Health Sector In Ghana Research Articles

Marginalization and women's healthcare in Ghana: Incorporating colonial origins, unveiling women's knowledge, and empowering voices.

The origins of marginalization in nursing and the health sector in Ghana can be traced to colonialism and how a colonial era laid a solid foundation for inequities and entrenched disparities, as well as the subsequent normalization of marginalizing acts, in the health sector, particularly for women. Drawing upon varied literature over a 60-year period and perspectives from feminist theory, this paper considers the lasting impact of Ghanaian women's historical position during the colonial era and within the patriarchal system that ensued. Through this process, it becomes possible to shed light on the crucial role that colonialism has played in women's experiences, perspectives, and health-seeking behaviors, and the manner in which it has created a healthcare sector that marginalizes women's health. Although women possess valuable knowledge which should be an asset to consider when providing healthcare services, marginalization of that knowledge has become normalized across society and the healthcare system. There is an urgent need to disrupt and challenge this normalization, and to advocate empowerment and recognition of women's valuable knowledge and experiences, providing women a voice in health decision-making discourses and in the research processes by which we understand and develop healthcare. Through this, healthcare in Ghana could become more empowering, inclusive, and responsive to the unique experiences and needs of Ghanaian women. By understanding something of the historical origins of women's health marginalization within colonialism, nurses can begin to appreciate women's knowledge and integrate it into healthcare strategies that are more gender-sensitive and equitable.

Social Protection Supports and Management of Non-Communicable Diseases in Ghana: A Qualitative Cross-Sectional Perspective of Health Stakeholders

Introduction: Africa faces a double burden of communicable and non-communicable diseases (NCDs). Already, health systems in Africa are overwhelmed with a high burden of communicable diseases with perennial outbreaks of highly infectious diseases. The rise in NCDs comprises an already fragile health system challenging its ability to provide comprehensive care to people living with these diseases. Without responsive social support systems, NCDs will draw more people into catastrophic health financing, worsening health outcomes, and poverty. This study explores how vulnerable people negotiate major disease burdens with the social protection supports available in Ghana. Methods: The study applied a cross-sectional design with a qualitative approach involving healthcare professionals and non-healthcare professionals in 4 regions in Ghana with a total of 32 qualitative interviews analyzed thematically. Results: The main social protection support for the health sector in Ghana is the National Health Insurance Scheme. Other social protection supports such as free maternal healthcare, Livelihood Empowerment Against Poverty, and conventional informal social protection mechanisms do not directly target people afflicted with NCDs. Even though national health insurance covers about 90% of diseases, the quality of care is questionable. Again, the exclusion of diagnostic investigations makes national health insurance a setback to NCD disease management. Also, NCD patients still do out-of-pocket expenses though they have valid national health insurance. Informal social protection supports which used to be effective sometime back are dwindling due to the rising cost of living, gradual breakdown of the African system of reciprocity, and infiltration of Western lifestyles. Conclusion: NCD patients have very limited social protection for the management of their condition. Health insurance which is the only option for many has limited applications. A multidisciplinary body is established by the government to outline more effective ways of offering social protection support for health services, especially chronic conditions such as NCDs which affect a greater proportion of the population.

Doctorpreneurship in the Digital Age

Many of the challenges faced by the various sectors of the economy are seen as opportunities by entrepreneurs. Yet, entrepreneurs are by definition excluded from a large part of the health sector due to the specialised nature of the medical profession and the complexities associated with service provision in the area of healthcare. In this paper, the term ‘Doctorpreneur' is used to connote doctors who engage in entrepreneurship in the health sector. The study adopts the Maslow's theory of motivation, the Herzberg's two-factor theory, and the theory of affordance to explore factors that promote ‘doctorpreneurship' in the digital age, using Ghana's health sector as a case. The findings of this qualitative study suggest that besides the monetary gains that primarily motivate doctors to engage in doctorpreneurship, other individual, organizational, and technological factors also underpin the phenomenon. Furthermore, the findings underscore the role of technology in consolidating doctorpreneurship in the digital age. The study presents several implications for research, policy, and practice.

