Health Care Services In Ghana Research Articles

Understanding adolescent health care services in Ghana: a scoping review

Understanding adolescent health care services in Ghana: a scoping review

Ghanaian women beliefs on the causes, prevention and treatment of cervical cancer: A qualitative Study

ObjectiveThe choice of the sick to access health care services in Ghana or consult a health care provider depends on the individuals’ beliefs about the disease and available services. This paper seeks to explore the health beliefs of cervical cancer survivors in Ghana. MethodsWe employed an exploratory qualitative approach in this study. We interviewed 12 participants to gain an in-depth understanding regarding the beliefs, causes, prevention and treatment of cervical cancer in Ghana. Data collection and analysis were done concurrently, and themes and subthemes were generated through content analysis. Verbatim quotes were used to support the findings. ResultsThree themes emerged. 1. Beliefs about the causes of cervical cancer, which include the choices of cloths and criminal abortions. 2. Beliefs on cervical cancer prevention; early education of the girl child on vagina hygiene and avoidance of highly processed food products. 3. Beliefs on cervical cancer treatment; participants believed that cervical cancer is one of the diseases not well managed in hospitals in Ghana. ConclusionsMistrusts for orthodox cancer treatment is the leading rationale patients report late to the hospital in Ghana. Much is desired for public education on contemporary treatment and cure for cervical cancer disease.

Effects of the COVID-19 pandemic on essential health and nutrition service utilisations in Ghana: interrupted time-series analyses from 2016 to 2020

ObjectivesThis study aimed to assess the national-level and subnational-level effects of the COVID-19 pandemic on essential health and nutrition service utilisation in Ghana.DesignInterrupted time-series.Setting and participantsThis study used facility-level data...

The Determinants of Places of Delivery by Women in the Savelugu/Nanton Municipality, Ghana

Despite improvement in health care services in Ghana, many women still choose to deliver at home. This practice has serious implications for maternal and child health. The phenomenon is not different in Savelugu/Nanton Municipal is even seriously educated women sometimes ignore the health facilities and deliver at home. This paper examines the factors associated with the choice of places of delivery by women in the Savelugu/Nanton Municipality. An analytical cross-sectional study design was used involving women, health workers, Traditional Birth Attendants, opinions, traditional and religious leaders and some key informants. Data was collected through questionnaires, in-depth interviews, focus group discussions and observations. The result indicates that distance to health centres, personal likes and dislikes of women and availability of TBAs in the community were among the factors influencing the choice of places of delivery. It was also revealed that bad attitudes of health workers and ineffective communication between health workers and patients are some of the factors that influence women's choice of places to deliver. The paper concludes that, despite improvement in health service delivery in Ghana, many women still deliver at home. The paper recommends effective health education by stakeholders to reverse the situation.

HEALTHCARE FINANCING AND SUSTAINABILITY IN GHANA: EVIDENCE FROM ADA FOAH MUNICIPALITY

Provision of quality and equitable healthcare is one strategy towards the realization of universal healthcare for all. Whereas many nations have enacted various policies to narrow the gap of access to quality healthcare between rural and urban populations, between the poor and rich, and among various cohorts in the society, the role of policies in financing healthcare seems to influence access and equity to quality healthcare in many developing nations. 340 health professionals in the Ada-Foah Municipality of Ghana were sampled for the study. The study aimed at verifying how funding of medical activities impacts on the sustainability of quality healthcare services in Ghana. Findings of the study revealed a statistically significant relationship between healthcare funding and its sustainability in Ghana. It was further ascertained that government policy statistically moderates the relationship between healthcare financing and sustainability. The study finally discussed its contribution, theoretically and practically. KEYWORDS: Public funding, private funding, donor support, healthcare sustainability, government policy.

What alternative and innovative domestic methods of healthcare financing can be explored to fix the current claims reimbursement challenges by the National Health Insurance Scheme of Ghana? Perspectives of health managers

