Services In Ghana Research Articles

Mediation and moderation effects of health system structure and process on the quality of mental health services in Ghana – structural equation modelling.

Incorporating consumers' perspectives into the quality of mental health service measurement is a growing priority among mental health professionals' and policymakers. Despite this, there is limited empirical evidence related to consumer perspectives of quality of mental health services. This study, therefore, aims to measure the mediation and moderation effects of health system structure and process on mental health quality in Ghana. A random sample of 510 consumers were recruited to complete the Verona Satisfaction Scale (54-items), together with the WHO Disability Assessment Instrument (36 items) using the Redcap application. Confirmatory factor analysis (CFA) and Structural Equation Modelling were used to test the hypothesised theory using STATA 15. The CFA showed that the hypothesised model had a good fit to the data. The findings confirmed the hypothesis that the process constructs mediate the relationship between the health system structure and the outcome of mental health services. Specifically, the health system structure had a positive and significant causal relationship with the mediator-process (β = 0.60; p<0.01) and outcome (β = 0.47; p<0.01). Additionally, the mediator-process had a positive causal relationship with the outcome of the mental health services (β = 0.32; p<0.01). Insurance status (β = 0.07; p>0.05) and type of services (β = 0.025; p>0.05) had a positive moderating effect on the relationship between health system structure and outcome but were not significant. Improvements to mental health system structure and the process could promote the quality of services as experienced by consumers. Government stakeholders are encouraged to accordingly strengthen health systems with the aim of improving the mental health outcomes for consumers.

Developing survivorship services in Ghana and Tanzania.

e24132 Background: The incidence of breast cancer is increasing in low- &amp; middle- income countries (LMICs). Alongside attempts to reduce the disparity in cancer survival between high-income countries (HIC) &amp; LMICs, it is important that survivorship is well understood and managed in an evidence based, resource and culturally sensitive manner. This project aimed to develop knowledge, skills and services concerning living with and beyond breast cancer primary treatment. Methods: This 3-phase study used mixed methods. Phase 1 used participant observation and focus group interviews (FGIs) to scope experience, resources, current practice, and challenges to implementing a recovery package. In Phase 2 nurses used the adapted Holistic Needs Assessment (HNA) with 500 women in Tanzania and Ghana, who were also offered a recovery care plan and treatment summary following their breast cancer primary treatment. Data was entered into a macro database &amp; analysed using descriptive statistics. Phase 3 was the development of a culturally sensitive “Foundations in Cancer Care” training toolkit for nurses. The toolkit was based on a “train the trainer” model and included slides, an existing palliative care toolkit and exercises. The training programme consisted of 5 days teaching covering theory and practice. Data collection included: Initial FGIs to ascertain learning needs, confidence in knowledge &amp; skills, assessed pre &amp; post teaching course, and course evaluation. Data were analysed using descriptive statistics. Results: In Phase 1 six themes were identified concerning experience of breast cancer which included cultural beliefs &amp; practices and access to treatment &amp; support. Phase 2 data from Tanzania showed a similar level of unmet need at the end of treatment to a previous similar published analysis from the UK. Data from Ghana showed a much higher level of unmet need. Evaluation following Phase 3 showed a positive change in nurses’ confidence in their knowledge. Conclusions: This mixed methods three-phase study has documented experience, resources and current practise around breast cancer survivorship in two African centers treating breast cancer. The feasibility of using HNA to identify unmet needs in these women has been demonstrated and needs the identified. Results from the HNA informed a training toolkit which was implemented and positively received and could be adapted for use in other LMICs.