Barriers and facilitators to nationwide implementation of the malaria vaccine in Ghana.

Interventions such as antimalarial drugs, bed nets and insecticides have helped curb the burden of malaria in the past decade, yet malaria remains a leading cause of morbidity and mortality in children below the age of 5 years. In 2019, Ghana, Malawi and Kenya in sub-Saharan Africa (countries with moderate to high transmission areas of malaria and deaths) started piloting the RTS,S/AS01E malaria vaccine in selected regions. Using qualitative methods, this study examined the main factors (forces) that will influence or hinder the nationwide implementation of the malaria vaccine, if approved, in Ghana. We conducted in-depth interviews with 12 key individuals (national, research/academia and programme implementing partners) in the public health sector in Ghana from October 2018 to February 2019. Results were analysed using Kurt Lewin's force field analysis to understand how organizations interact with their external environment in the delivery of health policies such as the implementation of the malaria vaccine. We found that the disease burden of malaria deaths in Ghana, the efficacy of the vaccine, stakeholder involvement and evidence for the feasibility of vaccine delivery generated by the consortium of researchers (body of researchers) that can track the implementation were the driving forces to scale up the vaccine into a routine health system. On the other hand, the needed logistics, funding, administration of the four-dose vaccine and follow-up were identified as potential barriers. The most influential force collectively highlighted by the respondents was the disease burden, and the most influential barrier was the logistics of delivering the vaccine. Our findings provide decision makers with key barriers and facilitators to guide policy and decision-making for malaria control in Ghana and other similar settings in low- and middle-income countries.

Accelerating the Control and Prevention of Non-communicable Diseases in Ghana: the Key Issues

NCDs were particularly prominent in the global, regional and national public health agenda in 2011. Globally, the "First global ministerial conference on healthy lifestyles and non-communicable disease control" was held in Moscow on 28-29 April 2011 and theUN High-level Meeting of the General Assembly on Non-Communicable Diseases in September 2011. Regionally, the WHO African Regional Consultation on the preparation for the Moscow Ministerial Meeting and the UN High Level Summit on NCDs was held inBrazzaville on 4-6 April 2011 . Nationally, the University of Ghana fifth College of Health Sciences’ Annual Scientific Conference had “The increasing burden of NCDs in Ghana” on 21 - 2 3 September as its theme. The Health Summit of the health sector in Ghana reviewed the national response to NCDs on 24 November 2011.

Nurses Perception of Management Styles and Factors Influencing Retention of Nurses in Ghana: A Cross-Sectional Survey

Abstract Background: Retention of health professionals in the health sector in Ghana is crucial to address human resource needs of the health sector and to promote efficient and effective healthcare system. Nurses are one of the key professionals whose role in the healthcare industry cannot be underestimated. This study assessed nurses' perception of management styles and factors influencing retention of nurses in Ghana. Methods: A cross-sectional quantitative descriptive survey was conducted among 135 Nurses at Akatsi Government Hospital and St Paul's Hospital in the Akatsi municipality of Volta region of Ghana using a simple random sampling in selecting participants. A structured questionnaire was used to collect data from the participants. Data was analysed using STATA statistical software Version 14.2. Statistical significance was set at 0.05. Results: Females dominated the study (68.89%). Most of the respondents (19.70%) strongly agreed that Nurse Managers exhibited participatory management style. However, majority (52.71%) of the respondents intended to leave their current facility. Nurses' intention to leave was higher in public hospital (55.45%) compared to the private hospital (45.95%). Salary and rewards was the major (39.53%) extrinsic factor that influenced retention of nurses at work and self -motivation was the major (27.91%) intrinsic factor that contributed to nurse's retention at work. Conclusion: Most of the respondents strongly agreed that managers practiced participatory management style. Benevolent authoritative management style was statistically significant with nurses' intention to leave.

