Healthcare Facilities In Ghana Research Articles

Measuring intersectional HIV, sexual diversity, and gender non-conformity stigma among healthcare workers in Ghana: scale validation and correlates of stigma

BackgroundMen who have sex with men (MSM) are at heightened risk for HIV acquisition, yet they may delay or avoid HIV testing due to intersectional stigma experienced at the healthcare facility (HCF). Few validated scales exist to measure intersectional stigma, particularly amongst HCF staff. We developed the Healthcare Facility Staff Intersectional Stigma Scale (HCF-ISS) and assessed factors associated with stigma in Ghana.MethodsWe analyzed baseline data from HCF staff involved in a study testing a multi-level intervention to reduce intersectional stigma experienced by MSM. Data are from eight HCFs in Ghana (HCF Staff n = 200). The HCF-ISS assesses attitudes and beliefs towards same-sex relationships, people living with HIV (PLWH) and gender non-conformity. Exploratory factor analysis assessed HCF-ISS construct validity and Cronbach’s alphas assessed the reliability of the scale. Multivariable regression analyses assessed factors associated with intersectional stigma.ResultsFactor analysis suggested an 18-item 3-factor scale including: Comfort with Intersectional Identities in the Workplace (6 items, Cronbach’s alpha = 0.71); Beliefs about Gender and Sexuality Norms (7 items, Cronbach’s alpha = 0.72); and Beliefs about PLWH (5 items, Cronbach’s alpha = 0.68). Having recent clients who engage in same-gender sex was associated with greater comfort with intersectional identities but more stigmatizing beliefs about PLWH. Greater religiosity was associated with stigmatizing beliefs. Infection control training was associated with less stigma towards PLWH and greater comfort with intersectional identities.ConclusionsAchieving the goal of ending AIDS by 2030 requires eliminating barriers that undermine access to HIV prevention and treatment for MSM, including HCF intersectional stigma. The HCF-ISS provides a measurement tool to support intersectional stigma-reduction interventions.

The changing health-care system in Ghana: forms of care within residential aged care facilities in urban Accra

Purpose The emergence of residential aged care facilities (RACFs) within the Ghanaian health-care system has raised eyebrows because, hitherto, the concept of nursing homes had largely been perceived as an anomaly. The purpose of this study is to understand this emerging phenomenon and the activities of care provided within two facilities in the nation’s capital, Accra. Design/methodology/approach The study draws on participant observations and in-depth interviews with purposively sampled 15 residents in the two facilities and eight caregivers. The data were analysed using thematic approach. Findings The study found that the daily forms of care mostly performed for the elderly were intimate and non-intimate physical, medical, emotional and spiritual and end-of-life care. The bulk of activities of care were performed in the morning. Originality/value The study reveals that the changing landscape of health-care facilities in Ghana to include RACFs indicates RACFs have come to stay to provide different forms of care to older persons who otherwise were cared for by the family.

Survival rate of cervical cancer: a five year review at a Major Teaching Hospital in Ghana, West Africa.

Cervical cancer (CC) is one of the leading causes of cancer-related deaths among females in Ghana. Despite the magnitude of the public health challenge posed by CC in Ghana, survival data as well as reported incidence and mortality rates are primarily based on studies conducted in the capital city of the country. Even though age at diagnosis is known to affect the overall survival of CC patients, the role of this factor in the prognosis of CC patients in Ghana has not been sufficiently explored. The aim of this study was to determine the 5-year survival rate of Ghanaian woman treated for CC at a large tertiary healthcare facility in Ghana. This research was a single-institution-based quantitative retrospective cohort study conducted among patients with histopathologically confirmed CC. Clinical and socio-demographic data were retrieved from patients' medical records. Data analysis was done using the Statistical Package for the Social Sciences software version 23. Kaplan Meier curves were used to present the survival rates and median survival time. The peak age at diagnosis was between 45 and 80 years with the modal age group of patients between 75 and 80 years. The mean age at diagnosis was 63.3 ± 15.7 years ranging from 27 to 104 years. The overall survival rates at 1, 3 and 5 years were 76.5%, 51.5% and 32.4%, respectively. The median survival time was 65.8 months. Age < 50 years was associated with higher survival estimates than age >50 years. The 5-year overall survival rate of CC patients reported in this study (32.4%) is relatively low compared with countries in the developed world but like previous reports at other healthcare facilities in Ghana as well as in other underdeveloped countries.

