Ghana National Research Articles

Integrating Global and National Knowledge to Select Medicines for Children: The Ghana National Drugs Programme

David Sinclair and colleagues discuss their experience at the Ghana National Drugs Programme reviewing the international evidence base for five priority pediatric medicines and report that applying the global recommendations to Ghana was not straightforward for any of the five medicines. Please see later in the article for the Editors' Summary

Sustainability of recurrent expenditure on public social welfare programmes: expenditure analysis of the free maternal care programme of the Ghana National Health Insurance Scheme

Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes. Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective. A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme-without a commensurate growth on the amounts generated annually-is an increasing threat to the sustainability of the fund. Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.

Profile of persons with vehicular related trauma presenting at Komfo Anokye Teaching Hospital Emergency Centre

Introduction Vehicular Related Trauma (VRT) is a major cause of morbidity and mortality. Worldwide, an estimated 1.2million people die yearly from VRT whilst about 50million people sustain non-fatal injuries. WHO predicts Road Traffic Accident as the third leading cause of death worldwide by 2020. Ghana has been experiencing an increasing number of VRT which imposes a high clinical and economic burden. In the year 2010 out of 16,904 casualties 1986 were killed in Ghana (National Road Safety Commission). This study was conducted to assess the morbidity and mortality resulting from VRT, the severity of presentation and the injury types. Methods The study was cross-sectional. Patients fulfilling inclusion criteria at the Komfo Anokye Teaching Hospital (KATH) Emergency Centre (EC) were recruited on admission. Written informed consent was obtained. Patients were triaged using the five-tier South Africa Triage system. Data were collected over a six-week period between July and August 2011. Results Out of the total sample of 1004, approximately 41% had some form of injury; of these almost half (49.6%) had injuries from Vehicular Related Trauma. A further look at VRT cases indicated that the principal presentations were caused by car crash (41.6%), pedestrian injuries (25.8%), and motorcycle related injuries (19.6%). Mini buses and bicycles accounted for 9.8% and 2.2%, respectively. 6.8% of the patients were triaged to red, 33.4% to orange, and 59.3% to yellow. Thirty-four and a half percent of the patients presented with lower extremity injuries and fractures, followed by head injuries (26.1%). Mortality rate (24h mortality) at the Emergency department during the period in respect with trauma is as follows: 15.78% for red, 1.27% for orange and none at yellow. None of the patients involved in bicycle accidents wore a helmet and only 5.3% of those riding motorcycles wore a crash helmet. Discussion This study confirms that injuries resulting from Vehicular Related Trauma contribute a significant cause of all injuries presenting at the KATH EC and therefore could have a significant economic burden on Ghana. Policy makers should make road safety a priority and implement cost effective measures to improve it.

Traditional healers as service providers in Ghana's National Health Insurance Scheme: The wrong way forward?

Concerned with the negative impacts of user fees on healthcare access and utilisation, following the enactment of a law in 2003, the Ghanaian government replaced the ‘cash-and-carry’ system with a National Health Insurance Scheme (NHIS). Even though many Ghanaians rely on traditional medicine (TRM) for reasons of culture, cost and personal preference, the incipient NHIS does not cover the services of TRM practitioners. Consultations with health policy-makers suggest that, in as much as the government recognises the invaluable contributions of TRM practitioners and would like to incorporate them in the incipient scheme, the provision of TRM in the country is still too disorganised, with few if any formal protocols and codes of conduct. Consequently, the inclusion of TRM practitioners in the NHIS is premature. This scholarly review seeks to bring TRM and its practitioners into the mainstream of healthcare provision in Ghana. Possibilities for medical pluralism in Ghana will be discussed with reference to best practices in countries such as China, India and Vietnam. This paper promotes medical pluralism in the form of Active Collaboration Between Fully Recognised Health Systems where there will be equity, mutual respect and understanding among traditional healers and physicians.