PIH58 GEOGRAPHICAL DISPARITIES IN NON-UTILIZATION OF HEALTH FACILITY DELIVERY AND POSTNATAL SERVICES IN GHANA

Non-utilization of obstetric services results in higher rates of maternal and child mortality, and is clearly a threat to achieving the sustainable development goals (SDGs) on maternal and child health in sub-Saharan African countries including Ghana. This study aims to: (1) identify communities with high risk of non-usage of health facility delivery and postnatal services to highlight areas that need critical attention, (2) examine the influence of community-level factors on non-utilization of health facility delivery and postnatal services in Ghana to inform targeted policies and programs to reduce these discrepancies across communities. This study used aggregated socio-demographic variables and Global Positioning System (GPS) data from the 2014 Ghana Demographic and Health Survey (GDHS) dataset to identify the community-level risk factors for non-utilization of health facility delivery and postnatal services using a negative binomial regression model. In addition, spatial Poisson-based models were conducted using Spatial Scan Statistics to identify communities with high rates of non-usage of health facility delivery and postnatal services. Hotspots of non-use of health facility delivery and postnatal services were identified and were found to be especially concentrated among communities in the Northern region of Ghana. The analyses indicated that a woman who dwells in a community that is rural with a poverty rate above national level and a longer distance to a health facility has an increased risk of non-utilization of health facility delivery. High-risk communities were identified in this study using special analyses. The concentration of non-utilization of obstetric services among certain communities highlights the need to formulate community-specific strategies to improve uptake of maternal health services. The empirical evidence generated by this research could help planning and resource allocation to reduce health inequities.

Abortion knowledge and experiences among young women and men in Accra, Ghana

Background : Despite the presence of legal abortion services in Ghana, unsafe abortion remains common, particularly among young women. Little is understood about what young people know about safe and legal abortion, and if and how they are utilizing it. Methods : To characterize abortion use and address gaps in safe access, from September-December 2013, we conducted a cross-sectional survey with 100 men and 250 women aged 18-24 in Accra, Ghana. Participants were asked about abortion experiences, including prior services, providers, methods, satisfaction, perceived support, and knowledge of laws. Descriptive statistics, Fisher’s exact tests, and chi-square tests were performed. Results : Among surveyed youth, most (87% of women, 64% of men) thought abortion was illegal or did not know the law. In total, 30% of women and 14% of men ever had an abortion and partner who had an abortion, respectively. Among women’s most recent abortions, medication abortion (61%), surgical methods (26%), and unsafe methods categorized “least safe” (14%) were the initial or only methods used. Most women who accessed medication abortion initially or as their only method saw a pharmacist (40%) or no one (33%). Nearly one-quarter of women (n=16, 24%) who initially took tablets used more than one method. Conclusions : Despite experiences with abortion, most young people in this study were unaware of its legality and unsafe abortions occurred. More needs to be done to ensure young people understand the law and have access to safe methods, and that pharmacists are trained to provide appropriate doses and formulations of medication abortion.

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.

Modelling the performance of waste management services in Ghana’s public hospitals

PurposeThe purpose of this paper is to explore and establish key performance indicators that could be considered towards improving the delivery of waste management (WM) services in public hospitals.Design/methodology/approachAn exploratory sequential mixed-methods approach was adopted for this study. This involved two phases of data collection and analysis. Specifically, interviews in selected case studies hospitals and a general questionnaire survey. Partial least squares structural equation modelling was used to model the relationships among the performance variables. An expanded balanced scorecard typology was used to categorize performance variables.FindingsThe results demonstrate that quality and internal business strategic indicators have a significant influence on WM performance. By implication, public hospital managers would be well advised to invest resources in improving internal business operations, learning and growths, as well as prioritizing finance in the process of managing healthcare waste.Practical implicationsThe developed WM structural model can be used to identify performance indicators that can be incorporated into public hospitals’ WM strategy to improve performance leading to a decent healthcare environment.Originality/valueThe majority of studies have centered on the knowledge and practices of healthcare WM. This study extends the knowledge of healthcare WM literature from the perspective of FM performance measurement. The developed model of the study is invaluable to many developing countries that are faced with the challenge of improving WM practices.

Persistence of the inverse care law in maternal health service utilization: An examination of antenatal care and hospital delivery in Ghana.

The gap in maternal health outcomes, access and utilization between the haves and have-nots continues to be a challenge globally despite improvements over the past decade. Though Ghana has experienced steady gains in maternal health access and utilization over the years, maternal outcomes, on the other hand, remain poor. In this regard, it is essential to know how various groups in the population achieved improvements and whether some women continue to be disproportionately disadvantaged. The paper performs an analysis of cross-sectional data from the 2017 Ghana maternal health survey to examine the existence of the inverse care law in maternal health services in Ghana. Using descriptive techniques and multivariate logistic regression models the study reveals a pro-rich and pro-urban gradient in the use of hospital facilities for delivery and antenatal care attendance — also, regions known for their high levels of poverty feature significantly lower rates of hospital deliveries. The paper concludes by stressing that unless policies are changed to accommodate these groups, overall gains in maternal health will continue to be incremental.