Towards an integrated type 1 diabetes management in low-resource settings: barriers faced by patients and their caregivers in healthcare facilities in Ghana

Background In Low-Middle-Income Countries (LMICs), young people living with Type 1 Diabetes Mellitus (T1DM) face structural barriers which undermine adequate T1DM management and lead to poor health outcomes. However, research on the barriers faced by young people living with T1DM have mostly focused on patient factors, neglecting concerns regarding plausible barriers that may exist at the point of healthcare service delivery.Objective This study sought to explore barriers faced by young people living with T1DM and their caregivers at the point of healthcare service delivery.MethodsData were drawn from a qualitative research in southern Ghana. The research was underpinned by a phenomenological study design. Data were collected from 28 young people living with T1DM, 12 caregivers, and six healthcare providers using semi-structured interview guides. The data were collected at home, hospital, and support group centres via face-to-face interviews, telephone interviews, and videoconferencing. Thematic and framework analyses were done using CAQDAS (QSR NVivo 14).ResultsEight key barriers were identified. These were: shortage of insulin and management logistics; healthcare provider knowledge gaps; lack of T1DM care continuity; poor healthcare provider-caregiver interactions; lack of specialists’ care; sharing of physical space with adult patients; long waiting time; and outdated treatment plans. The multiple barriers identified suggest the need for an integrated model of T1DM to improve its care delivery in low-resource settings. We adapted the Chronic Care Model (CCM) to develop an Integrated Healthcare for T1DM management in low-resource settings.ConclusionYoung people living with T1DM, and their caregivers encountered multiple healthcare barriers in both in-patient and outpatient healthcare facilities. The results highlight important intervention areas which must be addressed/improved to optimise T1DM care, as well as call for the implementation of a proposed integrated approach to T1DM care in low-resource settings.

Examining factors driving inequities in water, sanitation, hygiene, and waste management services in healthcare facilities in Ghana: An analysis of routine national data

Abstract In Ghana, little is known about the drivers of inequities of basic water, sanitation, and hygiene (WASH) services in healthcare facilities (HCFs). We aim to examine the status and factors driving access to basic WASH services in Ghana. This survey involved an analysis of routine health service data submitted to the District Information Management System 2 (DHIMS 2). Complete data were available for 1,646 HCFs across Ghana for analysis. Coverage of basic Water, Sanitation and hygiene services was 69, 58, and 64%, respectively. About 50% had a WASH-IPC action plan, and 67% had a WASH-IPC manager who is responsible for the day-to-day WASH management. Regional inequities in access to basic WASH services exist, with the newly established regions and those in Northern Ghana being disadvantaged. Significant drivers of basic WASH services were the location of HCF, the level of service delivery, and availability of a trained facility-based assistant WASH manager. WASH services in Ghanaian HCFs have improved, but it is still not up to the standards set by the Sustainable Development Goals for WASH. Universal access to basic WASH services can be attained by mounting targeted WASH interventions and appointing WASH-IPC managers at all levels of the health system.

Predictors of household direct cost of burn injury in adult patients at a tertiary healthcare facility in Ghana: an analytical cross-sectional study in Korle-Bu Teaching Hospital

Predictors of household direct cost of burn injury in adult patients at a tertiary healthcare facility in Ghana: an analytical cross-sectional study in Korle-Bu Teaching Hospital

Health Systems Barriers to the Implementation of Preventing Mother-to-Child Transmission of Human Immunodeficiency Virus Infection in Primary Health Care Facilities in Ghana

Background. Ghana has implemented the prevention of mother-to-child transmission strategy (PMTCT) to control HIV infection transmission to babies. However, this has not yielded the desired results, as there are still many mother-to-child HIV infection cases being reported due to factors such as those related to health system barriers. This study was, therefore, conducted to identify health system barriers to the implementation of PMTCT in selected districts in the Ashanti Region of Ghana. Methods. A cross-sectional study was conducted among 118 health workers in 20 selected health facilities within the Asante-Akim Central and South Municipalities in the Ashanti Region, Ghana, to assess the health system barriers to the prevention of mother-to-child transmission of HIV/AIDS. Data was collected using a structured, self-administered questionnaire, which was later transferred to Kobo Collect software. The study participants were chosen using multistage sampling approaches. The data cleaning and analysis were done using STATA version 16.1. Multiple logistic regression models, chi-square analysis for normality testing, and descriptive analysis were all used. The results were displayed in tables, and a p-value of 0.05 was used to determine the significance level. The study was carried out from June to September 2022. Results. In all, 118 participants were involved in this study. Of this, 57.4% had a good level of knowledge of PMTCT, even though all of them were aware of PMTCT. We found being more than 40 years (Odds Ratio, OR = 2.08 95% CI: 1.05, 5.00) and being in service with Ghana Health Service for more than 15 years (OR = 2.36 95% CI: 0.51,10.84) to be significant predictors of knowledge on PMTCT among our participants. A greater proportion of our participants revealed inadequate staffing as the major challenge faced in the delivery of PMTCT in Ashanti Region. Increased education on PMTCT was the most suggested solution to improve the management of HIV infection among pregnant women and further enhance the success rates of PMTCT in Ashanti Region, Ghana. Conclusions. The majority of the health professionals had good knowledge about the prevention of mother-to-child transmission. However, the number of staff in the two districts was not adequate, which affected public education. It is therefore important to increase the number of staff to enhance educating the public and minimize the transmission rate in the districts and the country as well.

