National Health Insurance Scheme Research Articles

Health insurance and hospitalisation duration: empirical evidence from Ghana’s national health insurance scheme

Health insurance and hospitalisation duration: empirical evidence from Ghana’s national health insurance scheme

A STUDY TO ASSESS THE KNOWLEDGE ATTITUDE AND UTILIZATION REGARDING NATIONAL HEALTH INSURANCE SCHEME AMONG HEALTH WORKERS IN SMVMCH, PUDUCHERRY

Background: National Health Insurance Schemes are the various health insurance programs. Some of the health insurance schemes launched by the government over the years, include Ayushman Bharat Yojana, Rashtriya Swasthya Bima Yojana, Central Government Health Scheme and Universal Health Insurance Scheme.A Positive Attitude Adequate knowledge and utilization of National Health Insurance Scheme on the clients/patients will delivered better clinical outcomes. A Study to assess the Knowledge Attitude and Utilization regarding National Health Insurance Scheme among health workers in SMVMCH, Puducherry. Methods: Descriptive cross research design was adopted for this study. Sample size 30. Data were assessed using Demographic variables, Self - Developed Knowledge and Attitude questionnaire, Self-developed Utilization questionnaire. Results: The study findings revealed that Majority of the health workers 23 (76.7%) had moderately adequate level of knowledge and 7(23.3%) had inadequate level of knowledge and the mean and standard deviation level of knowledge towards National Health Insurance Scheme among health workers is (9.07±2.463) respectively. Majority of the health workers 22 (73.3%) had unfavourable attitude and 8(26.7%) had favourable attitude and the mean and standard deviation level of attitude towards National Health Insurance Scheme among health workers is (13.33±5.695) respectively. Majority of the health workers not utilized 25 (83.3%) and 5(16.7%) had utilized the scheme and the mean and standard deviation level of Utilization towards National Health Insurance Scheme among health workers is (41.17±8.363) respectively. chi-square of the demographic variable Age in years and Dietary pattern had shown statistically significant association between the level of attitude regarding National Health Insurance Scheme among health workers with their selected demographic variables.The other demographic variable had not shown statistically significant association the level of attitude regarding National Health Insurance Scheme among health workers with their selected demographic variables respectively.The evident of chi-square of the demographic variable Gender and Residence had shown statistically significant association between the level of Utilization regarding National Health Insurance Scheme among health workers with their selected demographic variables.The other demographic variable had not shown statistically significant association the level of utilization regarding National Health Insurance Scheme among health workers with their selected demographic variables respectively. Conclusion: This study implies that on the content of study investigator have assessed the Knowledge Attitude and Utilization among health workers. It is concluded that the health workers have Moderate knowledge, Unfavorable Attitude and Not Utilized towards National Health Insurance Scheme.

Is the national health insurance scheme a pathway to sustained access to medicines in Nigeria?

ObjectiveThe debate surrounding access to medicines in Nigeria has become increasingly necessary due to the high cost of essential medicine drugs and the prevalence of counterfeit medicines in the country. The Nigerian government has proposed the implementation of the National Health Insurance Scheme (NHIS) to address these issues and guarantee universal access to essential medicines. Access was investigated using the 3 A’s (accessibility, affordability, and availability). This paper investigates whether the NHIS is a viable pathway to sustained access to medicines in Nigeria.DesignThis was a cross-sectional study using a mixed-methods design. Both qualitative and quantitative methods were utilized for the study.SettingThis study was conducted at NHIS-accredited public and private facilities in Enugu State.Participants296 randomly selected enrollees took part in the quantitative component, while, 6 participants were purposively selected for the qualitative component, where in-depth interviews (IDIs) were conducted face-to-face with NHIS desk officers in selected public and private health facilities.ResultsThe quantitative findings showed that 94.9% of respondents sought medical help. Our data shows that 78.4% of the respondents indicated that the scheme improved their access to care (accessibility, affordability, and availability). The qualitative results from the NHIS desk officers showed that respondents across all the socio-economic groups reported that the NHIS had marginally improved access to medicine over the years. It was also observed that most of the staff in NHIS-accredited facilities were not adequately trained on the scheme’s requirements and that most times, essential drugs were not readily available at the accredited facilities.ConclusionThe study findings revealed that although the NHIS has successfully expanded access to medicines, there remain several challenges to its effective implementation and sustainability. Additionally, the scheme’s coverage of essential medicines is could be improved even more, leading to reduced access to needed drugs for many Nigerians. A focus on the 3As for the scheme means that all facility categories (private and public) and their interests (where necessary) must be considered in further planning of the scheme to ensure that things work out well.

