement efforts on the continent and how they all fade out into obscurity upon the exit of the proponents. Six iterative steps are proposed in the use of the model and these are: leadership commitment and buy-in; situational analysis of quality management capacity; systems strengthening for quality management; quality improvement interventions for care outcomes; standardization/accreditation/certification; and iterative monitoring, evaluation of performance of interventions and learning. Most of the quality interventions and efforts on the continent have failed because the steps in this model have not been sufficiently followed and addressed. The required strengthening of the various components of the health system necessary to sufficiently bear the weight of any quality intervention and guarantee sustainability of the gains is often ignored. As authors, we have therefore formally adopted the use of this model and plan to further continue evaluating and monitoring its utility and its generalizability in different institutions and countries.
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Affiliation(s)
- Elom Hillary Otchi
- Africa Institute of Healthcare Quality Safety and Accreditation (AfIHQSA), Accra, Ghana
- Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Gilbert Buckle
- Africa Institute of Healthcare Quality Safety and Accreditation (AfIHQSA), Accra, Ghana
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Otchi EH, Esena RK, Srofenyoh E, Ameh EO, Asah-Opoku K, Beyuo T, Ken-Amoah S, Oduro F, Agbeno EK, Marfo K. Health Systems Factors Associated With Adverse Events Among Hospitalized Obstetric Clients in a Tertiary Health Care Facility in Ghana. J Patient Saf 2021; 17:e890-e897. [PMID: 34852414 DOI: 10.1097/pts.0000000000000904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The risk of an adverse event (AE) in obstetric clients receiving care in hospitals is greater than the risk of dying in aviation, road traffic accidents, and breast cancer. There is little understanding of AEs with respect to their causes at hospitals. The study aimed at assessing factors that are associated with the occurrence of AEs among hospitalized obstetric clients in a tertiary hospital in Ghana. METHOD This was a case-control study of 650 obstetric clients (equal number in both arms) who were admitted between January 1 and December 31, 2015, at the study site. A retrospective review of the clients' medical records was randomly allocated into both arms of the study. Descriptive and inferential statistics including confirmatory factor analysis were performed. Models were evaluated for goodness-of-fit measures. The reliability and validity of the scale were also tested using Cronbach α coefficient. RESULTS The mean gestational age of the clients was 37.4 ± 4.9 weeks. Leadership and governance (inadequate use of protocol and adherence) accounted for the most cause of AEs among obstetric clients. The overall Kaiser-Meyer-Olkin score was also 0.87. The scale also demonstrated high reliability (Cronbach α = 0.995; composite reliability > 0.7) and validity (average variance extraction > 0.50). There was a marginal model fit (root mean square error of approximation, 0.067), and the χ2 test was statistically significant (P < 0.05). CONCLUSIONS Inadequate use of protocol and adherence is a major cause of preventable AEs identified in this study. There is an urgent need to address this to ensure a reduction in the prevalence of AEs among obstetric clients.
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Affiliation(s)
| | | | | | | | | | - Titus Beyuo
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast, Cape Coast
| | - Frederick Oduro
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital (KBTH), Accra, Ghana
| | - Evans Kofi Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast, Cape Coast
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Abstract
Objectives The objective of the study was to assess the patient safety situation in Ghana. Specifically, the study aimed at assessing the WHO’s 12 action areas of patient safety. Design This was a descriptive cross-sectional survey. Data collection methods included interviews and observation using WHO adapted questionnaire. Setting The setting was mainly 16 selected hospitals, including two teaching hospitals selected from the northern and southern parts of the Ghana. Participants Respondents were purposively selected based on their position in the health facilities and the type of information required. Main Outcome Measure(s): The main outcome measures were the WHO’s 12 action areas of patient safety. Results The median bed capacity of the hospitals assessed was 93 (min = 60, max = 1812). The country’s highest score (94%) was in the action area of knowledge and learning in patient safety where all (16, 100%) sampled facilities had systems in place for recording adverse events, specific protocols for patient care, etc. Five (5) of the 12 action areas (i.e. national patient policy, hospital acquired infections, surgical safety, patient safety partnerships and patient safety funding) had scores lower than the mean score (66%). Conclusion The key strength identified in the patient safety situational analysis of Ghana was knowledge and learning in patient safety while patient safety surveillance was the weakest action area identified. There were also weaknesses in areas such as national patient policy, healthcare associated infections, surgical safety, patient safety partnerships and patient safety funding, respectively.
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Affiliation(s)
- EH Otchi
- Korle Bu Teaching Hospital, Accra, Ghana
| | - C Bannerman
- Institutional Care Division, Ghana Health Service, Accra, Ghana
| | - S Lartey
- Ministry of Health, Policy Planning, Monitoring & Evaluation, Accra, Ghana
| | - KP Amoo
- Korle Bu Teaching Hospital, Accra, Ghana
| | - E Odame
- Ministry of Health, Policy Planning, Monitoring & Evaluation, Accra, Ghana
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