Cost efficiency of primary health care facilities in Ghana: stochastic frontier analysis

Primary health care (PHC) is a universally accepted key strategy to achieve universal health coverage (UHC) and Sustainable Development Goal 3 (SDG 3) due to its potential to produce a range of economic benefits through improved health outcomes, health quality, and health system efficiency. However, little evidence exists about the cost efficiency of primary health care facilities (PHCFs) in Sub-Saharan Africa. This study evaluates the cost efficiency of two main types of PHCFs in Ghana that are at the forefront of delivering PHC services to a greater proportion of the population: Community Health Centers (HCs) and Community-Based Health Planning Services (CHPS) compounds. The dataset we used for this study included 39 HCs and 55 CHPS facilities. Furthermore, it examines the factors that influence the cost efficiency of these facilities. The study applies the stochastic frontier analysis (SFA) technique to panel data. The estimated cost efficiency for HCs and CHPS is 61.6% and 85.8%, respectively. The study further revealed that facility size, medical staff density, and facility age are the main factors that explain the differences in the cost efficiency of PHCFs in Ghana. The study's policy recommendation is that the Ghana Health Service should consider utilizing modern technology such as telehealth and telemedicine to enhance access to PHC services for people living in hard-to-reach and densely populated communities. This strategic approach can significantly contribute to improving the cost-efficiency of PHCFs.

Abstract P191: Health Services Availability And Readiness For Management Of Hypertension And Diabetes In Primary Level Healthcare Facilities In Ghana

Background: Hypertension (HTN) and diabetes (DM) are the leading cause of adult morbidity and mortality in Ghana and other African countries. We explored the service availability (SA) and readiness (SR) of health systems for managing HTN and DM in the Bono Region, Ghana. Methods: We conducted a multi-center cross-sectional study of four primary health facilities between June 2022 and July 2022. We modified the World Health Organization (WHO) Service Availability and Readiness Assessment tool to focus on management of HTN and DM. We computed composite scores for SR based on domains of functional equipment, diagnostic capacity, medications, and clinical guidelines &amp; protocols; SA based on service-specific domains and stratified by facility ownership (Mission vs Government). At a cutoff value of 70%, services were considered "available" or facility "ready" to manage HTN and DM based on previous studies. Results: The median number of HCWs was 7 (IQR 2-7). The overall average SR and SA scores were 75.5% and 63% respectively (Fig A &amp; B). SR scores were higher at mission hospitals (84.5%) than at government hospitals. SA scores were generally lower than SR Scores for both Mission and Government facilities. Half of the health facilities had guidelines and had CVD training in the last 2 years (n = 2; 50%), and all (n=4,100%) had received supervisory visits regarding CVD care in the last three months. Conclusion: There are gaps in diagnostic capacity, basic equipment, clinical guidelines, and a limited number of physicians accounting for low scores, particularly in government facilities. Improving resource allocation and implementing a team-based care policy may enhance HTN and DM care in Ghana .

Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage

Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage

Incidence of blood culture-related sepsis in neonates and antibiotics sensitivity of implicated organisms in a secondary healthcare facility in Ghana.