Potential feedstocks for bioethanol production as a substitute for gasoline in Ghana

Developed countries are aspiring to increase the production of biofuels in order to reduce dependence on crude oil and also improve energy security, developing countries such as Ghana can adopt biofuel technologies to provide supports for rural developments. Bioethanol has been identified as one of the biofuels that can be developed in order to meet the targets as stipulated in Ghana's Strategic National Energy Plan (SNEP) up to 2020. The focus of this study was to identify the available feedstocks and their quantities for bioethanol production that can support this policy. The potential energy crops identified were cassava, yam and maize. However, cassava was identified to be the most suitable feedstock for bioethanol production since an average of less than 50% of its domestic supply is consumed as food. Even if best farming practices were adapted, bioethanol from yam and maize would not be significant compared to that of cassava.

Emerging Urban System Demographic Trends: Informing Ghana's National Urban Policy and Lessons for Sub-Saharan Africa

Sub-Saharan Africa faces major urban challenges, so many governments of the region have responded by developing national urban policies. We present emerging urban-system demographic trends in Ghana by locating our analyses at the nexus of the relationship between urbanization and societal imperatives. Our analyses show, first, that the claim that Ghana is in its urban age should be made with caution, since we identify conflicting systemwide trends. After an acceleration immediately after independence, the rate of urban growth since 2000 has slowed; the number of localities within the urban system has grown, but many of them are no more than glorified villages. Second, we relate societal imperatives to urban localities of remarkable growth to explain why they have grown. Third, we detail the emergence of a city-region around Accra-Tema, suggesting this has matured, especially under globalization. We argue that the growth of the city-region may be beginning to slow down. We conclude by suggesting ways in which our findings can inform Ghana’s national urban policies and identifying three general lessons for sub-Saharan African countries.

Restoring the ‘Historical Deficit’: The Exercise of the Right to Freedom of Religion and Culture in Democratic South Africa

On 18 January 1960, Life magazine began a series of articles on democracy around the world. The newly independent nation of Ghana (1957) was featured in Part 1 and thecover photograph was of Augustus Molade Akiwumi, the Speaker of the House in Ghana, dressed in British-style wig and robes. The title of the feature article read, ‘Ghana’s Leap from Stone Age to Eager New Nationhood’. The feature explains that in Ghana ‘Courts are being built, and in lower courts the temporary local judges are being replaced with more qualified appointees to settle local disputes and initiate the people in the mechanics of Western justice’. However in stark contrast to the portrayal of pre-colonial Ghana as ‘Stone Age’ the Asanti peoples of Ghana developed a complex, hierarchical society and legal system centuries before Europeans ever arrived on the continent. In critical reflection of the magazine cover, this article is founded on demonstrating how the colonial, postcolonial, apartheid and post-apartheid state have through an oppressive stance suppressed indigenous religious and cultural diversity. In addition, it is asserted that the current constitutional arrangements have not at all times effectively dealt with this subjugation. It is presupposed that unless a positive approach towards religious and cultural integrity is displayed and an environment is created in which these rights to freedom of religion andculture may prosper, the constitutional endeavour of establishing unity and solidarity in our diverse society will remain elusive. In conclusion, some approaches to enhancing this constitutional endeavour are proffered.

Determinants of access to antenatal care and birth outcomes in Kumasi, Ghana

This study aimed to investigate factors that influence antenatal care utilization and their association with adverse pregnancy outcomes (defined as low birth weight, stillbirth, preterm delivery or small for gestational age) among pregnant women in Kumasi. A quantitative cross-sectional study was conducted of 643 women aged 19–48 years who presented for delivery at selected public hospitals and private traditional birth attendants from July–November 2011. Participants’ information and factors influencing antenatal attendance were collected using a structured questionnaire and antenatal records. Associations between these factors and adverse pregnancy outcomes were assessed using chi-square and logistic regression.Nineteen percent of the women experienced an adverse pregnancy outcome. For 49% of the women, cost influenced their antenatal attendance. Cost was associated with increased likelihood of a woman experiencing an adverse outcome (adjusted OR=2.15; 95% CI=1.16–3.99; p=0.016). Also, women with >5 births had an increased likelihood of an adverse outcome compared with women with single deliveries (adjusted OR=3.77; 95% CI=1.50–9.53; p=0.005). The prevalence of adverse outcomes was lower than previously reported (44.6 versus 19%). Cost and distance were associated with adverse outcomes after adjusting for confounders. Cost and distance could be minimized through a wider application of the Ghana National Health Insurance Scheme.