The effects of Ponzi schemes and revocation of licences of some financial institutions on financial threat in Ghana

PurposeThe purpose of this study was to assess the effects of the Ponzi schemes and revocation of licences of some financial institutions in Ghana on financial threat.Design/methodology/approachThe study adopted a quantitative research approach. Convenient sampling method was used to select 435 individuals from three regions in Ghana. Standardize questionnaire developed by the researcher was used as the main data collection instrument. The binary logistic regression was used to test the relationship between the dependent variable and the independent variables.FindingsThe results of the study showed a positive relationship between financial threat and job loss, general health, information search and loss of investment. However, negative relationship was identified between financial threat and total debt, stress, economic hardship and anxiety. Findings from this study imply that job loss, general health, information search and loss of investment are major factors that determined financial threat in Ghana.Practical implicationsThis indicates that individuals in Ghana have become uncertain regarding the use of current and future financial services in Ghana because most individuals have lost their jobs in the financial institutions, cannot get access to safe drinking water and education, need to gather more information before investing in financial institutions in Ghana and losing of funds invested.Originality/valueThis study is the first to test the effects of the Ponzi schemes and the revocation of licences of some financial institutions in Ghana on financial threat using binary logistic regression.

Caregiving motivations and experiences among family caregivers of patients living with advanced breast cancer in Ghana.

Significant number of women present with advanced-stage breast cancer in Ghana. These women usually depend on family caregivers for their multi-dimensional needs. Yet, there are gaps in research about what motivates family caregivers to assume the caring role and their experiences with caregiving within the Ghanaian context. To explore and describe the caregiving motivations and experiences among family caregivers of patients living with advanced breast cancer. In-depth, semi-structured qualitative interviews were conducted with 15 family caregivers who were providing unpaid care for women living with advanced breast cancer. Colaizzi's thematic analysis was used to analyze the data. Family relationship normally prescribed the caregiving role among family caregivers. Due to the lack of home-based palliative services in Ghana, findings suggest that family caregivers are the main managers of advanced breast cancer-related symptoms in the home. These findings are discussed under three major themes: (i) motivation for assuming the caregiving role; (ii) meeting self-care and psychosocial needs of the patient; and (iii) symptom management and monitoring. Socio-cultural values influence the role of family caregivers in Ghana. This presents opportunities for health professionals and relevant stakeholders to develop a culturally-appropriate intervention to support informal caregivers in their home-based care for women living with advanced breast cancer in Ghana.

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. &#x0D; 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.&#x0D; 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.&#x0D;

Fiber optic deployment challenges and their management in a developing country: A tutorial and case study in Ghana

AbstractThe telecommunication industry in Ghana has undergone various stages of transformation. The industry has experienced exponential growth over the last decades. Sustaining this growth hinges on efficient infrastructural deployment and management. Fiber optics technology has become the primary network infrastructure and a communication medium, which provides higher bandwidth capacity high speed for current and emerging technologies. As the demand for new technology and services increases, fiber optics technology brings the promise of a flexible, scalability, full‐service network platform with potentially unlimited capacity. Although mobile network operators have invested significantly and strategically in fiber optic infrastructure, there has been an increase in the number of network outages caused by frequent failures in fiber optics networks such as fiber cable cuts. Fiber cable cuts have become the single most significant cause of transmission failure or disruption to telecommunication services in Ghana with an enormous impact on the subscriber's experience. This research seeks to investigate the challenges in fiber cable deployment in Ghana, with emphasis on the technical, regulatory, managerial challenges and recommend the appropriate solutions. The challenges of frequent fiber cuts can be attributed to external factors such as dig‐ups during road construction. Lack of regulatory guidelines and policies on fiber deployment and management poses a major threat to the fiber management 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.

