Upper East Region Research Articles

The Importance of a Continuous Customer Relationship Management on the Profitability of Financial Institutions: A Study of Ghana Commercial Bank Ltd in Ghana

Purpose: the purpose of this study is to investigate the impact of Customer Relationship Management (CRM) on customer satisfaction, customer loyalty, customer retention and the profitability of financial institutions particularly banks in the service sector in Ghana. Design/Methodology: the study adopted a quantitative research method approach to describe the impact of the CRM on the profitability of service brand offering in the banking sector in Ghana, worthy for generalization. The study sampled four (4) branches of the Ghana Commercial Bank Ltd in a convenient manner in the Northern and Upper East Regions of Ghana. The two branches of the bank namely; the Bolgatanga main branch and the Navrongo main branch were selected in the upper East Region while the Walewale and Savelugu branches were picked in the Northern Region making the total of four branches of the Ghana Commercial Bank Ltd. In all, three hundred questionnaires were administered on customers comprising two hundred and eighty external customers and twenty internal customers. That is, seventy external customers and five employees from each branch selected. Findings: the study found that, the bank is doing well in terms of profitability because of its strong or vibrant CRM policies. The study revealed that a concrete CRM which is grounded on a strong relationship with a customer, conducive working environment, providing a quality and reliable service and being customer friendly lead to customer satisfaction, loyalty, and retention and therefore increases the bank’s profit. The customers are satisfied with the services provided by the bank and have decided to remained with the bank without switching off to a different bank. These satisfied customers do recommend the bank and its services to other people who are not customers of the bank and this had resulted in customers trafficking and hence an increased in the profit level of the bank. The study found that CRM; Customer Satisfaction Survey; Customer loyalty; Customer retention and Profitability are effectively correlated. Research Limitation: the study was limited to Ghana Commercial Bank Ltd in the service sector in Ghana. However, the findings can be applied to all banks in the service sector in Ghana because the needs of the banks customers and those in different banks are the same. Practical Limitation: the employees and other important stakeholders in the banking industry think that the responsibility of CRM rests solely on the staff at the marketing department rather than all the staff members of the entire bank. The present study urges all the employees working in the banks to be wary in their word-of-mouth communication with the customer and be ever prepared to offer reliable, satisfactory and quality services to the customers who called in. Originality/value: the current empirical study makes an original contribution to the existing literature by adding knowledge of the impact CRM in the context of banking institution in Ghana, where the moment of truth is highly evident.

The Agonies of Covid 19 on Vegetable Farmers Along the White Volta River Basin in the Upper East Region of Ghana

The emergence of COVID 19 coupled with the enforcement of its safety protocols, coincided with the peak of harvesting and saleof perishable vegetables in the 2020 dry season farming period in the Upper East Region of Ghana.Using a qualitative approach, this study investigates the effects of the pandemic on vegetable farmers along the White Volta River Basin in the Region. The findings are that there weredisrupted supply and demand in the production-consumption chain resulting in low sales; a shortage of hired labor; and high stigmatization. Farmers had few alternatives other than to leave their food stuff to rot on the farm, use the produce to feed livestock, or smuggleof the produce across borders. The implications are that the COVID 19 pandemic compounded the susceptibility of small-scale vegetable farmers in the region. Their resilience and household income levels are adversely affected.

English

In spite of several strategies implemented to improve sorghum production in Ghana, average grain yield in farmers’ fields remains low and far below the estimated potential. The development of effective strategies requires continuous, in-depth understanding of production constraints as well as farmer preferences for crop traits. To this end, a participatory rural appraisal using focus group discussions, interviews with semi-structured questionnaires and preference ranking was carried out among 122 smallholder sorghum farmers in the Upper East Region of Ghana. Majority (91%) of respondents were engaged in farming with more than half of their farm sizes allocated to sorghum cultivation. Drought, high cost of farm inputs and declining soil fertility were the top three constraints. Almost 42% of farmers described their soils as low in fertility. The most preferred traits by farmers were drought tolerance, high grain yield, earliness, grain quality as well as low fertilizer requirement. A better understanding of the perceptions of farmers and factors that limit the adoption of improved technology is important to guide policy towards the design of effective crop improvement and extension programmes. The study highlights the importance of breeding sorghum varieties with traits preferred by smallholder farmers that will lead to increased adoption of improved technology.  Key words: Sorghum bicolor, smallholder farmers, perception, production constraints, farmer-preferred traits.