Installation, Hookup, and Commission Phase of Ghana's Fast-Tracked Jubilee Project

This article, written by Editorial Manager Adam Wilson, contains highlights of paper OTC 23456, ’Jubilee Development Installation, Hookup, and Commissioning and Ready for Startup,’ by Laurent Culembourg, Kosmos Energy, Cory Weinbel, SPE, Anadarko Petroleum, Keith Mutimer, Tullow Oil, Frederic Chauvin, Technip, and Andrew McDonald, consultant, prepared for the 2012 Offshore Technology Conference, Houston, 30 April-3 May. The paper has not been peer reviewed. The Jubilee Field Development, 60 km offshore Ghana, began Phase 1 production just 3.5 years after field discovery. Here is highlighted the successful execution of the in-country installation, hookup, and commissioning (IHUC) phase of the project in conjunction with operations readiness and assurance activities to bring the production system safely to an on-time ready-for-startup (RFSU) condition. Success was found through integration of a multipartner project team and the management of critical interfaces. Introduction The Jubilee partners, along with the Ghana National Petroleum Corporation (GNPC), decided to develop the field using a phased approach. The integrated project team (IPT) developed a plan to target just less than 300 million bbl in Phase 1 with a 17-well subsea system and a 120,000-BOPD floating production, storage, and offloading (FPSO) unit. Phase 1 was approved in Au-gust 2008, and first oil was achieved in November 2010. The overall project schedule was aggressive, with critical path activities occurring primarily within the IHUC phase of the project. Despite efforts to plan and meet the aggressive schedule, the IPT still encountered some significant challenges onshore and offshore Ghana during the IHUC phase. The key to resolving these issues successfully was linked with the execution strategy and the experienced team’s ability to develop a response plan and implement it successfully. IHUC Planning, Organization, and Execution Strategy The Jubilee Leadership Team (JLT) recognized that the IPT organization and interfaces with the unit operator needed to evolve with the progression of the project. As such, the development activities were divided into the following four phases, with governance models designed for each: Phase 1—FPSO construction and subsea procurement Phase 2—IHUC Phase 3—Startup Phase 4—Steady state Contracting Strategy and Resources A contracting strategy was put in place to favor IPT control over schedule imperatives with the following elements: Selecting world-class contractors with records of delivering on-time projects with excellent engineering Incentives for meeting, and penalties for failing to meet, critical milestones Separating the scope of umbilical, riser, and flowline (URF) activities that could be performed off the critical path from those that had to be done on the critical path and negotiating different incentives/penalties for each

Three Tier level Data Warehouse Architecture For Ghanaian Petroleum Industry

The data warehouse (DW) is a modern proven technique of handling and managing diversity in data sources, format and structure. Recent advances in database technologies are leading to the proliferation of different kinds of information design with independent supporting hardware and software. This technology was developed therefore to integrate heterogeneous information sources for analysis purposes. Information sources are progressively becoming autonomous and they change their content rapidly due to perpetual transactions (data changes) and may change their structure due to continual users' requirements evolving (schema changes). Handling correctly all type of these changes however is a real challenge. Thus, strategic decision making is an ongoing process and part of human life. Businesses all over the world are faced with challenging decision making which is the very livelihood to their very existence. There has been intensive research in the field of databases including the grandfather of data warehousing Inmon which they offered tremendous insight into how the power of computing can be harnessed in strategic decision making. There achievement in the petroleum industry has been highlighted and written about by Nimmagadda and his fellow professionals. However how this can be implemented in Africa is remain to be solved. In this paper we investigated the various data capturing systems which they currently in use at the Ghana National Petroleum Cooperation (GNPC) – a state agency responsible for the overall management and supervision of the hydrocarbon endowment of the sub-region and recommending a tree tier level petroleum data warehouse architecture for cutting- edge decision making on petroleum resources.