The Ghana Project in Psychiatry: A Systematic Description of the Mental Health Services

Introduction: Mental health is a neglected field within the health care system in Ghana. Studies and public education focusing on mental health remain low, leading to poor knowledge and awareness of mental health among the population. Objective: The overall aim of this study was to provide a systematic description of mental health services in Ghana. Methods: A snowball technique was used to select a total of 42 mental health professionals from six hospitals for interviews. A structured questionnaire was used for data collection. Results: Major findings of this study include inadequate human and material resources; poor knowledge of mental health among the population; weak coordination between general practitioners and mental health professionals; inadequate mental health services in schools and prisons. Additionally, 54.8% of respondents reported limited mental health educational materials, and most schools (54.8%) lacking trained resident mental health professionals. The main interventions for service delivery are taking over activities of daily living by nurses, problem assessment, and psychological interventions which achieved the same results (69%). A tendency to consult faith-based healers and prayer camps; a lack of mental health research capacity, specifically research focusing on policies; and weakness in the organization and decentralization of mental health services in Ghana are among the common challenges to seeking care. Conclusion: Public mental health education on available resources and services is important. Capacity research focusing on dissemination and implementation of mental health policies can serve as the basis for addressing mental health challenges and improving service delivery in Ghana.

Effects of International and Internal Remittances on Financial Inclusion in Ghana

This article examines the relationship between remittances and financial inclusion in Ghana. The data for the study was extracted from the results of an analytical review of the living standards survey indicators in Ghana. The methodological tools of the study are represented by a regression equation based on the use of the Force Entry Method to test the functioning of variables in the model. The study empirically confirms and theoretically proves that domestic remittances have a positive and significant impact on access to financial services, while international remittances affect the likelihood of opening a bank account, but do not have any significant impact on applying for a loan and lending to remittance households. It is substantiated that domestic and international money transfers have a significant positive impact on the opening of bank accounts, even when forging collateral. Based on the results of calculations, the paper substantiates the conclusion that remittances contribute to increasing the availability of financial services in Ghana. It was noted that domestic remittances have a greater potential to improve financial inclusion in Ghana than international remittances. The paper emphasizes that the provision of collateral is an important lever for lending to households. Remittances will have very little impact on financial inclusion when financial institutions require collateral to facilitate the application and grant. According to the results of the study, the following recommendation were provideds: development of a strategy to improve domestic remittances to increase indicators of financial inclusion and economic development; improving the conditions for remittances, especially domestic remittances, in order to ensure their flexibility and deepen financial integration; use of domestic remittances as collateral for household loans. Keywords: collateral, financial inclusion, financial institutions, Ghana, remittances, loan application, migration.

Religion and the State in an Episodic Moment of COVID-19 in Ghana

The goal of this paper is to discuss the role religions are playing to stem the tide against the spread of coronavirus (COVID-19) in Ghana. Focusing on the ubiquity of religions in Ghana, the paper argues that religious experts deploy their ability to invoke the transcendental being to compel adherents to comply with the lockdown rules, as well as follow precautionary measures to fight the virus in Ghana. The paper also maintains that the state has taken advantage of the current crisis at hand to pass a law that is potentially dangerous for the future of religious freedom in Ghana. Methodologically, I draw on critical reflections on electronic and social media reports about religion and humanitarian services in Ghana to argue that religions are bridging the mundane and spiritual gaps to aid the state, while the state is also creatively engaging religions to invest in prayers and also pass laws that are potentially inimical to the future of religious freedom.

Provider and Consumer Perceptions on Mobile Money and Microfinance Integrations in Ghana: A Financial Inclusion Approach

This study examines the use and impact of mobile money and microfinance services in Ghana. It explores the perspectives of mobile money and microfinance service providers and consumers to identify the nature and extent of use, and their separate and complementary impact on financial inclusion. Qualitative data collected through interviews with service providers, agents, and consumer focus groups were used to draw parallels and contrasts between provider and consumer perceptions on impacts and challenges of the systems. The study addressed four specific objectives identified as provider perceptions on mobile money and microfinance integrations and financial inclusion; consumer perceptions on mobile money and microfinance integrations and financial inclusion; impacts of mobile money and microfinance integrations on the financial inclusion ecosystem; and challenges of mobile money and microfinance integrations for financial inclusion in Ghana. The results showed that provider perceptions primarily focus on consumer access, product range, convenience, and regulatory climate. Consumer perceptions also focus on network capacity, fraud and security, and complex user designs. The impacts of mobile money integrations appear to be additive for most users but also transformative for users who were previously excluded from the formal financial sector. However, there are eminent challenges related to system failures, fraud and security concerns, and consumer protection to be addressed to help facilitate the efficiency and sustainability of the mobile money ecosystem.