Framing of COVID-19 safety protocols in Kusaal musical health communication: Language and literary analysis

This article examines how indigenous language and music are used to promote the education of the Kusaal-speaking communities within the Upper East Region of Ghana on the COVID-19 safety protocols. Using the framing theory, the study conceptualises how the music composer frames COVID-19 safety protocols in a very practical yet entertaining manner to evoke adherence by natives to the protocols through a local musical performance called googi. The singer who doubles as the composer employs several language, linguistic and literary techniques to communicate the major themes (COVID-19 protocols) of the song. Further, the music communicates hope and promise in the capacity of ancestral deities to step back into time during periods of catastrophe to alleviate the sufferings of their subjects. The paper is entirely qualitative; it deploys the parallel text approach in transliterating the song. This study is the first of its kind in Kusaal and in the Mabia languages of West Africa and it has the potential of contributing significantly to debates around the subject matter. Future studies could examine how other local languages could be adopted as edutainment tools in the fight against global pandemics.

Impact of Mathematics Anxiety on the Academic Performance of Junior High School Pupils in the Bongo District of Ghana Stanley Appiah Essuman, Josephine Nyarko, Kwarteng Frimpong

This study aimed to explore the impact of mathematics anxiety on the academic performance of junior high school pupils in the Bongo district of Ghana. In this study, 492 pupils in the Bongo District of the Upper East Region of Ghana were sampled. Using a questionnaire to gather data for the study, Descriptive statistics such as frequency, percentage, mean, and standard deviation and inferential statistics such as the independent samples t-test, one-way between-groups analysis of variance (ANOVA) and Pearson Moment Correlation were used for analysis. Findings from the study identified that mathematics anxiety negatively affects the mathematics performance of pupils and the study also revealed that, gender plays a very key role in influence the mathematics anxiety of pupils. Based on the findings, it was recommended that mathematics teachers should teach Mathematics with the psychology of teaching and learning the subject to prepare pupils’ for the subject.

Health-seeking behaviour and cost of fever treatment to households in a malaria-endemic setting of northern Ghana: a cross-sectional study

ObjectivesTo examine the health-seeking behaviour and cost of fever treatment to households in Ghana.DesignCross-sectional household survey conducted between July and September 2015.SettingKassena-Nankana East and West districts in Upper East region...

Mapping land suitability for informal, small-scale irrigation development using spatial modelling and machine learning in the Upper East Region, Ghana

Small-scale irrigation has gained momentum in recent years as one of the development priorities in Sub-Saharan Africa. However, farmer-led irrigation is often informal with little support from extension services and a paucity of data on land suitability for irrigation. To map the spatial explicit suitability for dry season small-scale irrigation, we developed a method using an ensemble of boosted regression trees, random forest, and maximum entropy machine learning models for the Upper East Region of Ghana. Both biophysical predictors including surface and groundwater availability, climate, topography and soil properties, and socio-economic predictors which represent demography and infrastructure development such as accessibility to cities and proximity to roads were considered. We assessed that 179,584 ± 49,853 ha is suitable for dry-season small-scale irrigation development when only biophysical variables are considered, and 158,470 ± 27,222 ha when socio-economic variables are included alongside the biophysical predictors, representing 77-89% of the current rainfed-croplands. Travel time to cities, accessibility to small reservoirs, exchangeable sodium percentage, surface runoff that can be potentially stored in reservoirs, population density, proximity to roads, and elevation percentile were the top predictors of small-scale irrigation suitability. These results suggested that the availability of water alone is not a sufficient indicator for area suitability for small-scale irrigation. This calls for strategic road infrastructure development and an improvement in the support to farmers for market accessibility. The suitability for small-scale irrigation should be put in the local context of market availability, demographic indicators, and infrastructure development.