Economic cost of management of glaucoma in public and private health facilities in the Tema metropolis in Ghana

Objectives: This study sought to determine the economic cost of the management of glaucoma among patients seeking care in health facilities in Ghana.Design: A cross-sectional cost-of-illness (COI) study from the perspective of the patients was employed.Setting: The study was conducted in public and private eye care facilities in the Tema Metropolis of Ghana.Participants: About 180 randomly selected glaucoma patients seeking healthcare at two facilities participated in the study.Main outcome measure: Direct cost, including medical and non-medical costs, indirect cost, and intangible burden of management of glaucoma.Results: the cost per patient treated for glaucoma in both facilities was US$60.78 (95% CI: 18.66-107.80), with the cost in the public facilities being slightly higher (US$62.50) than the private facility (US$ 59.3). The largest cost burden in both facilities was from direct cost, which constituted about 94% of the overall cost. Medicines (42%) and laboratory and diagnostics (26%) were the major drivers of the direct cost. The overall cost within the study population was US$10,252.06. Patients paid out of pocket for the frequently used drug- Timolol, although expected to be covered under the National Health Insurance Scheme (NHIS). Patients, however, expressed moderate intangible burdens due to glaucoma.Conclusion: The cost of the management of glaucoma is high from the perspective of patients. The direct costs were high, with the main cost drivers being medicines, laboratory and diagnostics. It is recommended that the National Health Insurance Authority (NHIA) should consider payment for commonly used medications to minimize the burden on patients.

Financial burden faced by breastfeeding mothers caring for children diagnosed with cancer in Ghana; an exploratory qualitative study

BackgroundWhen children are diagnosed of cancer, parents face varied financial issues. Among some of the identifiable factors that cause financial challenges among breastfeeding mothers include the high cost of childhood cancer care. The high cost of childhood cancer care could impede the sustainability of access to prompt care. There is paucity of literature on the financial burdens faced by breastfeeding mothers with children diagnosed with cancer in Ghana. Therefore, this study sought to explore the financial burden faced by mothers with breastfeeding children diagnosed with cancer.MethodsThe study employed qualitative exploratory descriptive design. One-on-one interviews were conducted among 13 mothers with breastfeeding children diagnosed of cancer. Permission was sought for data to be recorded, transcribed concurrently and inductive content analysis done.ResultsThree main themes emerged after data analysis: High cost (sub-themes; expensive medications, laboratory investigation fees, and cost of mothers’ feeding), Public support (sub-themes; appeal for funds, national health insurance scheme) and Self-financing (loans, personal savings). Most of the breastfeeding mothers narrated that high cost of childhood cancer care generated financial distress to them. They shared that the cost involved in purchasing their children’s cancer medications, paying for laboratory investigations and feeding themselves to produce adequate breastmilk to feed their children were challenging. Some of the mothers self-financed the cost of their children’s cancer care through loans and personal savings.ConclusionGovernment and other stakeholders should allocate annual budget and funds towards childhood cancer care to lessen the financial burden breastfeeding mothers caring for children with cancer experience.

Public health insurance: An approach to mitigate the burden of diabetes in low resource settings

Background: Diabetes mellitus is a significant public health concern globally as well as in Owerri, Nigeria. The deleterious effects of diabetes have been linked to poor glycemic control. According to the International Diabetes Federation, poor glycemic control is reflected in glycosylated hemoglobin levels greater than 7.0%, which are associated with substantial morbidity and mortality. Studies have shown a dramatic rise in diabetic complications in Nigeria, particularly in Owerri. However, evidence is lacking on specific risk factors associated with poor glycemic control among diabetes mellitus patients in Owerri. There is a gap in the literature regarding the association between health insurance and glycemic control in diabetic patients in Owerri. With health insurance assuming a significant position in healthcare service delivery in Nigeria, addressing this gap is valuable. Methods: We performed a cross-sectional study of health insurance as a determinant of glycemic control among 160 type 2 diabetic patients attending the family medicine clinic at the Federal University Teaching Hospital, formerly the Federal Medical Center, Owerri. Participants were measured as not insured, insured-private, and insured-public/National Health Insurance Scheme. The dependent variable was glycemic control measured using glycosylated hemoglobin. We used ecosocial theory as the theoretical framework of this research. SPSS was used for data analysis; multiple logistic regression was applied to assess the association between insurance status and glycemic control in the participants. Results:In the patients without health insurance coverage, the prevalence of poor glycemic control was 93.8% whereas in those with health insurance coverage, the prevalence was 60.0%. Logistic regression analysis showed that lack of access to health insurance was a determinant of glycemic control, with uninsured subjects at 28 times and 6 times increased risk of poor glycemic control compared with insured-private and insured-public subjects, respectively. Conclusion: We have shown in our study that insured enrollees have an increased likelihood of good glycemic control relative to uninsured subjects. This finding has the potential to promote positive social change through optimization of the National Health Insurance Scheme. Enabling regulations and designing policies to explicitly cover diabetes preventive and control services in the scheme could lead to improved glycemic control, and, thus, reduce the burden of the disease.