‘Where were pharmaceuticals in Eden?’ Use of herbal medicine in old age: Focus group discussions among community-dwelling older adults in Ghana

ObjectiveThe use of herbs later in life is an important research area, yet there is little known about older adults’ herb use in Ghana. This qualitative study offers a better understanding of the motivations for herb use among older adults in Ghana. MethodsTwo separate focus group discussions were conducted for individuals who participated in a study investigating healthcare use among older adults in the Kumasi Metropolis of Ghana. Nineteen older adults (10 males, 9 females) participated in the focus group discussions. Discussion responses were coded and analysed. ResultsOlder adults used various kinds of medicinal herbs which include ginger (Zingiber officinale), garlic (Allium sativum), moringa (Moringa oleifera), Bonto (Nicotiana tabacum) and Sorowisa (Piper guineense) for treating and preventing various illnesses and diseases. Reasons for herb use in later life included: (1) the perceived safety and efficacy of herbal remedies; (2) a lack of trust in conventional drugs; (3) cultural sensitivity of herbal remedies; (4) perception of positive health outcomes and status as a result of herbal medicine use; (5) unpleasant experiences of using western medications; and (6) the availability, accessibility and affordability of herbal remedies compared to conventional drugs. There was a lack of disclosure of herb use to healthcare professionals. In most cases, participants used herbs concurrently with pharmaceuticals without the knowledge of possible side effects and interactions. ConclusionThis paper provides evidence to suggest that the implementation of an intercultural healthcare system should be considered by the relevant authorities within the Ghana health sector.

Identifying exposures of health facilities to potential disasters in the Greater Accra Metropolitan Area of Ghana

The Health sector in Ghana has over the years received huge capital investments from the government, its partners and other private entities. These have resulted in the transformation, upgrade and provision of new health facilities across the country. Despite these efforts, the sector still faces challenges of inadequate infrastructure. Furthermore, the existing facilities may be threatened by the occurrences of disasters in the country. The Greater Accra Metropolitan Area (GAMA), which contains the most advanced health facilities in the country is one area perceived to be most vulnerable to disasters. Hence, this study uses a multiple approach to identify and assess health facilities highly exposed to hazards and may be vulnerable should disaster occur. It samples 60 health facilities from twelve municipalities in the GAMA area for the assessment. The study reveals flooding as a key threat to health facilities in the entire GAMA area but identifies Accra metropolitan area as a locality with most exposed health facilities. Furthermore, the study discovers that, many of the health facilities in GAMA are clustered in a highly vulnerable enclave of about 20 km radius and estimates that, occurrence of any \\disaster within this area could affect more than twenty facilities and deny healthcare services to over two hundred thousand people. It suggests collective efforts from all stakeholders to secure and protect these facilities as priority for resilience.

Towards effective participation of the private health sector in Ghana's COVID-19 response.

The private health sector is a major service provider group within the health systems of most sub-Saharan African countries. Currently, 90% of COVID-19 cases in Ghana are in urban areas where private health facilities play a major role in service delivery. Yet, there is limited understanding of the issues mediating private health sector participation in public health emergency responses. Challenges related to its involvement in Ghana´s COVID-19 response include lack of clarity on its role, sub-optimal communication channels, inadequate personal protective equipment and fragmentation of the sector. Hence, operational and regulatory actions addressing these challenges will ensure the private sector is fully prepared to contribute to the COVID-19 response and future public health emergencies, thereby strengthening Ghana’s health system.