Regulatory compliance among over-the-counter medicine sellers facilities within the Upper East Region of Ghana

BackgroundEasy access to medicines provided by private medicine retailing facilities including that of over-the-counter medicine retailers, have gained prominence in sub-Saharan Africa. Although over-the-counter medicine-sellers (OTCMS) facilities play an indispensable role in healthcare delivery, there is inadequate information about their regulatory environment and whether their operations conform to regulatory provisions. Hence, this study sought to investigate the characteristics and predictors of regulatory practices among over-the-counter medicine sellers in Ghana.MethodsThis was a cross-sectional study involving participants from 208 OTCMS facilities in eight (8) municipalities and districts (MDA’s) of the Upper East Region of Ghana. An initial census of facilities in the region was conducted between May and August 2016 and a follow-up conducted between December 2016 and March 2017. This ensured the identification and location of all OTCMS facilities within the selected MDA’s for study planning and data collection. The main outcome variable was regulatory compliance which is a composite of three indicators for regulatory practices (retention of medicine supplier’s invoices and receipts on-premises), licensing and registration requirements (appropriate signage), and equipment and material requirements (availability of reference material). Regulatory compliance was assessed using bivariate and multivariate logistic regression analyses.ResultsIn this survey, 21.5%, 38.2%, and 23.1% of the facilities surveyed had a good state of repair, had the owner of the facility available on the premises, and had received regulatory visit(s) in less than 12 months, respectively. Only 29.2% of facilities were regulatory compliant. After statistical adjustment, OTCMS facility location (compared with Rural: Urban, AOR = 4.2, 95% CI 1.74–10.17, p = 0.001) and staff trained in less than 1 year (AOR = 2.78, 95% CI 1.02–7.62, p = 0.046) were significantly associated with regulatory compliance.ConclusionsRegulatory compliance was low in the Upper East Region of Ghana, particularly across rural locations, where most of the facilities failed to meet the laid down provisions of the Pharmacy Council regarding practice, staff and premises requirements. This could be attributed to the fact that these areas are poorly resourced. Policymakers are been called on to put in place pragmatic measures in relation to OTCMS facility’s location and regulatory requirements to address the inequities in compliance.

Assessing the effect of improved feed trough on feed utilization by small ruminants in Northern Ghana

The feeding systems of small ruminants in Northern Ghana are characterized by waste which necessitates efficient use of the available feed resources, particularly in the dry season. To this end, the use of improved feed trough was demonstrated in three communities in Northern Ghana, namely Duko and Tibali in Northern region; Gia in Upper East region in the late dry, wet, and early dry seasons between March 2019 and February 2020. This study involved 10 farmers randomly selected in each community. The participating farmers were provided with one improved feed trough each which was then compared to the traditional feed trough. Data were collected on the quantity of feed offered, amount wasted, and time spent feeding the animals for six consecutive days in the three study sites across seasons. To document the perception of the farmers on the improved feed trough, a semi-structured questionnaire was administered. Results showed that improved feed trough reduced feed waste significantly in the study sites across seasons. For example, the percentages of waste in feeding the animals using the traditional feed trough were 35%, 22%, and 27% in Duko, Gia, and Tibali, respectively, in the late dry season compared to less than 1% with the improved feed trough during the same season. The farmers' perceptions were similar to the findings of this study which suggest that efficient feed utilization by small ruminants can be enhanced with the use of improved feed trough.

