Prospects and Challenges of Implementing a Sustainable National Health Insurance Scheme: The Case of the Cape Coast Metropolis, Ghana

Accessibility to health services is a major development problem facing sub-Saharan African countries. The prevalence of poverty and unemployment is a major hindrance to making health services accessible to the population especially the poor. Many development theories have been on how to make basic services affordable and accessible to the poor. The World Development Report 2004 focuses on making services work for the poor. The government of Ghana introduced nationwide National Health Insurance Scheme (NHIS) with the aim of providing health insurance and making health services accessible and affordable to the average Ghanaian. The ‘cash and carry system’ that existed before the introduction of the National Health Insurance Scheme made health services quite inaccessible to the poor. The ‘cash and carry system’ compelled patients to pay for the cost of health services before they were given the desired medication. The poor resorted to self-medication with its accompanied complications and problems. The overall objective of the study was to assess the contribution of the NHIS to health care delivery in the country and examine the sustainability challenges of the scheme. The study revealed that the NHIS has assisted in increasing Out-Patients-Department (OPD) attendance, reduction of self medication and made health services more assessable to the poor. It was however, observed that for a sustainable national health insurance scheme to be achieved, issues such as maintaining and expanding the client base, regular payment of the services providers and ensuring the requisite institutional capacity should be given the deserved attention. Keywords: Affordable, Cape Coast, Ghana, Health Insurance, premium, sustainabl

Factors influencing dropout rate of intermittent preventive treatment of malaria during pregnancy

BACKGROUND: The burden of malaria in terms of morbidity and mortality is huge is Sub-Saharan Africa, particularly among pregnant women. Among the measures to curb down this burden include intermittent preventive treatment (IPT) and effective case management. These strategies were adopted by Ghana and implemented since 2003; however, there is still high dropout rate in IPT coverage. This study sought to investigate factors contributing to high dropout rate between IPT1 and IPT3 in the Tamale Metropolis, one of the health facilities with the highest IPT dropout rates in Ghana. METHODS: Survey, in-depth interviews and short ethnographic techniques were conducted among pregnant women, antenatal care (ANC) health workers and heads of health facilities to investigate factors which account for dropout rate of intermittent treatment of malaria. RESULTS: Shortage of sulphadoxine pyrimethamine (SP), inadequate supply of portable water for administration of SP, unavailability of IPT during outreach services, lack of knowledge by ANC staff about the dropout rate in their area of jurisdiction and poor attitude of some health workers were identified as barriers to achieving high IPT3 coverage. CONCLUSIONS: Late ANC visit, provider and logistical barriers account for the women's missed opportunities to prevent malaria in pregnancy through IPT. Addressing the above barriers will contribute to saving lives and ensuring progress towards the goal of combating malaria as well as reducing maternal, neonatal and child mortalities.BioMed Central open acces

Child Welfare Clinic Attendance among Children 24-59 Months in Assin North Municipality, Ghana

Child welfare clinics form an important component of the health care system in Ghana and renders invaluable health care services to children under five years. Despite the numerous advantages associated with child welfare clinic attendance, there are reported cases of low attendance among children 24-59 months. It is in line with this that the study examined child welfare attendance among children aged 24-59 months. Employing both qualitative and quantitative methods, the study selected 240 respondents for primary data collection and analysis in the Assin North Municipality of Ghana. It was established that child welfare clinic attendance declines by age of the child due to schooling, completion of immunization schedule and distance to the clinics among other factors. It was also found that the level of education of caregivers and distance travelled to the child welfare clinic have influence on child welfare clinic attendance. On the bases of the findings recommendations were made to capture children 24-59 months for child welfare services in schools. Secondly, health workers should sensitize care givers on the importance of child welfare clinic attendance for children aged 24-59 months

Effective Use of Electronic Health Records System for Healthcare Delivery in Ghana