Exploring the barriers to mental health service utilization in the Bolgatanga Municipality: the perspectives of family caregivers, service providers, and mental health administrators

BackgroundMental health service utilization remains a challenge in developing countries, with numerous barriers affecting access to care. Albeit data suggest poor utilization of mental health services in the Bolgatanga Municipality in Ghana, no studies have explored the barriers to the utilization of mental health services. Therefore, this study explored the perspectives of family caregivers, service providers, and mental health service administrators on the barriers to mental health service utilization in the Bolgatanga Municipality, Ghana.MethodsA qualitative descriptive design was employed for the study. Nineteen participants were purposively sampled from two hospitals including fifteen family caregivers, two service providers, and two mental health administrators. Data were collected through individual in-depth interviews using a semi-structured interview guide. Audio-recorded interviews were transcribed verbatim and thematically analyzed using NVivo 12 pro software.ResultsFive main themes emerged including individual-level barriers, interpersonal barriers, community-level barriers, organizational-level barriers, and policy-level barriers. At the individual level, lack of insight, poor treatment compliance, and financial challenges were prominent barriers. Interpersonal barriers included family pressure influenced by cultural and spiritual beliefs. At the community level, stigma and mental health illiteracy were identified as significant barriers. At the organizational level, barriers encompassed inadequate staffing, limited space, and staff attitudes. Policy-level barriers included the neglect of mental health in policies and the non-inclusion of mental health services in the National Health Insurance Scheme.ConclusionThis study highlights the complexity of barriers to mental health service utilization and underscores the need for a comprehensive approach to address them. Collaborative efforts involving healthcare providers, policymakers, communities, and families are essential to mitigate these barriers. It is imperative to consider these barriers when developing strategies to improve the utilization of mental health services in Ghana.

Examining Ghana's National Health Insurance Act, 2003 (Act 650) to Improve Accessibility of Artificial Intelligence Therapies and Address Compensation Issues in Cases of Medical Negligence

Objective: Examine Ghana’s National Health Insurance Act (Act 650) to identify coverage gaps limiting artificial intelligence (AI) therapy access and address medical negligence liability issues surrounding automated healthcare systems. 
 Methods:  Legal and regulatory analysis of Act 650 were conducted, review of academic literature on global uptake of AI interventions and medical negligence principles were elucidated, examination of case studies implementing pilot AI therapy programs under insurance schemes were considered.
 Results & Conclusions: Act 650 lacks clear provisions for funding innovative AI treatments with proven efficacy and undefined negligence determination guidelines involving AI systems, contributing to accessibility and accountability issues. Proposed amendments to reimburse certain AI therapies through the National Health Insurance Scheme, expand certified provider eligibility, and institute transparent negligence compensation formulas.
 Recommendations: Reform Act 650 to support increased appropriate use of AI healthcare services, protect patients undergoing automated diagnosis/treatment, and clarify liability rules for medical negligence incidents relating to AI.
 Novelty & Significance: First extensive analysis focused on opportunities for Ghana’s health insurance framework to catalyze equitable diffusion of advanced AI therapeutics and address emerging legal challenges and safety risks as automated medicine advances.