Assessing healthcare digitalisation in Ghana: A critical realist's approach

BackgroundThe emergence of digital technologies within the health sector has presented opportunities for improving medical care while strengthening health systems across the globe. Despite this promise, the extent of digitalisation, especially in developing countries, somewhat remains undetermined. Such knowledge is needed to learn and shape future advances in the sector. The purpose of this study, therefore, is to explore the generative mechanisms of digitalisation in the Ghanaian health sector, in order to understand and assess the extent of digitalisation, based on the digitalisation outcomes of the respective generative mechanisms. MethodsUnderpinned by the critical realism philosophy, a single case study approach was adopted to explore the generative mechanisms of digitalisation in the Ghanaian health sector, and how the varying degrees of digitalisation are interpreted and explained in the empirical world. ResultsThe study found five generative mechanisms of digitalisation in the Ghanaian health sector. These were Standardisation, Convergence and Connectivity, Storage Systems, Financial Transparency, and Data Security. Full activation of these mechanisms revealed that the first three generative mechanisms achieved high levels of digitalisation based on the extent of organisational transformations observed after the digitalisation process, as compared to the last two generative mechanisms which were rated as average. DiscussionThis study concludes that the extent of digitalisation in Ghana's health sector is more of reality than mere perception. The demonstration of how critical realism can be used to unearth insights into the extent of healthcare digitalisation in a developing country context spells the contribution of this paper.

Health worker transfer processes within the public health sector in Ghana: a study of three districts in the Eastern Region

IntroductionThe lack of appropriate policies and procedures to ensure transparent transfer practices is an important source of dissatisfaction among health workers in low- and middle-income countries. In order to alter and improve current practices, a more in-depth and context-specific understanding is needed. This study aims to (1) identify rationales behind transfer decisions in Ghana and (2) examine how transfers are managed in practice versus in policies.MethodsThe study took place in 2014 in three districts in Eastern Ghana. The study population included (1) national, regional, and district health administrators with decision-making authority in terms of transfer decisions and (2) health workers who had transferred between 2011 and 2014. Data was collected through semi-structured and structured face-to-face interviews focusing on rationales behind transfer decisions, health administrators’ role in managing transfers, and health workers’ experience of transfers. A data triangulation approach was applied to compare identified practices with national policies and procedures.ResultsA total of 44 health workers and 21 administrators participated in the study. Transfers initiated by health workers were mostly based on family conditions and preferences to move away from rural areas, while transfers initiated by administrators were based on service requirements, productivity, and performance. The management of transfers was not guided by clear and explicit procedures and thus often depended on the discretion of decision-makers. Moreover, health workers frequently reported not being involved in transfer decision-making processes. We found existing staff perceptions of a non-transparent system.ConclusionOur findings suggest a need to foster incentives to attract and retain health workers in rural areas. Moreover, health worker-centered procedures and systems that effectively guide and monitor transfer practices must be developed to ensure that transfers are carried out in a timely, fair, and transparent way.

Repositioning traditional birth attendants to provide improved maternal healthcare services in rural Ghana.

Following the World Health Organization's recommendation for developing countries to discontinue the use of Traditional Birth Attendants (TBAs) in rural areas, the government of Ghana banned TBAs from offering maternal health care services. Since this ban, community-level conflicts have intensified between TBAs, (who still see themselves as legitimate culturally mandated traditional midwives) and nurses. In this articles, we propose a partnership model for a sustainable resolution of these conflicts. This article emanates from the apparent ideological discontent between people from mainstream medical practice who advocate for the complete elimination of TBAs in the maternal health service space and individuals who argue for the inclusion of TBAs in the health sector given the shortage of skilled birth attendants and continued patronage of their services by rural women even in context where nurses are available. In the context of the longstanding manpower deficit in the health sector in Ghana, improving maternal healthcare in rural communities will require harnessing all locally available human resources. This cannot be achieved by "throwing out" a critical group of actors who have been involved in health-care provision for many decades. We propose a win-win approach that involve retraining of TBAs, partnership with health practitioners, and task shifting.

Obituary - Frank K. Nyonator

The sudden death of Dr. Frank Kwadjo Nyonator on August 13, 2018 was a shock to his colleagues and the health sector in Ghana and abroad. At the time of his death, he was the Project Director of the USAID supported initiative of Management Systems International (MSI) that is known as Evaluate for Health (E4H). He took up this position after his retirement from the Ghana Health Service, where he spent most of his career in the public health system. He served at operational and leadership levels and rose through the ranks from medical officer, Medical Superintendent, District Director of Health Services, Regional Director of Health Services, Director of Policy Planning Monitoring and Evaluation, and Acting Director General of the Ghana Health Services.