Prevalence, progress, and social inequalities of home deliveries in Ghana from 2006 to 2018: insights from the multiple indicator cluster surveys

BackgroundDelivery in unsafe and unsupervised conditions is common in developing countries including Ghana. Over the years, the Government of Ghana has attempted to improve maternal and child healthcare services including the reduction of home deliveries through programs such as fee waiver for delivery in 2003, abolishment of delivery care cost in 2005, and the introduction of the National Health Insurance Scheme in 2005. Though these efforts have yielded some results, home delivery is still an issue of great concern in Ghana. Therefore, the aim of the present study was to identify the risk factors that are consistently associated with home deliveries in Ghana between 2006 and 2017–18.MethodsThe study relied on datasets from three waves (2006, 2011, and 2017–18) of the Ghana Multiple Indicator Cluster surveys (GMICS). Summary statistics were used to describe the sample. The survey design of the GMICS was accounted for using the ‘svyset’ command in STATA-14 before the association tests. Robust Poisson regression was used to estimate the relationship between sociodemographic factors and home deliveries in Ghana in both bivariate and multivariable models.ResultsThe proportion of women who give birth at home during the period under consideration has decreased. The proportion of home deliveries has reduced from 50.56% in 2006 to 21.37% in 2017–18. In the multivariable model, women who had less than eight antenatal care visits, as well as those who dwelt in households with decreasing wealth, rural areas of residence, were consistently at risk of delivering in the home throughout the three data waves. Residing in the Upper East region was associated with a lower likelihood of delivering at home.ConclusionPolicies should target the at-risk-women to achieve complete reduction in home deliveries. Access to facility-based deliveries should be expanded to ensure that the expansion measures are pro-poor, pro-rural, and pro-uneducated. Innovative measures such as mobile antenatal care programs should be organized in every community in the population segments that were consistently choosing home deliveries over facility-based deliveries.

Trends of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence in selected regions across Ghana

Background: We set out to estimate the community-level exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ghana. Methods: Phased seroprevalence studies of 2729 participants at selected locations across Ghana were conducted. Phase I (August 2020) sampled 1305 individuals at major markets/lorry stations, shopping malls, hospitals and research institutions involved in coronavirus disease 2019 (COVID-19) work. The study utilized a lateral flow rapid diagnostic test (RDT) which detected IgM and IgG antibodies against SARS-CoV-2 nucleocapsid protein. Results: During Phase I, 252/1305 (19%) tested positive for IgM or IgG or both. Exposure was significantly higher at markets/lorry stations (26.9%) compared to malls (9.4%), with 41–60-year group demonstrating highest seropositivity (27.2%). Exposure was higher in participants with no formal education (26.2%) than those with tertiary education (13.1%); and higher in informally employed workers (24.0%) than those in the formal sector (15.0%). Results from phases II and III, in October and December 2020 respectively, implied either reduced transmissions or loss of antibody expression in some participants. The Upper East region showed the lowest seropositivity (2%). Phase IV, in February 2021, showed doubled seropositivity in the upper income bracket (26.2%) since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases. This suggested that high transmission rates had overcome the initial socioeconomic stratification of exposure risk. Reflective of second wave hospitalisation trends, the 21-40 age group demonstrated modal seropositivity (24.9) in Phase IV whilst 40-60 years and 60+ previously demonstrated highest prevalence. Conclusions: Overall, the data indicates higher COVID-19 seroprevalence than officially acknowledged, likely implying a considerably lower-case fatality rate than the current national figure of 0.84%. The data also suggests that COVID-19 is predominantly asymptomatic COVID-19 in Ghana. The observed trends mimic clinical trends of infection and imply that the methodology used was appropriate.