BackgroundLow-and-middle -income countries (LMICs), to achieve sustainable universal health coverage (UHC) governments are implementing local and sustainable methods of healthcare financing. However, in Ghana, there is limited evidence on these local methods for healthcare financing to inform policy. This study aimed at exploring health managers views on alternative domestic and sustainable methods of healthcare financing for UHC under the National Health Insurance Scheme (NHIS).MethodsA qualitative study using in-depth interviews with 16 health facility managers were held. The health facilities and participants were selected using convenience and purposive sampling methods. A written consent was obtained from participants prior to participation in the interview. Data was transcribed verbatim and analyzed using thematic framework approach.ResultsHealth managers across all the health facilities mentioned delayed and erratic claims reimbursement to health facilities as the main challenge. Participants attributed the main reason to lack of funds by the National Health Insurance Authority (NHIA). They said the delayed and irregular payments has been a challenge to efficient delivery of quality healthcare to clients. That in some instances they have been compelled to demand cash or out-of-pocket payment from insured clients or insurance card bearers to be able to render needed healthcare services to them. Participants think that to ensure regular reimbursement of claims to the health facilities by the NHIA, the managers think alternative local sources of funding need to be explored to fill the funding gap. To put in place this, they suggested the need to start levying special taxes on natural resources such as crude oil and gas, gold, bauxite, cocoa, mobile money transfers, airtime and increasing the proportion of levies on the existing Value Added Tax (VAT).ConclusionThe study provides important insights into potential innovative alternative domestic sources for raising additional funds to finance healthcare services in Ghana. Despite the potential of these sources, it is important for governments and health policy makers in Ghana and other LMICs who are working towards implementing innovative local methods using special levies on mobile communication services and natural resources to finance their UHC, to implement those that best suit their economies to ensure equity for better health.

Equity and access to maternal and child health services in Ghana a cross-sectional study

BackgroundInequities in the distribution of and access to maternal and child health care services is pervasive in Ghana. Understanding the drivers of inequity in maternal and child health (MCH) is important to achieving the universal health coverage component of the Sustainable Development Goals (SDGs) and poverty reduction in developing countries. However, there is increasing disparities in MCH services, especially in rural -urban, and income quintiles. The study aimed to examine the disparities in maternal and child health care services in Ghana for policy intervention.MethodsData for this study was extracted from the nationally representative Ghana Statistical Service (GSS) Multiple Indicator Cluster Survey (MICS) round 4, 2011. Respondents of this survey were women of reproductive age 15–49 years with a sample size of 10,627 households. The models were estimated using multivariate regression analysis together with concentration index (CI) and risk ratio (RR) to assess the distribution of MCH indicator groups across the household wealth index.ResultsThe results show that women with secondary school level and above were more likely to receive family planning, prenatal care, and delivery by a skilled health professional than those without formal education. Mothers with low level of educational attainment were 87% more likely to have their first pregnancy before the age of 20 years, and 78% were more likely to have children with under-five mortality, and 45% more likely to have children who had diarrhoea. teenage pregnancy (CI = − 0.133, RR =0.679), prenatal care by skilled health worker (CI = − 0.124, RR =0.713) under five mortality, child underweight, reported diarrhoea, and suspected pneumonia, though not statistically significant, were more concentrated in the poorer than in the richer households, The RR between the top and bottom quintiles ranged from 0.77 for child underweight to 0.82 for child wasting.ConclusionGeographic location, income status and formal education are key drivers of maternal and child health inequities in Ghana. Government can partner the private sector to implement health policies to address inequalities in MCH services through primary health care, and resource allocation skewed towards rural areas and the lower wealth quintile to bridge the inequality gaps and improve MCH outcomes. The government and the private sectors should prioritize female education, as that can improve maternal and child health.

Statistical Analysis of Patients Waiting Time in Accessing Health Care Services in Ghana: A Case Study of University of Cape Coast Hospital

Delayed access to health care in terms of diagnosis and treatment has unforeseen health and cost implications on the patients and the public health system in general. Thus, the study examines patients’ waiting time in accessing health care services. The study employs a convenience sampling technique in collecting data from a sample of 350 Outpatients using a questionnaire. The main analytic tools used in the study are the paired sample t-test, binary logistic regression and SmartPLS structural equation modelling. Results from the study show that the actual waiting times of patients are generally higher than the expected times. Furthermore, the probability of a patient’s waiting time being rated as unacceptable is affected by the Day of attendance, Arrival time of patients, Large number of patients or long queue, Long registration time, Type of diagnosis, and Type of treatment sought. Finally, the study also establishes that there is no relationship between socio-demographic characteristics and unacceptable waiting time, as well as no relationship between hospital factors and unacceptable waiting time. Additionally, the study shows that unacceptable waiting time does not have any influence on overall patients’ satisfaction. However, a strong positive relationship between process factors and unacceptable waiting time was established. The study recommends that there is the need for health care policy formulators to adopt more efficient strategies, like use of computer modelling to help assign appointment time to patients, so as to significantly reduce the time patients spend waiting at the hospitals.
 Citation: Kunu, E. K. and Agbede, P. S. (2021). Statistical Analysis of Patients Waiting Time in Accessing Health Care Services in Ghana: A Case Study of University of Cape Coast Hospital. International Journal of Technology and Management Research. Vol. 6, Issue 1: 14－27.
 Received: October 23, 2020Accepted: March 30, 2021