Trade credit and supply chain delivery in the Ghanaian construction industry

PurposeTrade credit is treated as a financial intermediation device whereby construction vendors act as financial providers to their customers through deferred payments of goods purchased. The purpose of this paper is to investigate and report upon the key factors and motives influencing vendors' decision on trade credit provision to small to medium sized construction firms.Design/methodology/approachAdopting deductive methodological approach, this paper utilises a combination of primary data emanating from structured survey questionnaires supplemented by secondary source of data from an extensive literature review, to present insightful commentary about trade credit provision in Ghana. The structured survey questionnaire was administered to 100 construction vendor firms/suppliers to elicit relevant data about their trade credit intentions. Drawing upon the principles of a total design method (TDM) of survey, a relatively high response rate of 57 percent was achieved. Principal component (factor) analysis was adopted to obtain simplification of variables and to detect underlying dimensions and reveal potential complex structures within decision variables.FindingsThe underlying constructs and motives of vendors on trade credit were intricately interwoven in two principal factors: risk distribution and liquidity; and sustaining business relationship and liquidity. Despite the uncharacteristic manifestation of the liquidity measure being associated with the two principal components, the findings demonstrate the relative importance of liquidity in the trade credit debate. A critical observation stemming from the analysis was that trade policy was absent within the trade credit market in Ghana; this poses a potential threat to trade credit exchange and its development.Originality/valueThe paper's methodological approach is uniquely positioned between the conceptual and empirical interface and the overarching research is pioneering within the developing world nation of Ghana. The paper's findings will be useful to contractors, particularly, small and medium size contractors who are considering feasible finance options; and vendors who seek to consolidate their clientele base.

Offshore Ghana's Jubilee Project Finds Success With Cooperation and Rapid Development

This article, written by Editorial Manager Adam Wilson, contains highlights of paper OTC 23430, ’Jubilee Project Overview,’ by Dennis McLaughlin, Kosmos Energy, prepared for the 2012 Offshore Technology Conference, Houston, 30 April-3 May. The paper has not been peer reviewed. The Jubilee project was an ambitious challenge for the first significant development offshore Ghana. The joint venture used a split operatorship to execute a world-class deepwater project in an area with no existing infrastructure in less than 3 years from the start of concept selection. Despite several significant technical and commercial hurdles, the project achieved excellent health/safety/environment (HSE), schedule, and cost performance. Jubilee’s unique circumstances justified a very aggressive appraisal development strategy and dictated an unconventional approach to organizing and managing the project, which ultimately was highly successful. Introduction The Jubilee field was discovered in June 2007 in the Gulf of Guinea, approximately 60 km offshore western Ghana. It is a very large light/sweet oil accumulation in 1200–1500 m of water. The Jubilee partners, along with the Ghana National Petroleum Corporation (GNPC), decided in January 2008 to develop the field using a phased approach after just one appraisal well. Discovery The Jubilee field was discovered offshore Ghana by Kosmos in June 2007 with the Mahogany-1 wildcat well on the West Cape Three Points block near its western boundary (Fig. 1). A large oil field was confirmed by the Hyedua-1 well drilled in August 2007, 5 km southwest of Mahogany-1, across the lease line on the Deepwater Tano block. The field was Ghana’s first significant oil find after some 40 years of offshore exploration, and it was also one of the largest fields discovered in the last decade offshore Africa. Understandably, the discovery was a source of immense pride and hope in Ghana, and, consequently, the Mahogany discovery was renamed Jubilee field to commemorate Ghana’s golden jubilee—50 years of independence—which was celebrated in 2007. The discovery holds a light (37°API), sweet, high-gas/oil-ratio crude and covers approximately 110 km2 across the two blocks. Resources are located in five stacked zones of thick, high-quality rock.