A review of the process of knowledge transfer and use of evidence in reproductive and child health in Ghana

BackgroundThe paper carries out a situational analysis to examine the production, dissemination and utilisation of reproductive and child health-related evidence to inform policy formulation in Ghana’s health sector.MethodsThe study used Wald’s model of knowledge production, transfer and utilisation as a conceptual model to collect relevant data via interviews and administration of questionnaire to a network of persons who either previously or currently hold policy-relevant positions in Ghana’s health sector. Additional data was also gathered through a scoping review of the knowledge transfer and research utilisation literature, existing reproductive and child health policies, protocols and guidelines and information available on the websites of relevant institutions in Ghana’s health sector.ResultsThe findings of the study suggest that the health sector in Ghana has major strengths (strong knowledge production capacity, a positive environment for the promotion of evidence-informed policy) and opportunities (access to major donors who have the resources to fund good quality research and access to both local and international networks for collaborative research). What remains a challenge, however, is the absence of a robust institutional-wide mechanism for collating research needs and communicating these to researchers, communicating research findings in forms that are friendlier to policy-makers and the inability to incorporate funding for research into the budget of the health sector.ConclusionThe study concludes, admonishing the Ministry of Health and its agencies to leverage on the existing strengths and opportunities to address the identified challenges.

Sensitivity of health sector indicators' response to climate change in Ghana

There is accumulating evidence that the emerging burden of global climate change threatens the fidelity of routine indicators for disease detection and management of risks to public health. The threat partially reflects the conservative character of the health sector and the reluctance to adopt new indicators, despite the growing awareness that existing environmental health indicators were developed to respond to risks that may no longer be relevant, and are too simplistic to also act as indicators for newer global-scale risk factors. This study sought to understand the scope of existing health indicators, while aiming to discover new indicators for building resilience against three climate sensitive diseases (cerebro spinal meningitis, malaria and diarrhea). Therefore, new potential indicators derived from human and biophysical origins were developed to complement existing health indicators, thereby creating climate-sensitive battery of robust composite indices of resilience in health planning. Using Ghana's health sector as a case study systematic international literature review, national expert consultation, and focus group outcomes yielded insights into the relevance, sensitivity and impacts of 45 indicators in 11 categories in responding to climate change. In total, 65% of the indicators were sensitive to health impacts of climate change; 24% acted directly; 31% synergistically; and 45% indirectly, with indicator relevance strongly associated with type of health response. Epidemiological indicators (e.g. morbidity) and health demographic indicators (e.g. population structure) require adjustments with external indicators (e.g. biophysical, policy) to be resilient to climate change. Therefore, selective integration of social and ecological indicators with existing public health indicators improves the fidelity of the health sector to adopt more robust planning of interdependent systems to build resilience. The study highlights growing uncertainties in translating research into protective policies when new indicators associated with non-health sources are needed to complement existing health indicators that are expected to respond to climate change.

Motivation and incentive preferences of community health officers in Ghana: an economic behavioral experiment approach.

BackgroundHealth worker shortage in rural areas is one of the biggest problems of the health sector in Ghana and many developing countries. This may be due to fewer incentives and support systems available to attract and retain health workers at the rural level. This study explored the willingness of community health officers (CHOs) to accept and hold rural and community job postings in Ghana.MethodsA discrete choice experiment was used to estimate the motivation and incentive preferences of CHOs in Ghana. All CHOs working in three Health and Demographic Surveillance System sites in Ghana, 200 in total, were interviewed between December 2012 and January 2013. Respondents were asked to choose from choice sets of job preferences. Four mixed logit models were used for the estimation. The first model considered (a) only the main effect. The other models included interaction terms for (b) gender, (c) number of children under 5 in the household, and (d) years worked at the same community. Moreover, a choice probability simulation was performed.ResultsMixed logit analyses of the data project a shorter time frame before study leave as the most important motivation for most CHOs (β 2.03; 95 % CI 1.69 to 2.36). This is also confirmed by the largest simulated choice probability (29.1 %). The interaction effect of the number of children was significant for education allowance for children (β 0.58; 95 % CI 0.24 to 0.93), salary increase (β 0.35; 95 % CI 0.03 to 0.67), and housing provision (β 0.16; 95 % CI −0.02 to 0.60). Male CHOs had a high affinity for early opportunity to go on study leave (β 0.78; 95 % CI −0.06 to 1.62). CHOs who had worked at the same place for a long time greatly valued salary increase (β 0.28; 95 % CI 0.09 to 0.47).ConclusionsTo reduce health worker shortage in rural settings, policymakers could provide “needs-specific” motivational packages. They should include career development opportunities such as shorter period of work before study leave and financial policy in the form of salary increase to recruit and retain them.

The contribution of community leadership upon the performance of mutual health organisations in Ghana.

The purpose of this paper is to investigate the effect of social dynamics on the performance of mutual health organisations (MHOs) exploring the influence of community wealth and community leadership on policy implementation. Four operating district mutual health insurance schemes were selected using geographical locations, among other criteria, as case studies. Data were gathered through interviews and documentary review. The findings were analysed using community field and social capital theories. Traditional leaders like the Chiefs serve as the pivot around which social and human capital of the communities revolve in the developmental process of the country. Lack of exhaustive examination of the financial and institutional viability issues of the MHOs. Future studies could assess the interplay between financial, institutional and social viability models when measuring the financial and overall sustainability of MHOs. Health policy makers need to involve traditional leaders in the formulation and implementation of national policies since their acceptance or rejection of central government policy could have negative consequences. Ghana is a dynamic country and there is the need to utilise existing social networks: inter-family and inter-tribal relationships to ensure the viability of MHOs. There is and can be a successful interplay between public sector funding and community sector revenue mobilisation for financing the health sector in Ghana. This justifies the complementarity between government funding and community's resource mobilisation efforts in the health sector.

Barriers to implementing health sector administrative decentralisation in Ghana

This paper aims to examine empirically the ways in which workforce knowledge and organisational factors of an implementing agency affected the implementation of health sector administration decentralisation in Ghana with insights from the Nkwanta district health administration. This is a qualitative study using data from individual and group interviews through purposive selection of health officials, who were directly involved in the work of actual implementation of the programme. Specifically, participants included senior management, middle management and junior workers, who had worked at least for the past three months in the district. The study found that most of the interviewees involved in the implementation process are knowledgeable of the objectives of the decentralisation process. Also, major factors that are militating against effective decentralisation in the district include inadequate funds, lack of qualified personnel, inadequate logistics and equipment, poor interpersonal relationships, lack of transparency and a good operational system, lack of incentives to motivate the staff, political interference, poor infrastructure and high rate of illiteracy. The findings of this study will help improve the implementation of decentralisation within the health sector in Ghana. The paper provides recommendations, which, if considered for implementation, will help improve the decentralisation process.

Communication challenges in implementing health sector decentralisation at district level in Ghana

PurposeThe aim of this paper is to examine how internal communication of reform objectives to health workforces and stakeholders has influenced the implementation of Ghana's health sector decentralisation at district level.Design/methodology/approachData collection involved in‐depth interviews with district public health officials, private health providers, local government officials and health‐related non‐government organisations which had been working in the district for at least two years.FindingsThe study's findings showed that communication (the sharing of information) about reform objectives were centralised among the top hierarchy of the District Health Management Teams; and the process of transferring reform information to district health workforces and stakeholders was through a top‐downward approach. This vertical style of communication resulted in limited information getting through to district health workforces tasked with the implementation. This impacted negatively on reform implementation.Originality/valueThe paper reveals that there is a connection between the level of comprehension of the objectives for decentralisation reform both by the health workforce and stakeholders, particularly the expected new roles they are supposed to play. A lack of effective transfer of information affects commitment and ownership of the decentralisation reform at district level; contributing significantly to the poor implementation of the reform programme.

The role of the Pharmacy Council in regulating the health sector in Ghana

The role of the Pharmacy Council in regulating the health sector in Ghana