معرفی یک ابزار کارآمد برای شاخص های سلامت در سطح جهانی

Reliable and up-to-date data are essential for proper and timely decisions. However, most accessible data are limited to specific locations and subjects, which do not present the big picture. Besides, data might be manipulated to serve a group of people's political and economic interests. Although the World Health Organization has been developed to act impartially as an international organization, they fail to ignore the supreme authorities' impact. Therefore, they confine to republishing the official reports of the member governments. However, policy-makers in healthcare not only depend on comprehensive and reliable data but also need to figure out the relations between the indicators of health and their determinants. Accordingly, Hans Rosling, a Swedish physician, developed a comprehensive and practical tool named the Gapminder. Rosling, who was previously a member of the Doctors without Borders, provided healthcare services in Ghana when he realized this gap in the health data accessibility. Hence, he developed the Gapminder in cooperation with his son and daughter-in-law. This software has provided awareness about health indicators and the relations with their determinants in a global perspective. Thus, Gapminder creates an updated and fact-based perception of global health for users. This editorial is written to gain readers' attention to the article entitled Global Indicators of Health: Changes and New Facts, published in this issue. We are looking forward to publishing more articles in this subject area in future issues.

Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis

BackgroundInequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored.MethodsWe used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis.ResultsThe initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR = 2.54, 95% CI: 1.90–3.39) and in Ghana (OR = 1.257, 95% CI: 0.77–2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR = 1.579, 95% CI: 1.081–2.307, p ≤ 0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services.ConclusionsThese differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.

Assessing Service Quality in the Ghanaian Private Healthcare Sector: The Case of Comboni Hospital.

The healthcare industry has become a paramount concern for most people in Ghana and the quality of services rendered to the patients in the private hospitals cannot be overemphasized. Patients need quality of services most and are willing to seek better services. The government has been the main provider of health care services in Ghana but recently, some Non-Governmental Organization’s (NGO’s), private individuals and stakeholders also provide health care services which has surged the competitiveness in creating more healthcare facilities in Ghana. This study seeks to explore patients' choice of selecting quality healthcare services and the factors that affect patient satisfaction in private hospitals using the Comboni Hospital in Sogakope, Ghana. 
 The study therefore used the quantitative research method to collect the data and SPSS version 22 was used to analyze the data on high-quality healthcare. Also, the SERVQUAL model was used as the measurement scale. Multiple regression analysis was used to reveal the effect of the independent variables (reliability, responsiveness, empathy, assurance, and tangibility) on the dependent variable (patient satisfaction). A detailed description in the analysis and the data processing identified the main factors affecting the general perceptions and patient preferences about their healthcare in the private hospital.
 The study revealed that there exist a positive result and perception for quality healthcare services without a negative expectation of the patient healthcare being compromised. In this case, the study recommends that both the government and the private agencies should consider the important aspects of hospital’s healthcare management and also the policy and decision makers should have an efficient and effective standard that impact the quality of healthcare assessment in Ghana.

The Deinstitutionalization of Psychiatric Hospitals in Ghana: An Application of Bronfenbrenner’s Social-Ecological Model

Institutionalization of people living with mental illness has evolved over the years, especially in the 19th and early 20th century. This has created over crowdedness in various psychiatric institutions, specifically in low and-middle-income countries, including Ghana. The objective of this study is to use Bronfenbrenner’s Social-Ecological Model (1979) to propose a process for deinstitutionalizing psychiatric services in Ghana while supporting a transition to community-based mental health care. Using the concept of Bronfenbrenner’s Social-Ecological Model, this article explores some benefits and difficulties with the concept of deinstitutionalization with regards to mental health care services in Ghana. Individuals living with mental illness will be more comfortable in various communities in Ghana where education on stigmatization and discrimination is heightened to subsequently prevent it. Education and intervention policies are required to intensify the campaign to win the support of all people in the community. Residents of Ghana should learn to say no to stigma and discrimination among people living with mental illness.