We determined the incidence of blood culture-related sepsis, causative bacteria, and antibiotics sensitivity among newborn babies with suggestive signs of sepsis admitted at the Upper East Regional Hospital in Bolgatanga, Ghana. Prospective cross-sectional study. Newborn Care Unit of the Upper East Regional Hospital, Bolgatanga. Neonates admitted to the Newborn Care Unit from August 2019 to August 2020 with signs of sepsis. Organisms isolated from blood cultures and sensitivity of isolated organisms to antibiotics. The study included two hundred and seventy-six (276) patients. Laboratory confirmed sepsis was 13.4% (37/276). Early onset sepsis was 3.3% (9/276), while late-onset sepsis was 10.1% (28/276). The most common clinical signs associated with positive culture cases were temperature instability (35.5%), poor feeding (14.5%), neonatal jaundice (11.3%), vomiting (9.7%), and respiratory distress (8.1%). Staphylococcus aureus and Staphylococcus epidermidis were the most common bacterial isolates (46% and 32%, respectively). There was no relationship between independent variables and blood culture confirmed sepsis. Antibiotics to which isolates were most resistant included flucloxacillin 4/4, penicillin 14/15, ampicillin 16/18, and tetracycline 23/28. Bacterial isolates were most sensitive to amikacin 16/16, levofloxacin 5/5, erythromycin 8/8, cefazolin 7/8, and ciprofloxacin 18/24. Late-onset sepsis is a common sepsis category, and the implicated microorganisms are resistant to commonly prescribed antibiotics. This work was funded by Upper East Regional Hospital, Bolgatanga.

The development of colonial health care provision in Ghana and Côte d’Ivoire: ca. 1900–55

ABSTRACT Colonial administrations introduced various social infrastructures in Africa. This paper analyses and compares the development of colonial governments' health care provision and policies in Ghana and Côte d’Ivoire from circa 1900 to 1955. Using qualitative and quantitative information from colonial reports, a new dataset captures the development of four factors relevant to these aims: health care expenditures, health care facilities, medical staff, and patients. Deflated health care expenditures per capita were found to be higher in Ghana than in Côte d’Ivoire in almost all years. The number of health care facilities per capita was larger in Côte d’Ivoire than in Ghana, and facilities were more geographically dispersed. Ghana had a lower number of medical staff per capita than Côte d’Ivoire as of the 1920s. Medical staff from Côte d’Ivoire formed the majority of the staff base as early as the mid-1910s. Finally, the analysis shows that the number of patients treated in health care facilities in Ghana was low until the 1920s, and took off as more facilities became available during the 1940s. These findings provide evidence that even two countries that are relatively similar (apart from their colonial history) can have different colonial health care trajectories.

Sexual harassment as experienced by nurses from selected healthcare facilities in Ghana

BackgroundWorkplace Sexual Harassment (WSH) remains a major occupational health hazard to many nurses globally. Despite the negative impact of WSH on health and safety of nurses, there are limited studies exploring sexual harassment experiences of nurses in the line of duty in Low- and middle-income countries (LMICs) including Ghana.AimThis study aimed at exploring the lived sexual harassment experiences among nurses working in healthcare facilities in the Central Region of Ghana.MethodThis study used a qualitative interpretive phenomenological approach (IPA). Data from 24 participants, 13 participants’ written descriptive narratives of sexual harassment experiences (via online) and 11 telephone interviews were analysed concurrently using the IPA.ResultsParticipants experienced verbal, non-verbal and physical forms of sexual harassment, often perpetrated by physicians, colleague workers, and patients. Most victims reacted passively to the acts sexual harassment and cases are often not reported despite the negative impact on victims’ health. While some participants dealt with sexual harassment by accepting the behaviour as an inevitable part of their job, others either quit or intend to quit the job to avoid the harassers. Most participants are unaware of any workplace measure such as policy that addresses sexual harassment in the health sector in Ghana.ConclusionThis study highlights the problems of sexual harassment against nurses in the healthcare sector in Ghana, and calls for urgent development of measures such as a sexual harassment policy to prevent occurrence and promote effective resolution of sexual harassment within the healthcare sector in the country. Sexual harassment against nurses could be hampering quality healthcare delivery in the region.