Using traditional agroecological knowledge to adapt to climate change and variability in the Upper East Region of Ghana

Ghana's susceptibility to climate change is well documented and the agricultural sector which is the backbone of the country's economy is one of the most vulnerable sectors to the adverse effects of climate change. This study employed both quantitative and qualitative research methods including household surveys and focus group discussions to examine the extent to which traditional agroecological knowledge is used to manage climate change in three selected communities (Gia, Gaani and Nyangua) of the Kassena Nankana Municipality in the Upper East Region of Ghana. The study specifically answers the following research questions: (i) What is the extent of rainfall and temperature changes in the municipality from 1983–2017? (ii) What is the perception of farmers on rainfall and temperature changes in the selected communities for the past three decades? (iii) What are the key adaptation practices used by farmers to reduce the threats of climate change? (iv) What are the traditional agroecological indicators used by farmers to predict rainfall in the study communities? Mann-Kendall trend test was used to assess rainfall and temperature trends over the study period. Results from the trend analysis indicated an inconsistent pattern in rainfall and an increasing trend in temperature in the municipality. Results also showed that farmers perceived decreasing trend in rainfall as well as increasing temperature. Farmers’ perception of decreased trend in rainfall was inconsistent with the analysed rainfall data as the trend of rainfall was statistically insignificant (p>0.05) and Sen's slope confirmed a positive slope indicating that amounts of rainfall had increased in the municipality. The farmers employed a variety of on-farm and off-farm practices including the use of traditional agroecological knowledge, use of improved varieties of crops and temporary migration to adapt to the impacts of climate change in the study communities. The farmers predicted rainfall onset using a variety of traditional agroecological indicators including direction of wind, croaking of frogs, appearance of cattle egret and flowering and fruiting of local trees. The study recommends the putting in place of a framework that blends traditional agroecological knowledge and scientific knowledge to develop effective climate change adaptation strategies.

Geographical variations and factors associated with recent HIV testing prevalence in Ghana: spatial mapping and complex survey analyses of the 2014 demographic and health surveys

ObjectiveTo examine the factors associated with recent HIV testing and to develop an HIV testing prevalence surface map using spatial interpolation techniques to identify geographical areas with low and high...

Common-pool community resource use: Governance and management of community irrigation schemes in rural Ghana

ABSTRACT The Hardian solutions to the excessive abuses of common-pool resources are still being contested. However, studies on governance and management of community irrigation facilities as a “common” in developing countries is limited. Contributing to literature on irrigation water management in the Global South, this paper examines the role of communities in the governance and management of small-scale irrigation dams in the Upper East Region of Ghana. The study employs a qualitative approach to research with 25 interviews and seven Focus Group Discussions (FGDs). Using a thematic approach to analysis, the study reveals that smallholder farmers through the Water Users’ Associations (WUAs) have defined user boundaries and instituted ground rules and regulations to enable them to sustainably manage these water resources for their activities of agriculture. Further results revealed that irrigable land for dry season gardening was equitably shared among farmers who are members of WUA, and as a result, minimized possible conflicts among the resource users. The study recommends the need for the Ministry of Food and Agriculture and the Ghana Irrigation Authority to provide more technical support to WUAs in the Upper East Region of Ghana to enable them to better manage these water resources.

Predictors of Pregnancy Termination among Young Women in Ghana: Empirical Evidence from the 2014 Demographic and Health Survey Data.

Pregnancy termination remains a delicate and contentious reproductive health issue because of a variety of political, economic, religious, and social reasons. The present study examined the associations between demographic and socio-economic factors and pregnancy termination among young Ghanaian women. This study used data from the 2014 Demographic and Health Survey of Ghana. A sample size of 2114 young women (15–24 years) was considered for the study. Both descriptive (frequency, percentages, and chi-square tests) and inferential (binary logistic regression) analyses were carried out in this study. Statistical significance was pegged at p < 0.05. Young women aged 20–24 were more likely to have a pregnancy terminated compared to those aged 15–19 (AOR = 3.81, CI = 2.62–5.54). The likelihood of having a pregnancy terminated was high among young women who were working compared to those who were not working (AOR = 1.60, CI = 1.19–2.14). Young women who had their first sex at the age of 20–24 (AOR = 0.19, CI = 0.10–0.39) and those whose first sex occurred at first union (AOR = 0.57, CI = 0.34–0.96) had lower odds of having a pregnancy terminated compared to those whose first sex happened when they were less than 15 years. Young women with parity of three or more had the lowest odds of having a pregnancy terminated compared to those with no births (AOR = 0.39, CI = 0.21–0.75). The likelihood of pregnancy termination was lower among young women who lived in rural areas (AOR = 0.65, CI = 0.46–0.92) and those in the Upper East region (AOR = 0.18, CI = 0.08–0.39). The findings indicate the importance of socio-demographic factors in pregnancy termination among young women in Ghana. Government and non-governmental organizations in Ghana should help develop programs (e.g., sexuality education) and strategies (e.g., regular sensitization programs) that reduce unintended pregnancies which often result in pregnancy termination. These programs and strategies should include easy access to contraceptives and comprehensive sexual and reproductive health education. These interventions should be designed considering the socio-demographic characteristics of young women. Such interventions will help to achieve Sustainable Development Goal 3.1 that seeks to reduce the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030.

Analysis of the Leaves of Five Sweet Potato Varieties for Their Nutrient, Mineral and Phytochemical Properties

Aim: To determine the nutrients, minerals and phytochemicals contained in leaves of five sweet potato varieties.&#x0D; Study Design: The study was carried out in the dry season from November 2018 to March 2019, using a randomized complete block design (RCBD).During planting, 10 cm length of each 30 cm long soft wood vine cutting was inserted into the soil and immediately watered. A space of 60cm was left between the plants and there were five vine cuttings planted per ridge. The order of planting the vine cuttings was the same on each replicate ridge. Each treatment had three replications with each replicate having five plants to give a total of75 vine cuttings in all. Leaves of the sweet potato varieties; Agric white (AW), Agric orange flesh (AO), Red skin (RS), Orange flesh (OF) and Red local (RL) were parceled; each variety in a separate parcel, appropriately labelled and sent to the Food Science Laboratory of Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, for analysis.&#x0D; Study Site: The sweet potatoes were cultivated in the experimental field of Ecological Agriculture Department, Bolgatanga Technical Universityin Bolgatanga Municipality of Upper East Region, Ghana.&#x0D; Methodology: Proximate analysis was done and nutrient content expressed in percentages (%). Concentrations of the minerals iron (Fe), potassium (K), calcium (Ca), zinc (Zn), manganese (Mn) and magnesium in milligrams per kilogram (Mg/Kg) were determined. Total phenolic content (TPC) as well as the concentrations of carotenoids and Flavonoids were also estimated and expressed in Mg/Kg. Antioxidant properties of the leaves was determined and reported in mg/Kg.&#x0D; Results: Proximate analysis of the leaves show that all five sweet potato varieties are very nutritious. Leaves of AW variety recorded the highest protein (6.17± 0.43%) and carbohydrates (8.61 ± 0.32%). The content of crude fibre is generally high in leaves of all varieties, ranging from1.42 ± 0.50% in AO to 2.42 ± 0.18% in OF. The proportion of fat in all the varieties is similar, averaging 2,096 ± 0.046%, with the highest of 2.25 ± 0.06% in AO. The two orange flesh varieties, OF and AO, had the highest and higher concentrations of iron (Fe) of 2,020.41 and 467.11 mg/Kg respectively. Magnesium (Mg) is the element that occurred in highest concentration of all the minerals, with an average concentration of 7,991.02 mg/Kg. The OF variety contained the highest concentration of total phenol of 875.00 ± 95.86 mg/Kg. With an average of 4,915.00 ± 166.00 mg/Kg, the concentration of flavonoids in all five varieties in the current study is similar. The concentration of total carotene decreased in the order RL&gt;RS&gt;AW&gt;AO&gt;OF, with the RL variety containing 124.22 ± 10.00 mg/Kg while the OF one possessed 49.39 ± 2.00 mg/Kg. The content pattern of beta carotene was RL&gt; RS&gt; AW&gt; OF&gt; AO, with RL variety containing 4.56 ± .03mg/Kg as AO had 1.57 ± 0.53 mg/Kg. The capacity of phytochemicals in the sweet potato varieties to scavenge and inhibit free radicals as well as reactive oxygen species [using the DPPH (1,1-diphenyl-2-picrylhydrazyl) assay] was highest in the OF variety (51.073%).&#x0D; Conclusion: Leaves of the five sweet potato varieties studied are rich in diverse nutrients and phytochemicals. Therefore, encouraging the growth and consumption of both leaves and root tubers is a cheaper means of reducing malnutrition and enhancing good public health. It is therefore, essential for more investigations to establish the nutrient content and nutrachemical capabilities of both roots and leaves of the different varieties of sweet potato in the different environments so as to equip the general public with appropriate information to guide dieting choices.

Land governance in Northern Ghana: Creating communities of practice between tribal leaders and the government

Land is of primary importance to rural people whose livelihoods are in one way or another linked to the property where they live and work. This is especially true in the rural region of the Upper East Region of Northern Ghana. However, developments such as de-agrarianization, establishment of protected land areas, urbanization, migration, land reform, resettlement and re-peasantization have dramatically changed lands and land use in rural communities. These changes have impacted not only rural communities’ sources of income and employment, but also their overall access to land and thus their livelihoods and future ability to care for themselves. In addition, these developments have impacted family relationships, culture and the peace of the people which are the building blocks of rural community living. The purpose of this paper is to provide a conceptual description of how land access, under the traditional system, can be reconciled with statutory law by communities of practice. Beyond just being a knowledge management tool that is employed for co-creating new compounds of shared knowledge, communities of practice can be used as standing committees that tie solid bonds within stakeholder groups and establish commonly accepted solutions to all problems related to a conflict-laden issue. In describing how this can be used to effectively merge the traditional with legislative land use policy, the paper provides an overview of the detrimental impact of land conflicts, the presence of dubious and unscrupulous land deals and of the role of women in these issues. It further discusses which specific provisions in Ghanaian law should prove to be effective. Yet, as the paper points out, central to the success of balancing the old with the new will be the continuation of the varied tasks performed by the traditional custodians of land, the “tindemba” (Earth priests are collectively called Tindaama/Tindaaba/ Tindaaduuma by the Gurure speaking people of Upper East Region, Tindemba by the Dagbani speaking speaking people of Northern Region and Tindaaba/Tendamba by the Gagaare speaking people of Upper West Region), who historically have always been involved in land transfers within the villages, as well as the important role which traditional leaders (tribal chiefs) need to play in land issues. The paper will demonstrate how communities of practices can be used to not only merge the old with the new, but also incorporate new policies that produce a more equitable structure in rural communities.

Assessing selection procedures and roles of Community Health Volunteers and Community Health Management Committees in Ghana's Community-based Health Planning and Services program.

BackgroundCommunity participation in health care delivery will ensure service availability and accessibility and guarantee community ownership of the program. Community-based strategies such as the involvement of Community Health Volunteers (CHVs) and Community Health Management Committees (CHMCs) are likely to advance primary healthcare in general, but the criteria for selecting CHVs, CHMCs and efforts to sustain these roles are not clear 20 years after implementing the Community-based Health Planning Services program. We examined the process of selecting these cadres of community health workers and their current role within Ghana’s flagship program for primary care–the Community-based Health Planning and Services program.MethodsThis was an exploratory study design using qualitative methods to appraise the health system and stakeholder participation in Community-based Health Planning and Services program implementation in the Upper East region of Ghana. We conducted 51 in-depth interviews and 33 focus group discussions with health professionals and community members.ResultsCommunity Health Volunteers and Community Health Management Committees are the representatives of the community in the routine implementation of the Community-based Health Planning and Services program. They are selected, appointed, or nominated by their communities. Some inherit the position through apprenticeship and others are recruited through advertisement. The selection is mostly initiated by the health providers and carried out by community members. Community Health Volunteers lead community mobilization efforts, support health providers in health promotion activities, manage minor illnesses, and encourage pregnant women to use maternal health services. Community Health Volunteers also translate health messages delivered by health providers to the people in their local languages. Community Health Management Committees mobilize resources for the development of Community-based Health Planning and Services program compounds. They play a mediatory role between health providers in the health compounds and the community members. Volunteers are sometimes given non-financial incentives but there are suggestions to include financial incentives.ConclusionCommunity Health Volunteers and Community Health Management Committees play a critical role in primary health care. The criteria for selecting Community Health Volunteers and Community Health Management Committees vary but need to be standardized to ensure that only self-motivated individuals are selected. Thus, CHVs and CHMCs should contest for their positions and be endorsed by their community members and assigned roles by health professionals in the CHPS zones. Efforts to sustain them within the health system should include the provision of financial incentives.

Effects of combined decision-support and performance-based incentives on reported client satisfaction with maternal health services in primary facilities: A quasi-experimental study in the Upper East Region of Ghana.

BackgroundComputerized decision-support systems (CDSS) and performance-based incentives (PBIs) have potential to contribute to client satisfaction with health services. However, rigorous evidence is lacking on the effectiveness of these strategies in lower-income countries such as Ghana. This study aimed to determine the effect of a combined CDSS-PBI intervention on client satisfaction with maternal health services in primary facilities in the Upper East Region of Ghana.MethodsWe employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey. Our analysis used difference-in-difference logistic regression, controlling for potential covariates, to compare variables across intervention and comparison facilities at baseline and endline.ResultsThe combined CDSS-PBI intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline. Antenatal client difference-in-difference of mean satisfaction scores were significant at endline for intervention (n = 378) and comparison (n = 362) healthcare facilities for overall satisfaction (DiD 0.058, p = 0.014), perception of providers’ technical performance (DiD = 0.142; p = 0.006), client-provider interaction (DiD = 0.152; p = 0.001), and provider availability (DiD = 0.173; p = 0.001). Delivery client difference-in-difference of satisfaction scores were significant at endline for intervention (n = 318) and comparison (n = 240) healthcare facilities for overall satisfaction with delivery services (DiD = 0.072; p = 0.02) and client-provider interaction (DiD = 0.146; p = 0.02). However, mean overall satisfaction actually reduced slightly in intervention facilities, while DiD for technical performance and provider availability were not significant.ConclusionThis combined CDSS-PBI intervention was associated with greater antenatal and delivery client satisfaction with some aspects of maternity services within two years of implementation. It could be expanded elsewhere if funds allow, though further research is still required to assess cost-effectiveness and long-term effects on client satisfaction and maternal health outcomes.

Challenges experienced by midwives working in rural communities in the Upper East Region of Ghana: a qualitative study

BackgroundIn 2017, a total of 295,000 women lost their lives due to pregnancy and childbirth across the globe, with sub-Saharan Africa and South Asia accounting for approximately 86 % of all maternal deaths. The maternal mortality ratio in Ghana is exceptionally high, with approximately 308 deaths/100,000 live births in 2017. Most of these maternal deaths occur in rural areas than in urban areas. Thus, we aimed to explore and gain insights into midwives’ experiences of working and providing women-centred care in rural northern Ghana.MethodsA qualitative descriptive exploratory design was used to explore the challenges midwives face in delivering women-centred midwifery care in low-resource, rural areas. A total of 30 midwives practicing in the Upper East Region of Ghana were purposefully selected. Data were collected using individual semistructured interviews and analysed through qualitative content analysis.ResultsFive main themes emerged from the data analysis. These themes included were: inadequate infrastructure (lack of bed and physical space), shortage of midwifery staff, logistical challenges, lack of motivation, and limited in-service training opportunities.ConclusionsMidwives experience myriad challenges in providing sufficient women-centred care in rural Ghana. To overcome these challenges, measures such as providing adequate beds and physical space, making more equipment available, and increasing midwifery staff strength to reduce individual workload, coupled with motivation from facility managers, are needed.