Factors that contribute to prolonged hospital stay after discharge among surgical patients in a tertiary hospital in North Central Nigeria

Background: Surgical practice has hospitalization of patients for surgery and treatment as an inherent part of it; after which the patients are found fit for discharge. There is however a group of patients who remain on bed even after they have been deemed fit for discharge. This study aimed to determine the number of days surgical patients classified as having prolonged stay remain in hospital after they were deemed fit for discharge and identify the reasons for this.
 Methods: Surgical patients still on bed more than 48 hours after they were discharged who consented to participate in the study were recruited.
 Results: A total of 341 patients were recruited. The mean duration of stay after discharge was 17.6± 13 days. The specialty with the highest number of patients was Neurosurgery. Lack of finance and absence of a caregiver were the causes (96.5% and 3.5% respectively). The top three suggestions by patients on how to reduce prolonged hospital stay were bill waiver for indigent patients, reduced cost of health care services and financial aid by philanthropists.
 Conclusion: The mean number of days patient remained in hospital after discharge was 17.6 days. Financial reasons and absence of a caregiver are the major reasons for prolonged hospital stay. There is a need for a multi-sectoral approach to improve enrollment in the National Health Insurance Scheme and provide social support for patients in need of care post-discharge to reduce the adverse effects of prolonged hospital stay on the hospital and patients.

Exploring the experiences of mental health nurses in the management of schizophrenia in the Upper East Region of Ghana: a qualitative study

ObjectiveSchizophrenia is a chronic condition, of which the diagnosis and management require comprehensive care. The role mental health nurses play in this management cannot be overemphasised. In an effort to...

Utilization of Primary Health Care Under National Health Insurance in Samarinda Municipality, East Kalimantan Province, Indonesia.

In Indonesia, basic community health services are provided to all citizens through Primary Health Care (PHC) settings under the National Health Insurance (NHI) scheme. The insurance is compulsory and provides basic community health needs. Based on a gatekeeper concept, the PHC is deemed to be the first contact point for all basic healthcare needs. Despite the commencement of services through PHC settings in 2014 under this concept, utilization in PHC settings remains lower than in hospital settings. This study aimed to assess factors associated with utilization of PHC under National Health Insurance in Samarinda Municipality, East Kalimantan Province, Indonesia. The research examined the utilization of services over six months. It employed a cross-sectional method and included 382 NHI participants in 10 districts of Samarinda Municipality. Each district was divided into urban and semi-urban areas based upon local government indicators representing the whole research area. A two-stage random sampling and purposive sampling approach was implemented to select the sample. The participants were interviewed using a structured questionnaire. Chi-square and multiple logistic regressions were conducted to determine the impact of factors on the utilization of PHC. Only 17.3% of participants used PHC services regularly. Three constitutive factors, type of NHI participants (Adj. OR: 2.62; p<0.005), accommodation (Adj. OR: 2.18; p<0.005) and awareness (Adj. OR: 3.27; p<0.005) most profoundly influenced the under-utilization of PHC by NHI participants. The study found that the type of NHI participant and the utilization factors of accommodation and awareness significantly influenced the degree of utilization of PHC facilities by NHI participants and that the differences arose from variations in knowledge and experience. Strengthening these factors will rely upon an expanded role of government and community collaboration, emphasizing the needs of NHI participants.

The views of family physicians on National Health Insurance in Gauteng Province, South Africa.

Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level.Contribution:This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level.

Knowledge, Accessibility and Utilization of the National Health Insurance Scheme (NHIS) Among Registered Employees of Federal Government Institutions in Ebonyi State: Lessons for Medical Social Workers

ABSTRACT Like most low-and-middle-income countries, Nigeria has been finding it difficult to meet the basic needs of her populace including their health needs. Nigerians are dying of preventable diseases because of poverty and the lack of a functional healthcare system. As a result, the Nigerian government introduced the National Health Insurance Scheme (NHIS) to cater to the health needs of its population. This study assessed the knowledge, accessibility and utilization of the NHIS among registered employees of federal government institutions in Ebonyi state. The study used Focus Group Discussions (FGDs) and in-depth interviews (IDIs) to collect data from 43 participants. The collected data was analyzed using thematic analysis. Findings revealed that most of the participants have accessed and utilized the scheme and saw it as a good healthcare system. They also reported a lack of most of the prescribed drugs and inadequate personnel at the NHIS clinics which is impacting the effectiveness of the scheme. The paper recommends that NHIS should create more awareness about the scheme, and cover more dependents, drugs, tests, and treatment bills to make it more effective in healthcare delivery.