Feasibility of the use of WhatsApp messaging technology to facilitate obstetric referrals in rural Ghana

BackgroundObstetric referrals thrive on rapid transfer of information and data, and effective communication in order to reduce delays in receiving of quality care once the woman reaches the facility. We explored health care workers’ perception of the feasibility and acceptance of WhatsApp messaging technology to facilitate obstetric referrals in selected health facilities in rural Ghana.MethodsThe study used a qualitative research method and adheres to the interpretivist ideology. This study was conducted in the Sene East District (SED) and Sene West District (SWD) in the Bono East region of Ghana. Sixteen healthcare facilities were sampled. In-depth interviews and focused group discussions were conducted. QSR NVivo-12 for data management and analysis. Collaizzi's descriptive phenomenological technique of analysis was used to analyse the data.ResultsFrom the analysis, three main themes emerged. The themes included the HCWs’ perceptions of the feasibility of WhatsApp messaging technology (sub: optimist and pessimist perspectives), challenges to the acceptance of WhatsApp messaging technology (sub: challenge with getting data, network challenges, and risk of platform used for unintended purposes), and the HCWs’ perceptions of the acceptance of WhatsApp messaging technology (sub: easy communication and information sharing, improvement in quality of service, and tracking referred clients’ compliance).ConclusionWe conclude that the implementation of WhatsApp messaging technology in obstetric referral is feasible and acceptable to HCWs in rural healthcare facilities in Ghana. To promote the acceptance and use of WhatsApp messaging technology in obstetric referrals, there is a need to build the capacity of HCWs and provide a working guideline to regulate the platform. The government and its partners must consider providing internet data and airtime, as well as dedicated phones to support the implementation of the use of WhatsApp messaging technology in promoting effective obstetric referral.

Antibiotic consumption trends in Ghana: analysis of six-years pharmacy issue data from a secondary healthcare facility.

Surveillance of hospital antibiotic consumption provides data to inform corrective action and for monitoring antimicrobial stewardship activities. This study described antibiotic consumption patterns from 2016 through 2021 at a secondary healthcare facility in Ghana. Using the WHO methodology for surveillance of antimicrobial consumption in hospitals, we analysed a 6-year pharmacy issue data at the Eastern Regional Hospital. We report on the defined daily dose (DDD) per 100 patients, types of antibiotics consumed according to Anatomic Therapeutic Classification (ATC), WHO AWaRe classification; trends in antibiotic consumption and expenditure per DDD of antibiotics consumed. Over the period, the mean (±standard deviation) antibiotic consumption rate was 256.7 ± 33 DDD/100 patients per year. A linear regression model showed an insignificant decreasing trend in antibiotic consumption (coefficient for time -0.561; P = 0.247). The top three consumed antibiotics in DDD/100 patients at ATC level 5 were amoxicillin-clavulanate (n = 372.6), cefuroxime (n = 287.4) and sulfamethoxazole-trimethoprim (n = 145.8). The yearly Access-to-Watch ratio decreased from 2.4 in 2016 to 1.2 in 2021. The mean yearly cost of antibiotics was $394 206 ± 57 618 US dollars. The top three antibiotics consumed in terms of cost were clindamycin $718 366.3, amoxicillin-clavulanate $650 928.3 and ceftriaxone $283 648.5. This study showed a sturdy rate of antibiotic consumption over the 6-year period with a year-on-year decrease in the Access-to-Watch antibiotic ratio. Data from pharmacy drug issues offer an opportunity to conduct antibiotic consumption surveillance at the hospital and national level in Ghana.

Perceptions and Cues to Action as Predictors of Nurses' Vaccination Intentions at Two Primary Health Care Facilities in Ghana.

Uptake of hepatitis B vaccination by health care providers remains suboptimal in Ghana, although it is considered an effective strategy against the hepatitis B virus. This study aimed to identify the predictors of nurses' hepatitis B vaccination intentions at two municipal health care facilities in Ghana. A descriptive cross-sectional survey was adopted. A section of the health belief model-based questionnaire was administered to 181 nurses conveniently sampled from the two facilities. Data analysis was done using Statistical Product and Service Solutions software version 23.0. Frequencies and percentages were used to assess the demographic characteristics of participants. Pearson r coefficients were used to assess the intercorrelations between individual perceptions, and the cues to action on vaccination intentions. Simple and multiple regression was used to estimate the prediction of individual perceptions, and the cues to action on hepatitis B vaccination intentions of nurses. The findings showed that nurse-perceived benefits and cues to action were positive and significantly related to hepatitis B vaccination intentions of nurses (r = 0.14, P < 0.05; r = 0.17, P < 0.05). Perceived susceptibility and perceived barrier were negative and significantly related to vaccine intentions (r = -0.13, P < 0.05; r = -0.24, P < 0.01). Notably, perceived barrier predicted hepatitis B vaccination intentions (β = -0.22, t = -2.48, P = 0.01). Nurses' vaccination behavioral intentions were positive. It was recommended that perceived barriers to hepatitis B vaccination such as vaccination ineffectiveness, time constraints, high costs, and side effects should be addressed to increase nurses' vaccination uptake.