Introduction: In the pursuit of improving effective health service delivery, developing nations including Ghana are progressively integrating electronic health record systems into healthcare frameworks. This research explored the proficient utilization of an EHR called the Lightwave Health Information Management System used by healthcare professionals in Ghana. Material and Methods: A descriptive cross-sectional study design and a multi-stage sampling technique (stratified and simple random sampling) were used to recruit 1126 respondents for this study. Weighted averages were computed to determine scores for all the indicators measuring the effectiveness construct. Results: The study found that LHIMS improved productivity, patient data gathering, sharing of patient information among service providers, care continuity, data exchange among facilities, decision-making, and coordination/organization of care. Also, health professionals’ work experience, educational qualification, and training status were statistically significant predictors of effective use of the LHIMS at the multivariate level. Age and professional type were statistically significant only at the bivariate level. Conclusion: The study concludes that incorporating the LHIMS improves healthcare professionals' effectiveness in gathering patient information while reducing the likelihood of errors by promptly notifying them of any inaccuracies. The study emphasized the importance of training for effectively using the LHIMS

Assessing the efficient use of the lightwave health information management system for health service delivery in Ghana

Background In achieving the WHO’s Universal Health Coverage and the Global Developmental Agenda: Sustainable Development Goal 3 and 9, the Ministry of Health launched a nationwide deployment of the lightwave health information management system (LHIMS) in the Central Region to facilitate health service delivery. This paper assessed the efficient use of the LHIMS among health professionals in the Central Region.Methods A non-interventional descriptive cross-sectional study design was employed for this research. The study used stratified and simple random sampling for selecting 1126 study respondents from 10 health facilities that use the LHIMS. The respondents included prescribers, nurses, midwives and auxiliary staff. Descriptive statistics (weighted mean) was computed to determine the average weighted score for all the indicators under efficiency. Also, bivariate (χ2) and multivariate (ordinal logistic regression) analyses were conducted to test the study’s hypotheses.Results Findings revealed that the LHIMS enhanced efficient health service delivery. From the bivariate analysis, external factors; sex, educational qualification, work experience, profession type and computer literacy were associated with the efficient use of the LHIMS. However, training offered prior to the use of the LHIMS, and the duration of training had no association. At the multivariate level, only work experience and computer literacy significantly influenced the efficient use of the LHIMS.Conclusion The implementation of LHIMS has the potential to significantly improve health service delivery. General computing skills should be offered to system users by the Ministry of Health to improve literacy in the use of computers. Active participation in the use of LHIMS by all relevant healthcare professionals should be encouraged

High-risk fertility behaviours among women in sub-Saharan Africa

Seidu A-A, Ahinkorah BO, Anjorin SS, et al. High-risk fertility behaviours among women in sub-Saharan Africa. Journal of Public Health. 2021:1-11.BACKGROUND: High-risk fertility behaviours such as too early or advanced age at delivery, shorter birth interval, birth order and a higher number of live births to a woman often lead to adverse maternal and child health outcomes. We assessed high-risk fertility behaviours and their associated factors among women in sub-Saharan Africa (SSA).; METHODS: Data on 200716 women pooled from the demographic and health surveys of 27 countries conducted between 2010 and 2020 in SSA were analysed. High-risk fertility behaviour from four indicators, mother aged 34 years at the time of delivery; mother of a child born after a short birth interval (3 children), was derived. Multi-level multi-variable logistic regression analyses were carried out and the results were presented as adjusted odds ratios at 95% confidence interval.; RESULTS: Women who were in polygamous marriages had higher odds of single and multiple high-risk fertility behaviour compared with their counterparts who were in monogamous marriages. Women with middle or high maternal decision-making power had higher odds of single and multiple high-risk fertility behaviours compared with those with low decision-making power. Single and multiple high-risk fertility behaviours were lower among women with access to family planning, those with at least primary education and those whose partners had at least primary education compared with their counterparts who had no access to family planning, those with no formal education and those whose partners had no formal education.; CONCLUSION: Family structure, women's decision-making power, access to family planning, women's level of education and partners' level of education were identified as predictors of high-risk fertility behaviours in SSA. These findings are crucial in addressing maternal health and fertility challenges. Policy makers, maternal health and fertility stakeholders in countries with high prevalence of high parity and short birth intervals should organize programs that will help to reduce the prevalence of these high-risk factors, taking into consideration the factors that predispose women to high-risk fertility behaviours. © The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected]