Trend and determinants of contraceptive use among women of reproductive age in Ghana

The study examined the trend in contraceptive use among sexually active women of reproductive age in Ghana. The study also investigated the socioeconomic determinants of contraceptive use. Cross tabulations and logistic regression analyses were performed on data from the Ghana Demographic and Health Surveys 1988 - 2008. The results indicate low contraceptive use among women with marked variation in contraceptive use across various socioeconomic groups and administrative regions. Evidence from the logistic regressions suggests that improving education and reducing poverty are critical in improving contraceptive use and reducing unmet need for family planning. Child survival, access to family planning services and knowledge of contraceptive methods were also found to be significant determinants of contraceptive use. The importance of improving financial and infrastructural access to contraceptives was confirmed by the findings of the study.

HIV/AIDS-related stigma and HIV test uptake in Ghana: evidence from the 2008 Demographic and Health Survey

The study examined the association between HIV test uptake and socioeconomic characteristics of individuals, including HIV-related stigma behaviours. The study also investigated the socioeconomic determinants of HIV-related stigma in Ghana. Cross tabulations and logistic regression techniques were applied to data from the 2008 Ghana Demographic and Health Survey. The results showed significantly low HIV test uptake and some level of HIV-related stigma prevalence in Ghana. Higher wealth status, educational attainment and HIV-related stigma were significant determinants of HIV test uptake. Aside wealth status and education, rural place of residence and religious affiliation were positive and significant determinants of HIV-related stigma. The findings call for comprehensive HIV education including treatment, prevention and care. Legislations to discourage stigma and improve HIV-testing will be critical policy steps in the right direction.

Fiscal space for health in Sub-Saharan African countries: an efficiency approach

The study argues that potential savings from efficiency could be effective alternative to increasing health system financing in SSA. Health system efficiency estimates were derived from the Data Envelopment Analysis and Stochastic Frontier Analysis and used to compute potential gains from efficiency. Data was sourced from the World Bank's world development indicators for 45 SSA countries in 2011. The results reveal that average potential saving in health expenditure from improved efficiency was 0.10% and 0.75% of GDP per capita in the DEA and SFA models, respectively. The results also showed that a 1% increase in efficiency of health expenditure reduced infant mortality rate by 0.91% compared to 0.40% reduction in infant mortality if health expenditure increased by 1%. The results imply that in the face of significant economic challenges and burden on government budget, improving health expenditure efficiency to create some fiscal space will be an important step

Fiscal space for health in Sub-Saharan African countries: an efficiency approach

The study argues that potential savings from efficiency could be effective alternative to increasing health system financing in SSA. Health system efficiency estimates were derived from the Data Envelopment Analysis and Stochastic Frontier Analysis and used to compute potential gains from efficiency. Data was sourced from the World Bank's world development indicators for 45 SSA countries in 2011. The results reveal that average potential saving in health expenditure from improved efficiency was 0.10% and 0.75% of GDP per capita in the DEA and SFA models, respectively. The results also showed that a 1% increase in efficiency of health expenditure reduced infant mortality rate by 0.91% compared to 0.40% reduction in infant mortality if health expenditure increased by 1%. The results imply that in the face of significant economic challenges and burden on government budget, improving health expenditure efficiency to create some fiscal space will be an important step

Methods for estimating economic benefits of surgical interventions in low income and middle-income countries: a scoping review

Objectives: Studies indicate that many types of surgical care are cost-effective compared with other health interventions in low-income and middle-income countries (LMICs). However, global health investments to support these interventions remain limited. This study undertakes a scoping review of research on the economic impact of surgical interventions in LMICs to determine the methodologies used in measuring economic benefits. Design: The Arksey and O’Malley methodological framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and MetaAnalyses Extension for Scoping Reviews checklist were used to review the data systematically. Online databases were used to identify papers published between 2005 and 2020, from which we selected 19 publications that quantitatively examined the economic benefits of surgical interventions in LMICs. Results: The majority of publications (79%) reported the use of disability-adjusted life-years (DALYs) to assess economic impact. In comparison, 21% used other measures, such as the value of statistical life or cost-effectiveness ratios, or no measure at all. 31% were systematic or retrospective reviews of the literature on surgical procedures in LMICs, while 69% either directly assessed economic impact in a specific area or evaluated the need for surgical procedures in LMICs. All studies reviewed related to the economic impact of surgical procedures in LMICs, with most about pediatric surgical procedures or a specific surgical specialty. Conclusion: To make informed policy decisions regarding global health investments, the economic impact must be accurately measured. Researchers employ a range of techniques to quantify the economic benefit of surgeries in LMICs, which limits understanding of overall economic value. We conclude that the literature would benefit from a careful selection of methods, incorporating age and disability weights based on the Global Burden of Disease weights, and converting DALYs to dollars using the value of statistical life approach and the human capital approach, reporting both estimates

The poverty and inequality nexus in Ghana: a decomposition analysis of household expenditure components

The study examined the linkages between inequality in household expenditure components and total inequality and poverty in Ghana. Using micro data from the sixth round of the Ghana Living Standards Survey conducted in 2012/2013, marginal effects and elasticities were computed for both within-and between-component analysis. The results suggest that, in general, reducing within-component inequality significantly reduces overall poverty and inequality in Ghana, compared to between-component inequality. Specifically, inequality in education and health expenditure components were the largest contributors to overall poverty and inequality. The findings imply that policies directed towards reducing within-component inequality will be more effective than those directed towards between-component inequality. Specifically, the findings of the study corroborates with tax policies (such as Value Added Tax and National Health Insurance Levy in the case of Ghana) that provide exemptions for educational, health and agricultural inputs. This will lead to reduction in overall poverty and inequality by reducing inequality within these expenditure components. The results were robust to the choice of poverty line and consistent for both rural and urban locations

The poverty and inequality nexus in Ghana: a decomposition analysis of household expenditure components

The study examined the linkages between inequality in household expenditure components and total inequality and poverty in Ghana. Using micro data from the sixth round of the Ghana Living Standards Survey conducted in 2012/2013, marginal effects and elasticities were computed for both within-and between-component analysis. The results suggest that, in general, reducing within-component inequality significantly reduces overall poverty and inequality in Ghana, compared to between-component inequality. Specifically, inequality in education and health expenditure components were the largest contributors to overall poverty and inequality. The findings imply that policies directed towards reducing within-component inequality will be more effective than those directed towards between-component inequality. Specifically, the findings of the study corroborates with tax policies (such as Value Added Tax and National Health Insurance Levy in the case of Ghana) that provide exemptions for educational, health and agricultural inputs. This will lead to reduction in overall poverty and inequality by reducing inequality within these expenditure components. The results were robust to the choice of poverty line and consistent for both rural and urban locations

Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates.

BACKGROUND: Numerous studies have reported the economic burden of childhood diarrhea in low- and middle-income countries (LMICs). Yet, empirical data on the cost of diarrheal illness is sparse, particularly in LMICs. In this study we review the existing literature on the cost of childhood diarrhea in LMICs and generate comparable estimates of cost of diarrhea across 137 LMICs. METHODS: The systematic literature review included all articles reporting cost estimates of diarrhea illness and treatment from LMICs published between January 2006 and July 2018. To generate country-specific costs, we used service delivery unit costs from the World Health Organization's Choosing Interventions that are Cost-Effective (WHO-CHOICE database). Non-medical costs were calculated using the ratio between direct medical and direct non-medical costs, derived from the literature review. Indirect costs (lost wages to caregivers) were calculated by multiplying the average GDP per capita per day by the average number of days lost to illness identified from the literature. All cost estimates are reported in 2015 USD. We also generated estimates using the IHME's service delivery unit costs to explore input sensitivity on modelled cost estimates. RESULTS: We identified 25 articles with 64 data points on either direct or indirect cost of diarrhoeal illness in children aged < 5 years in 20 LMICs. Of the 64 data points, 17 were on the cost of outpatient care, 28 were on the cost of inpatient care, and 19 were unspecified. The average cost of illness was US$36.56 (median$15.73; range $4.30 -$145.47) per outpatient episode and $159.90 (median$85.85; range $41.01 -$538.33) per inpatient episode. Direct medical costs accounted for 79% (83% for inpatient and 74% for outpatient) of the total direct costs. Our modelled estimates, across all 137 countries, averaged (weighted) $52.16 (median$47.56; range $8.81 -$201.91) per outpatient episode and $216.36 (median$177.20; range $23.77 -$1225.36) per inpatient episode. In the 12 countries with primary data, there was reasonable agreement between our modelled estimates and the reported data (Pearson's correlation coefficient = .75). CONCLUSION: Our modelled estimates generally correspond to estimates observed in the literature, with a few exceptions. These estimates can serve as useful inputs for planning and prioritizing appropriate health interventions for childhood diarrheal diseases in LMICs in the absence of empirical data

Advancing the application of systems thinking in health : provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme; a systems approach

As countries work towards Universal Health Coverage, there is a need to design, implement, and manage provider payment methods reforms, but from a systems perspective, rather than traditional linear models. The wider national context as well as characteristics of the health system into which the payment method is introduced shape and modify supply behaviour and incentives. Assuring equitable universal access to essential health services without financial hardship requires resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The study describes provider behaviour related to supply of health services to insured clients in Ghana