Facilitators and barriers of patient-centered care at the organizational-level: a study of three district hospitals in the central region of Ghana

BackgroundImproving patient experience of care has gained enormous attention from policy makers and providers of healthcare services in Ghana. In spite of the supposed support for patient-centered care as the means for improving patient experience of care, scientific evidence point to poor patient experience of care in Ghana. Moreover, there seem to be little evidence on organizational-level factors that facilitate or hamper patient-centered care. In this study we assess organizational-level factors that facilitate or impede patient-centered care in three district hospitals in the Central Region of Ghana.MethodsThe study was exploratory research that used qualitative methods to collect data from seven senior managers and 3 junior managers in three district hospitals in the Central Region of Ghana. Data were collected with the aid of an interview guide and a checklist. Data were analyzed using content analysis.ResultsTwo main Organizational-level factors were identified, namely, facilitators and barriers of patient-centered care. Facilitators to patient-centered care included: 1) Leadership commitment. 2) Leadership support. 3) Training and education for patient-centered care. Patient-centered care barriers identified in the hospitals were: 1) Leadership conceptualization of patient-centered care. 2) Lack of goals and sufficient activities for patient-centered care. 3) Communication related challenges.4) Ownership type. 5) Degree of centralization. 6) Financial constraints.ConclusionOrganizational-level factors that promoted patient-centered care were fairly present in the hospitals. Yet, several other factors negatively affected patient-centered care in the hospitals. A suitable patient-focused intervention is recommended for implementation at the health system and institutional-levels to improve patient-centered care. Hospitals managers should develop suitable goals and activities to stimulate patient-centered care with the full participation of hospital employees and patients and families.

Examining trends in inequality in the use of reproductive health care services in Ghana and Nigeria

BackgroundEquitable use of reproductive health care services is of critical importance since it may affect women’s and children’s health. Policies to reduce inequality in access to reproductive health care services are often general and frequently benefit the richer population. This is known as the inverse equity situation. We analyzed the magnitude and trends in wealth-related inequalities in the use of family planning, antenatal and delivery care services in Ghana and Nigeria. We also investigate horizontal inequalities in the determinants of reproductive health care service use over the years.MethodsWe use data from Ghana’s (2003, 2008 and 2014) and Nigeria’s (2003, 2008 and 2013) Demographic and Health Surveys. We use concentration curves and concentration indices to measure the magnitude of socioeconomic-related inequalities and horizontal inequality in the use of reproductive health care services.ResultsExposure to family planning information via mass media, antenatal care at private facilities are more often used by women in wealthier households. Health worker’s assistance during pregnancy outside a facility, antenatal care at government facilities, childbirth at home are more prevalent among women in poor households in both Ghana and Nigeria. Caesarean section is unequally spread to the disadvantage of women in poorer households in Ghana and Nigeria. In Nigeria, women in wealthier households have considerably more unmet needs for family planning than in Ghana. Country inequality was persistent over time and women in poorer households in Nigeria experienced changes that are more inequitable over the years.ConclusionWe observe horizontal inequalities among women who use reproductive health care. These inequalities did not reduce substantially over the years. The gains made in reducing inequality in use of reproductive health care services are short-lived and erode over time, usually before the poorest population group can benefit. To reduce inequality in reproductive health care use, interventions should not only be pro-poor oriented, but they should also be sustainable and user-centered.

Mental Health Service in Ghana: A Review of the Case

Mental health care in Ghana has been fraught with several challenges leading to stagnant growth in mental health service delivery and in some cases a severe depreciation in the nature of care. The Government of Ghana pays little or no attention to mental health care in the country, a situation that has led to poor service delivery in the three major psychiatric hospitals in Ghana. The implementation of the Ghana Mental Act of 2012 has also been faced with major challenges with no significant progress being made. This studytherefore sought to review and document the development of mental health care services in Ghana. Specifically, the study examined the various legislations on mental health that have been enacted in Ghana since 1900; investigated the implementation of the current Mental Health Act of Ghana; found out whether the Ghanaian government has prioritise mental health services in the country and assessed the challenges and problems that confronted mental health services in Ghana since 1900.The study concludes that, since 1888 efforts have been made by various governments to legislate the provision of mental services in Ghana. However, these legislations have not always protected the rights and interest of the mentally ill.