National health insurance scheme: perceived factors influencing enrolment and health-seeking behaviour among employees of federal government establishments in Ebonyi State, Nigeria

National health insurance scheme: perceived factors influencing enrolment and health-seeking behaviour among employees of federal government establishments in Ebonyi State, Nigeria

Maternal health care utilization following the implementation of the free maternal health care policy in Ghana: analysis of Ghana demographic and health surveys 2008–2014

BackgroundIn July 2008, Ghana introduced a ‘free’ maternal health care policy (FMHCP) through the national health insurance scheme (NHIS) to provide comprehensive antenatal, delivery and post-natal care services to pregnant women. In this study, we evaluated the ‘free’ policy impact on antenatal care uptake and facility-level delivery utilization since the policy inception.MethodsThe study used two rounds of repeated cross-sectional data from the Ghana Demographic and Health Survey (GDHS, 2008–2014) and constructed exposure variable of the FMHCP using mothers’ national health insurance status as a proxy variable and another group of mothers who did not subscribe to the policy. We then generated the propensity scores of the two groups, ex-post, and matched them to determine the impact of the ‘free’ maternal health care policy as an intervention on antenatal care uptake and facility-level delivery utilization, using probit and logit models.ResultsAntenatal care uptake and facility-level delivery utilization increased by 8 and 13 percentage points difference, observed coefficients; 0.08; CI: 95% [0.06–0.10]; p < 0.001 and 0.13; CI: 95% [0.11–0.15], p < 0.001, respectively. Pregnant women were 1.97 times more likely to make four plus [a WHO recommended number of visits at the time] antenatal care visits and 1.87 times more likely to give birth in a health care facility of any level in Ghana between 2008 and 2104; aOR = 1.97; CI: 95% [1.61–2.4]; p < 0.001 and aOR = 1.87; CI: 95% [1.57–2.23]; p < 0.001, respectively.ConclusionsAntenatal care uptake and facility-level delivery utilization improved significantly in Ghana indicating a positive impact of the FMHCP on maternal health care utilization in Ghana since its implementation.

National Health Insurance Scheme: Effect of Out-of-Pocket Payment and Access to Health Services. A Case Study of Federal Medical Center, FMC, Jabi, Abuja

National Health Insurance Scheme: Effect of Out-of-Pocket Payment and Access to Health Services. A Case Study of Federal Medical Center, FMC, Jabi, Abuja

Assessment of Structural and Process Factors in Delivering Quality Adolescent Sexual and Reproductive Health Services in Ghana.

Sexual and reproductive health services are often underserved to adolescents in many societies. For many of these sexually active adolescents, reproductive health services such as the provision of contraception and treatment for sexually transmitted infections, either are not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. This study assessed the structural and process factors available in delivering quality adolescent sexual and reproductive health (ASRH) services in health facilities across three regions in Ghana. A facility-based descriptive cross-sectional study assessed the structural and process factors available for delivering quality adolescent sexual reproductive health services in 158 selected health facilities across three regions (Oti, Eastern, and Volta) of Ghana. A simple random sampling by balloting was used to select the health facilities and a total of 158 adolescents who used ASRH services in the selected facilities were sampled for an existing interview. The Donabedian model of quality assessment was adopted and modified into an assessment tool and a questionnaire to assess the selected health facilities and respondents. The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyze the data collected and the findings presented in the tables. The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. A proportion of 85 (53.50%) of the facilities assessed did not have separate spaces for delivering services for adolescents. All 158 health facilities had the National Health Insurance Scheme (NHIS) covering contraceptive/family planning services for adolescents. Most (128, 81.01%) facilities had available educational materials on ASRH but were not made available for take home by adolescents. The findings indicated that most respondents did not require parental, spouse, or guardian consent before using ASRH services. The average waiting time for adolescents to be attended to by service providers was ≤30 minutes. The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. ASRH services, particularly contraceptive/family planning services, were well integrated into NHIS to improve access and utilization by adolescents.

DETERMINANTS IN NATIONAL HEALTH INSURANCE SCHEME AWARENESS AND PARTICIPATION IN KADUNA STATE

National Health Insurance Scheme (NHIS) is a social basic service offered by the Federal Government of Nigeria to its citizen, in order to achieve universal healthcare (UHC) coverage but its progress seems to be facilitated or hindered by some factors. This paper seeks to access the determinants of NHIS participation of Kaduna State. Adopt multiple stages sampling in the collection of data from 400 respondents. Frequencies, percentages and tables were used to present results obtained but applied Pearson product moment correlation coefficient to test for significant relationship at 0.01significant levels. The result shows that majority (80.1%) of NHIS participants in the study are within the productive and reproductive age group, married with children, have a minimum household size of five but enrolled 3-4 family members (28.8%), educated, 45% are income earners that obtain health services from mainly private HCFs with distance that is less than 5km, and awareness in NHIS had positive relationship with age, sex, number of children and household size. Positive relationship existed between age, household size, education, monthly income earned and immediate participation in NHIS while duration in NHIS participation had positive relationship with income and immediate participation in NHIS but employment status had a negative relationship. The paper recommends a comprehensive public awareness on NHIS participation that surpasses the office environment and encourages informal sectors to participate in NHIS is needful and avoids delay in participation after been informed about the scheme, for a successful UHC coverage.