Preoperative Intravenous Dexamethasone and Postoperative Analgesia Following Breast Surgery: A Prospective, Randomized Double-Blind Trial at a Tertiary Healthcare Facility in Ghana.

Breast surgery may be associated with significant postoperative pain and if not adequately treated, may lead to the development of chronic post-surgical pain. This necessitates the use of effective management, involving the use a multimodal analgesia regimen for the management of post breast surgery pain. The analgesic effect of perioperative use of dexamethasone has been explored but findings have been inconsistent. The aim of this study was to determine the postoperative analgesic enhancing effect of a single preoperative dose of dexamethasone on patients undergoing breast surgery at a tertiary hospital in Ghana. This was a prospective, double-blind, placebo-controlled study involving 94 consecutively recruited patients. Patients were randomized into two groups: dexamethasone (n = 47) and placebo (n = 47). Patients in the dexamethasone group had 8mg (2 mL of 4 mg/mL) dexamethasone and those in the placebo group had 2 mL of saline administered intravenously just before induction of anaesthesia. All patients received a standard general anaesthesia with endotracheal intubation. The numerical rating score (NRS), time to first analgesic request and the total opioid consumed in the first 24 h were recorded. Patients receiving dexamethasone had lower NRS scores at all measured time points but this was significant only at 8 h post-surgery (P = 0.037). The time to first rescue analgesia was significantly prolonged in the dexamethasone group (339.26 ± 312.90 min vs. 182.10 ± 166.72 min; P = 0.020). However, the mean total opioid (pethidine) consumed in the first 24 h postoperatively was not significantly different between the dexamethasone and control groups (113.75 ± 51.35 mg vs. 100.00 ± 60.93 mg; P = 0.358). A single preoperative dose of 8mg dexamethasone given intravenously, reduces postoperative pain compared to placebo, significantly reduces the time to first analgesia but not the total opioid consumed in the first 24 h post breast surgery.

Bacteriological Profile and Antibiotic Susceptibility Patterns of Sepsis-Causing Bacteria at the Neonatal Intensive Care Unit of a Tertiary Health Care Facility in Ghana

Bacteriological Profile and Antibiotic Susceptibility Patterns of Sepsis-Causing Bacteria at the Neonatal Intensive Care Unit of a Tertiary Health Care Facility in Ghana

Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety.

IntroductionRecognizing the values and norms significant to healthcare organizations (Safety Culture) are the prerequisites for safety and quality care. Understanding the safety culture is essential for improving undesirable workforce attitudes and behaviours such as lack of adverse event reporting. The study assessed the frequency of adverse event reporting, the patient safety culture determinants of the adverse event reporting, and the implications for Ghanaian healthcare facilities.MethodsThe study employed a multi-centre cross-sectional survey on 1651 health professionals in 13 healthcare facilities in Ghana using the Survey on Patient Safety (SOPS) Culture, Hospital Survey questionnaire. Analyses included descriptive, Spearman Rho correlation, one-way ANOVA, and a Binary logistic regression model.ResultsThe majority of health professionals had at least reported adverse events in the past 12 months across all 13 healthcare facilities. Teamwork (Mean: 4.18, SD: 0.566) and response to errors (Mean: 3.40, SD: 0.742) were the satisfactory patient safety culture. The patient safety culture dimensions were statistically significant (χ2 (9, N = 1642) = 69.28, p < .001) in distinguishing between participants who frequently reported adverse events and otherwise.ConclusionPromoting an effective patient safety culture is the ultimate way to overcome the challenges of adverse event reporting, and this can effectively be dealt with by developing policies to regulate the incidence and reporting of adverse events. The quality of healthcare and patient safety can also be enhanced when healthcare managers dedicate adequate support and resources to ensure teamwork, effective communication, and blame-free culture.

The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment

Health insurance enrollment in many Sub‐Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study assesses the impact of a community engagement intervention designed to improve the quality of healthcare and health insurance services on households living nearby the facilities. Although the intervention improved the medical‐technical quality of health services, our results show that households' subjective perceptions of the quality of healthcare and insurance services did not increase. Nevertheless, the likelihood of illness and concomitant healthcare utilization reduced, and especially households who were not insured at baseline were more likely to enroll in health insurance. The results show that solely increasing the technical quality of care is not sufficient to increase households' subjective assessments of healthcare quality. Still, improving technical quality can directly contribute to health outcomes and further increase health insurance coverage, especially among the previously uninsured.