Urban-rural difference in satisfaction with primary healthcare services in Ghana

BackgroundUnderstanding regional variation in patient satisfaction about healthcare systems (PHCs) on the quality of services provided is instrumental to improving quality and developing a patient-centered healthcare system by making it more responsive especially to the cultural aspects of health demands of a population. Reaching to the innovative National Health Insurance Scheme (NHIS) in Ghana, surpassing several reforms in healthcare financing has been a milestone. However, the focus of NHIS is on the demand side of healthcare delivery. Studies focusing on the supply side of healthcare delivery, particularly the quality of service as perceived by the consumers are required. A growing number of studies have focused on regional differences of patient satisfaction in developed countries, however little research has been conducted concerning patient satisfaction in resource-poor settings like in Ghana. This study was therefore dedicated to examining the variation in satisfaction across rural and urban women in Ghana.MethodsData for the present study were obtained from the latest demographic and health survey in Ghana (GDHS 2014). Participants were 3576 women aged between 15 and 49 years living in non-institutional settings in Ghana. Summary statistics in percentages was used to present respondents’ demographic, socioeconomic characteristics. Chi-square test was used to find association between urban-rural differentials with socio-economic variables. Multiple logistic regression was performed to measure the association of being satisfied with primary healthcare services with study variables. Model fitness was tested by pseudo R2. Statistical significance was set at p < 0.05.ResultsThe findings in this study revealed that about 57.1% were satisfied with primary health care services. The urban and rural areas reported 57.6 and 56.6% respectively which showed no statistically significant difference (z = 0.64; p = 0.523; 95%CI: -0.022, 0.043). Bivariate analysis showed that region, highest level of education, wealth index and type of facility were significantly associated with location of residence (urban-rural areas). After adjusting for confounding variables using logistic regression, geographical location became a key factor of satisfaction with primary healthcare services by location of residence. In urban areas, respondents from Greater Accra had 64% increase in the level of satisfaction when compared to those in Western region (OR = 1.64; 95CI: 1.09–2.47), Upper East had 75% increase in satisfaction compared to Western region (OR = 1.75; 95%CI: 1.08–2.84), Northern had an estimated 44% reduction in satisfaction when compared to Western region (OR = 0.56; 95%CI: 0.34–0.92). However, rural areas in Central, Volta, Eastern, Ashanti, Brong Aghafo, Northern and Upper West region had 51, 81, 69, 46, 62, 75 and 61% reduction respectively in the level of satisfaction when compared to Western region.ConclusionsPatient satisfaction is an important indicator of health outcomes. Quality of care and measuring level of patient satisfaction has been found to be the most useful tool to predict utilization and compliance. In fact, satisfied patients are more likely than unsatisfied ones to continue using health care services. Our results suggest that policymakers need to better understand the determinants of satisfaction with the health system and how different socio-demographic groups perceive satisfaction with healthcare services so as to address health inequalities between urban and rural areas within the same country.

Improving the quality and efficiency of healthcare services in Ghana through HTA

A case for further investment in health cannot be made unless systems are in place to ensure good value for money for every Cedi spent. Identifying in an evidence informed way, opportunities for releasing resources for reinvestment to expand coverage whilst ensuring health outcomes remain the same or improve, is a powerful argument for more and better spending on health in Ghana. This report goes some way towards making the case for an HTA mechanism for strengthening the handle of the Ghanaian authorities over its own budget through tackling a specific case of high spending and high burden area, namely hypertension management. Using Ghanaian data and making all assumptions explicit, this analysis points to areas for improved spending, quantifies potential savings and health gains from reallocation and makes a case for an institutionalised approach to HTA in Ghana, as an important tool for transitioning away from aid and move towards sustainable and affordable Universal Healthcare Coverage. A technical working group comprised of UK and Ghanaian members adapted an existing Excel model, initially developed for the 2006 update of the NICE clinical guidelines on hypertension. This model compared the cost-effectiveness of the four main classes of antihypertensive drugs (ACE inhibitors/ ARBs, beta-blockers (BB), calcium channel blockers (CCBs), thiazide-like diuretics (TZD), and no intervention). The model predicted that in the Ghanaian context, diuretics and CCBs would be more effective and less expensive than other drug classes. Compared with no treatment, diuretics cost an additional GH¢ 642 per DALY avoided, while the incremental cost per DALY avoided for CCBs compared with diuretics was much higher at GH¢ 32,482. Furthermore, in order to enhance the policy relevance and usefulness of the model to Ghanaian policy makers, the report goes through a number of policy scenarios. The extent to which there are policy levers for acting on them (e.g. drug price), and whether the model could offer credible analytics to back such policy actions were discussed. The results show substantial potential for cost savings, if such policy scenarios could be implemented. For instance, a 10% reduction in mean drug cost would yield the greatest savings, over GH¢ 25 million over the first five years. This was followed by 10% prescription shift from CCB to TZD, with five-year savings of over GH¢ 18 million, and 10% shift from ACEi/ARB/BB to TZD yielding 5-year savings of over GH¢ 5 million, not to mention the addition of health benefits following such shift. Finally, the findings of this report consider the reallocation of savings from these cost saving scenarios to improve health benefits and coverage in Ghana. For example, providing diuretic treatment to all patients with diagnosed but untreated hypertension would only cost an extra GH¢ 5.9 million over five years, only using a fraction of the savings of above scenarios, as well as yielding a net gain of avoiding over 46,000 extra DALYs.