Gaussian process emulation to improve efficiency of computationally intensive multidisease models: a practical tutorial with adaptable R code

BackgroundThe rapidly growing burden of non-communicable diseases (NCDs) among people living with HIV in sub-Saharan Africa (SSA) has expanded the number of multidisease models predicting future care needs and health system priorities. Usefulness of these models depends on their ability to replicate real-life data and be readily understood and applied by public health decision-makers; yet existing simulation models of HIV comorbidities are computationally expensive and require large numbers of parameters and long run times, which hinders their utility in resource-constrained settings.MethodsWe present a novel, user-friendly emulator that can efficiently approximate complex simulators of long-term HIV and NCD outcomes in Africa. We describe how to implement the emulator via a tutorial based on publicly available data from Kenya. Emulator parameters relating to incidence and prevalence of HIV, hypertension and depression were derived from our own agent-based simulation model and other published literature. Gaussian processes were used to fit the emulator to simulator estimates, assuming presence of noise for design points. Bayesian posterior predictive checks and leave-one-out cross validation confirmed the emulator’s descriptive accuracy.ResultsIn this example, our emulator resulted in a 13-fold (95% Confidence Interval (CI): 8–22) improvement in computing time compared to that of more complex chronic disease simulation models. One emulator run took 3.00 seconds (95% CI: 1.65–5.28) on a 64-bit operating system laptop with 8.00 gigabytes (GB) of Random Access Memory (RAM), compared to > 11 hours for 1000 simulator runs on a high-performance computing cluster with 1500 GBs of RAM. Pareto k estimates were < 0.70 for all emulations, which demonstrates sufficient predictive accuracy of the emulator.ConclusionsThe emulator presented in this tutorial offers a practical and flexible modelling tool that can help inform health policy-making in countries with a generalized HIV epidemic and growing NCD burden. Future emulator applications could be used to forecast the changing burden of HIV, hypertension and depression over an extended (> 10 year) period, estimate longer-term prevalence of other co-occurring conditions (e.g., postpartum depression among women living with HIV), and project the impact of nationally-prioritized interventions such as national health insurance schemes and differentiated care models.

Factors Influencing Treatment Adherence Among Newly Diagnosed Diabetic Clients of Ledzokuku Krowor Municipal Assembly (Lekma)

The study focused on assessing compliance among newly diagnosed diabetic client in Ledzokuku Krowor Municipal Assembly (LEKMA) Hospital. A descriptive survey design was adopted and 120 diabetic patients were sampled using random sampling techniques. A self-developed questionnaire instrument was the main data collection tool and quantitative analysis was used with the aid of IBM SPSS (v.23). The study found that most of the respondents were of the view that diabetes mellitus was hereditary. It was recorded that all respondents considered hospital-based treatment as effective in treating the condition.  About 90 (72.0%) were of the view that of a diabetic patient skipped a dose, he/she was to ignore that dose and wait till the time for the next dose. Moreover, 116 (92.0%) respondents shared with researcher that diabetics were supposed to avoid all fatty foods. All respondents visited the hospital facility on a monthly basis to receive medical-care.  Female turn to have adhered more to their medication regimen than the males did, but it was not statistically significant (t=.047, p= .963). Age has negative relationship (r = -.123, p= 533) with their adherence to medication. It was realized that those who had secondary education adhered mostly to diabetic medications followed by tertiary education and primary education attainers respectively.  There was a positive relationship (r = .050, p=0.732) between the marital status, occupational status (r = .272, p = .056) of respondents and their adherence status to taking medications.  Respondents (40%) disagreed that prescribed medications were fully covered under the National Health Insurance Scheme (NHIS).  All of the respondents agreed that finance was a challenge to seeking treatment and medical care for the management of DM. About 40 percent of the respondents feared about side effect of drugs. It was recommended that government should extend the NHIS to cater for DM medications. There was also the need that government subsidized the treatment cost of patients seeking for healthcare with respect to DM