Social Support Systems and the Self-Management of Non-Communicable Diseases (NCDs) in Ghana

There is a large body of literature on the role of social support systems in the management of chronic conditions in the West, with limited research on the sub-Saharan African and Ghanaian context. In the past, the organization and delivery of formal health services in Ghana were geared towards the treatment of infectious diseases rather than non-communicable diseases (NCDs). We conducted qualitative interviews with a sample of 33 NCD patients purposefully selected from two teaching hospitals in Ghana. The information they provided indicated that the most common types of support received were instrumental and emotional. While a majority of stroke patients experienced activity limitations related to bathing and cooking, they received the emotional support necessary to maintain their psychological well-being. Overall, we found social connections and relationships were an important strategy in the promotion of the physical and mental well-being of these NCD patients.

Access to Adolescent Pregnancy Prevention Information and Services in Ghana: A Community-Based Case-Control Study.

Background: Pregnancy among girls 10–19 years remains a challenge that requires critical resolution all over the world. Despite this worrying sexual phenomenon, research pertaining to prevention information and related services in Sub-Saharan nations like Ghana is sparse. This study sought to determine the influence of access to pregnancy prevention information and services on adolescent pregnancy in the Komenda-Edina-Eguafo-Abrem Municipality in the Central Region of Ghana.Methods and Results: Adopting a matched case-control research design with a 1:1 mapping, female adolescents aged between 15 and 19 years in the KEEA Municipality were selected using a facility based sampling technique. Results from both bivariate and multivariate analyses revealed that non-pregnant adolescents were about two times more likely to have access to pregnancy prevention information from health workers compared to pregnant adolescents [OR = 0.57, 95% CI = (0.33–0.96), p = 0.036]. Likewise, pregnant adolescents were five times more likely to have access to pregnancy prevention information from media compared to non-pregnant adolescents [OR = 5.44, 95% CI = (2.64–11.23), p = 0.000]. Additionally, non-pregnant adolescents were two times more likely to receive information on pregnancy prevention from school compared to pregnant adolescents [OR = 0.48, 95% CI = (0.28–0.81), p = 0.006].Conclusion: Sexuality and reproductive health (SRH) programme organizers should target specific intervention programmes that focus on training health workers and/or other analogous staff to enhance their awareness, attitudes, and skills to more effectively meet with the specific needs of adolescents. Specific health workers training and redesign of health facilities to foster more adolescent user friendly working environment (e.g., extension in operational times, reduction in fees of SRH services, transforming physical design to promote privacy or confidentiality) ought to be encouraged. Different media outreach programmes should also combine other community level events [e.g., informative methods through schools (e.g., focus group discussions, participatory learning), assisting connections to health services, community information network (e.g., use of sirens)] to provide well–tailored advocacy that would help modify SRH and sociocultural norms that hinder positive sexual behaviors among young people.

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.

Rural Transport Services Indicators: Using a new mixed-methods methodology to inform policy in Ghana

Rural people need access to markets and services. In developing countries, where private vehicle ownership is limited, villagers depend on public transport services. However, research evidence available to inform policy formulation is often extremely limited. To better understand the characteristics, costs, frequencies and acceptability of rural transport services in Ghana, data was collected using a methodology developed by the International Forum for Rural Transport and Development. This methodology combines traffic count data with structured qualitative interviews with transport users, operators, regulators and local development experts. A key finding concerned motorcycle taxis which, although officially banned in 2012, remain a common sight in rural Ghana and are generally appreciated by transport users and other stakeholders. Following our presentation of findings to an audience of national stakeholders and policy-makers, a consensus emerged to continue restricting commercial motorcycle operations in cities and on highways, but allowing them on rural roads, if combined with appropriate safety training and regulations. These findings feed into an ongoing policy debate about motorcycle taxi transport in Sub-Saharan Africa.