Severe acute malnutrition in children aged under 5years can be successfully managed in a non-emergency routine community healthcare setting in Ghana.

This study investigated the performance of community-based management of severe acute malnutrition (CMAM) within routine healthcare services in Ghana. This was a retrospective cohort study of n=488 children (6-59months) who had received CMAM. Data for recovery, default, and mortality rates were obtained from enrolment cards in 56 outpatient centres in Upper East region, Ghana. Satisfactory rates of recovery of 71.8% were reported. Children who were enrolled with higher mid-upper arm circumference (MUAC) ≥11.5cm had seven times greater chance of recovery compared with children who were enrolled with lower MUAC <11.5cm, OR=7.35, 95% CI [2.56, 21.15], p<.001. Children who were diagnosed without malaria at baseline were 30 times, OR=30.39, 95% CI [10.02, 92.13], p<.001, more likely to recover compared with those with malaria (p<.001). The average weight gain was 4.7g-1 ·kg-1 ·day-1 , which was influenced by MUAC status at baseline, β=.78, 95% CI [0.46, 1.00], p<.001, presence of malaria, β=-1.25, 95% CI [-1.58, 0.92], p<.001, and length of stay, β=0.13, 95% CI [0.08, 0.18], p<.001. The default rate (28.5%) was higher than international standards recommendations by Sphere. Mortality rate (1.6%) was lower than international standards. Our findings suggest that community-based management of SAM can achieve similar success when delivered in routine non-emergency settings. However, this success can be diluted by a high default rate, and the factors contributing to this need to be explored to improve programme effectiveness within communities.

HIV/AIDS clients, privacy and confidentiality; the case of two health centres in the Ashanti Region of Ghana.

BackgroundWhile most studies on HIV/AIDS often identify stigmatization and patients’ unwillingness to access health care as critical problems in the control of the pandemic, very few studies have focused on the possible consequences of accessing health care by sero-positives. This paper examines the socio-psychological trauma patients experience in their desire to access health care in two health facilities in the Ashanti Region of Ghana.MethodsThrough participant observation, informal conversation and in-depth interviews, data were collected from health workers and clients of the voluntary counselling (VCT) and antiretroviral therapy units in the two hospitals.The data gathered were analysed and categorized into themes and supported with illustrative quotes obtained from health workers and clients.ResultsThe study found that the mere presence of a person at the HIV counselling centre or clinic is enough for the person to be labelled as or suspected to be HIV patient. It demonstrates that stigmatization may occur not only in the community but also overtly or covertly, in the health facility itself. Consequently, for many HIV/AIDS patients, access to antiretroviral therapy and treatment of related nosocomial infections are problematic. Besides, the study found that many clients and potential users of services were uncomfortable with the quality of care given by some health workers, especially as they overtly and covertly breached confidentiality about their clients’ health status. This has compelled many patients and potential users of the services to adopt a modus vivendi that provides them access to some care services while protecting their identity.ConclusionThe paper argues that by examining issues relating to privacy and confidentiality in the provision of care for and use of services by seropositives, more light will be shed on the whys of the limited uptake of HIV-related health care services in Ghana.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-016-0123-3) contains supplementary material, which is available to authorized users.

Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study.

BackgroundWhile a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana.Methods and FindingsA qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability.ConclusionsMaternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare providers as well as the provision of disability-friendly transport and healthcare facilities and services are needed.