Hybrid Peacemaking: Building National “Infrastructures for Peace”

POTENTIALLY VIOLENT TENSIONS OR ONGOING VIOLENCE ARE INCREASINGLY insusceptible to one-time external mediation or local conflict resolution as: 1. Conflicts are not limited to the primary protagonists alone, but extend through the different levels of society, from political and civic leaderships down through to communities, and over issues such as land, natural resources, and governance; 2. Contemporary societies face continuous political or socioeconomic transformation where the challenge is not the resolution of a specific conflict, but providing sustained accompaniment to all relevant actors so that the eventual outcomes are based on inclusion and consensus and do not lead to more instability (many countries in the Middle East are undergoing such transition); 3. Potentially violent instability may result from the creeping influence of illicit trafficking, especially in weapons or narcotics. Instead, what are required are standing internal capacities for managing recurring tensions at national and local levels so that new conflicts are transformed into opportunities for greater reform and inclusion, rather than violence, in an approach referred to as conflict transformation. Such transformation in turn requires the use of external norms and skills as well as traditionally available resources within a society to obtain mediated results that encompass several levels of a conflict. This hybrid peacemaking bridges the illiberal and liberal frameworks identified in this issue by Anna K. Jarstad and Roberto Belloni. In supporting countries to build these capacities, external partners can help bridge the real or perceived gaps between international norms and practices on the one hand, and existing internal mechanisms for conflict management on the other. These hybridized internal mediation capacities therefore enable a more progressive teleology for governance in that constructively negotiated solutions to governance-related contests, generated within a context of national capacity and ownership, are also likely to be more and participatory across a wider range of actors than otherwise. National Infrastructures for Peace as Hybrid Peacemaking A critical emerging tool for hybrid peacemaking is for peace. Meeting in Naivasha, Kenya, in 2010, representatives from fourteen African countries agreed on a definition of infrastructures for peace, or the dynamic network of interdependent structures, mechanisms, resources, values, and skills which, through dialogue and consultation, contribute to conflict prevention and peace-building in a society. (1) Such infrastructures can help a country: 1. Manage recurrent conflicts over land, natural resources, apportioning of mineral wealth, and contested elections, especially where development itself has exacerbated these conflicts; 2. Complement external mediation targeted at the primary parties with internal negotiations that bring together actors at different levels of the society and polity, thus broadening the base for peace; 3. Negotiate and implement new governing arrangements in an and consensual manner, especially after periods of turbulent political or socioeconomic transition. The World Bank's World Development Report for 2011 focuses on the challenges of addressing protracted fragility and highlights the extended period of time required for meaningful transformation and the necessity in this context of inclusive enough that can generate the collective political will for reform. The internal bargaining required to sustain these coalitions highlights the necessity for infrastructures for peace, and the report mentions Ghana's National Peace Council (described below) as one example. The report of the UN Secretary-General to the General Assembly on Civilian Capacity in the Aftermath of Conflict (2011) also advocates for better use of existing national capacities. …

Managerial problems of hospitals under Ghana's National Health Insurance Scheme

PurposeHospital and health system managers are facing several problems following the introduction of Ghana's national health insurance policy. This study aims to investigate the opinions of health managers about the problems emanating from the national health insurance policy for hospital managers in regard to reimbursement, claims management, service delivery and waiting time.Design/methodology/approachThe study involved key informants from 12 National Health Insurance Scheme (NHIS) accredited district hospitals, which were purposively selected from five regions in Ghana. Data were collected using in‐depth personal interviews with managers of pharmacy, supply/procurement, accounts and insurance scheme units of the hospitals. Data analysis was guided by the major themes that emerged during the interviews. A framework approach to analysis was used, grouping and incorporating themes and sub‐themes that emerged from the interview data.FindingsThe major findings identified by interviewees with regards to problems confronting hospital management were: cash flow delays from the health insurance authority; lack of capacity to procure essential drug and non‐drug consumables; and the inability to take initiatives and carry on effective administrative work. Other problems identified by the interviewee included inadequate logistics and human resources, limited space within the hospitals to cope with the increasing number of service users and “moral hazard” on the part of policy holders.Originality/valueThe NHIS has brought many organizational and service management challenges to hospitals. To overcome these challenges, services under the health insurance authority need to be streamlined to remove cash flow bottlenecks. Also, accredited hospitals need to adopt and use new technology, especially computerization and automation of the health insurance service delivery system. This would enable the authority to cope with the huge management problems confronting hospitals and the national insurance scheme. Above all, appropriate fund management systems would have to be established in the hospitals to reduce moral hazards.

A Comparison of MNC and Domestic Firm CSR in Emerging Markets: Evidence from Ghana

This study examines differences in expenditures on CSR between MNCs and domestic firms in the sub-Saharan nation of Ghana. Taking an institutional perspective and relating those ideas to the “asset...

Peripheral modernism: Charles Polónyi and the lessons of the village

The Hungarian architect Károly (Charles) Polónyi (1928–2002), the only Team 10 member from Hungary, studied during the immediate post-war years at the Technical University of Budapest and became involved in the post-war reconstruction of Budapest and the resettlement of flood-damaged villages in the countryside. He attended the CIAM Congress in Otterlo, 1959, and was in regular exchange with members of Team 10. From 1963 to 1969, Polónyi moved to Ghana to work for the Ghana National Construction Corporation. He was appointed Professor of the architectural school of the Kumasi University of Science and Technology and published on the educational, research and design work in Le carré bleu and other journals. From 1969 onwards, Polónyi was in charge of a large Hungarian-Nigerian team commissioned with planning Calabar, the new capital of Nigeria's South-Eastern state, before returning to Hungary in 1969. Working on the periphery of socialism and capitalism, in countries in transition, he refused to view colonisation merely as a victimising process and noticed the dangers of destructive tendencies operating under the surface to control the post-colonial as well as the post-socialist periphery. Moving constantly between Africa and Hungary, he frequently reflected on the historical, aesthetical, political and ethical questions of ‘peripheral’ culture.

Policy initiation and political levers in health policy: lessons from Ghana’s health insurance

BackgroundUnderstanding the health policy formulation process over the years has focused on the content of policy to the neglect of context. This had led to several policy initiatives having a still birth or ineffective policy choices with sub-optimal outcomes when implemented. Sometimes, the difficulty has been finding congruence between different values and interests of the various stakeholders. How can policy initiators leverage the various subtle mechanisms that various players draw on to leverage their interests during policy formulation. This paper attempts to conceptualise these levers of policy formulation to enhance an understanding of this field of work based on lived experience.MethodologyThis is a qualitative participant observation case study based on retrospective recollection of the policy process and political levers involved in developing the Ghana National Health Insurance Scheme. The study uses a four-concept framework which is agenda setting, symbols manipulation, constituency preservation and coalition building to capture the various issues, negotiations and nuanced approaches used in arriving at desired outcomes.ResultsTechnical experts, civil society, academicians and politicians all had significant influence on setting the health insurance agenda. Each of these various stakeholders carefully engaged in ways that preserved their constituency interests through explicit manoeuvres and subtle engagements. Where proposals lend themselves to various interpretations, stakeholders were quick to latch on the contentious issues to preserve their constituency and will manipulate the symbols that arise from the proposals to their advantage. Where interests are contested and the price of losing out will leave government worse off which will favour its political opponent, it will push for divergent interests outside parliamentary politics through intense negotiations to build coalitions so a particular policy may pass.ConclusionsThis paper has examined the policy environment and the political leverages in retrospect at arriving at Ghana’s health insurance policy and design. New perspectives have been brought to the dynamics of the interactions of the 3 streams of problem, policy and politics. It provides lessons which suggest that in understanding the policy process, it is important that actors engage with the content as well as the context to understand viewpoints that may be expressed by interest groups. This will empower policy proponents to achieve easier results and limit the frustrations associated with the policy process. There are no straight and determined pathways for achieving outcomes so appreciating the evidence and basis for design, negotiation process and building coalitions along the way are skills to be mastered.

A logistic regression model for Ghana National Health Insurance claims

In August 2003, the Ghanaian Government made history by implementing the first National Health Insurance System (NHIS) in Sub-Saharan Africa. Within three years, over half of the country’s population had voluntarily enrolled into the National Health Insurance Scheme. This study had three objectives: 1) To estimate the risk factors that influences the Ghana national health insurance claims. 2) To estimate the magnitude of each of the risk factors in relation to the Ghana national health insurance claims. In this work, data was collected from the policyholders of the Ghana National Health Insurance Scheme with the help of the National Health Insurance database and the patients’ attendance register of the Koforidua Regional Hospital, from 1 st January to 31 st December 2011. Quantitative analysis was done using the generalized linear regression (GLR) models. The results indicate that risk factors such as sex, age, marital status, distance and length of stay at the hospital were important predictors of health insurance claims. However, it was found that the risk factors; health status, billed charges and income level are not good predictors of national health insurance claim. The outcome of the study shows that sex, age, marital status, distance and length of stay at the hospital are statistically significant in the determination of the Ghana National health insurance premiums since they considerably influence claims. We recommended, among other things that, the National Health Insurance Authority should facilitate the institutionalization of the collection of appropriate data on a continuous basis to help in the determination of future premiums.

Ghana's National Health Insurance Scheme: Helping the Poor or Leaving Them Behind?

We present findings on the determinants of enrolment for Ghana's National Health Insurance Scheme (NHIS). With this study we contribute to the literature by providing one of the few quantitative analyses on a nationwide survey. Using data from the 2008 Ghana Demographic and Health Survey, we find that those from the poorest households remain significantly less likely to enrol in the NHIS compared with respondents from wealthy households, even after controlling for theoretically relevant variables. However, our analysis also shows that respondents in Northern Ghana, considered the poorest part of the country, are more likely to be enroled than those in Southern Ghana. The findings present a clear challenge to the original mandate of the NHIS as a propoor policy and suggest that health policy makers should consider expanding and clarifying the criteria for declaring a person as indigent and that the scheme be further evaluated for obstacles that may be hindering enrolment.

Open-heart surgery and coronary artery bypass grafting in Western Africa

We read with concern the paper of Budzee and colleagues in a recent issue of the Pan African Medical Journal. We wish to draw the attention of the authors and the readership of the journal to gross inaccuracies in the report. The first open-heart surgery in Nigeria is reported to have taken place on 1(st) February 1974 at the University of Nigeria Teaching Hospital (UNTH) in Enugu. Publications from the group in Abidjan indicate the performance of the first 300 cases of open-heart surgery by 1983, the figure increasing to 850 by 1987. Senegal reportedly began performing open-heart surgery in 1995 and is currently a reference point for open cardiac procedures for francophone West Africa. The Ghanaian open-heart experience began in 1964 when surface cooling was used to achieve hypothermia for the successful closure of an atrial septal defect. However, it was not until 1989 that Ghana's National Cardiothoracic Center (NCTC) was established. The NCTC performs regular open-cardiac procedures covering almost the entire spectrum of cardiothoracic procedures including video-assisted thoracoscopic surgery (VATS). The NCTC is equipped with modern cardiovascular/thoracic facilities and has been accredited by the West African College of Surgeons as a center of excellence for the training of cardiothoracic surgeons and has performed creditably in this regard. It is emphasized that open-heart surgery has been practiced in West Africa for decades and continues to be practiced with excellence matching international standards at Ghana's National Cardiothoracic Center.