Perspectives of frontline health workers on Ghana's National Health Insurance Scheme before and after community engagement interventions

BackgroundBarely a decade after introduction of Ghana’s National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services. However, sustainability of the scheme is increasingly threatened by concerns on quality of health service delivery in NHIS-accredited health facilities coupled with stakeholders’ discontentment with the operational and administrative challenges confronting the NHIS. The study sought to ascertain whether or not Systematic Community Engagement (SCE) interventions have a significant effect on frontline health workers’ perspectives on the NHIS and its impact on quality health service delivery.MethodsThe study is a randomized cluster trial involving clinical and non-clinical frontline health workers (n = 234) interviewed at baseline and follow-up in the Greater Accra and Western regions of Ghana. Individual respondents were chosen from within each intervention and control groupings. Difference-in-difference estimations and propensity score matching were performed to determine impact of SCE on staff perceptions of the NHIS. The main outcome measure of interest was staff perception of the NHIS based on eight (8) factor-analyzed quality service parameters.ResultsStaff interviewed in intervention facilities appeared to perceive the NHIS more positively in terms of its impact on “availability and quality of drugs (p < 0.05)” and “workload on health staff/infrastructure” than those interviewed in control facilities (p < 0.1). Delayed reimbursement of service providers remained a key concern to over 70 % of respondents in control and intervention health facilities.ConclusionCommunity engagement in quality service assessment is a potential useful strategy towards empowering communities while promoting frontline health workers’ interest, goodwill and active participation in Ghana’s NHIS

Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana:A Randomized Cluster Trial

BackgroundHealth worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps.Purpose To evaluate the effect of SCE interventions on health worker motivation and experiences with clients.Methods The study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation.Results Intrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were ranked lowest. Intervention health facilities that were assessed by female community groups (Coef. = 0.2720, p = 0.0118) and informal groups with organized leadership structures like Artisans (Coef. = 0.2268, p = 0.0368) associated positively with higher intrinsic motivation levels of staff.Conclusion Community-based approach to health worker motivation is a potential complementary strategy that needs policy deliberation to explore its prospects. Albeit financial incentives remain critical sources of staff motivation, innovative non-financial approaches like SCE should complement the latter

Contribution à la dépollution d’un rejet textile par adsorption sur un coagulant à base du mélange fer/aluminium préparé par électrocoagulation

L’industrie textile consomme une grande quantité d’eau, générant ainsi des rejets liquides à charge élevée en divers types de polluants. Ces derniers produisent des effets nocifs sur l’environnement. Ce travail s’intéresse à la dépollution d’un rejet d’une industrie textile, par addition d’un coagulant synthétique à base de fer et d’aluminium, préparé par le procédé d’électrocoagulation. Les résultats ont montré que le traitement de ce rejet par ce coagulant, a permis d’atteindre un rendement d’élimination des matières colorantes de 83.37% en terme de demande chimique en oxygène (DCO).Mots clés: traitement, hydroxyde, coagulation, demande chimique en oxygèn

Perspectives of frontline health workers on Ghana's National Health Insurance Scheme before and after community engagement interventions

BackgroundBarely a decade after introduction of Ghana’s National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services. However, sustainability of the scheme is increasingly threatened by concerns on quality of health service delivery in NHIS-accredited health facilities coupled with stakeholders’ discontentment with the operational and administrative challenges confronting the NHIS. The study sought to ascertain whether or not Systematic Community Engagement (SCE) interventions have a significant effect on frontline health workers’ perspectives on the NHIS and its impact on quality health service delivery.MethodsThe study is a randomized cluster trial involving clinical and non-clinical frontline health workers (n = 234) interviewed at baseline and follow-up in the Greater Accra and Western regions of Ghana. Individual respondents were chosen from within each intervention and control groupings. Difference-in-difference estimations and propensity score matching were performed to determine impact of SCE on staff perceptions of the NHIS. The main outcome measure of interest was staff perception of the NHIS based on eight (8) factor-analyzed quality service parameters.ResultsStaff interviewed in intervention facilities appeared to perceive the NHIS more positively in terms of its impact on “availability and quality of drugs (p < 0.05)” and “workload on health staff/infrastructure” than those interviewed in control facilities (p < 0.1). Delayed reimbursement of service providers remained a key concern to over 70 % of respondents in control and intervention health facilities.ConclusionCommunity engagement in quality service assessment is a potential useful strategy towards empowering communities while promoting frontline health workers’ interest, goodwill and active participation in Ghana’s NHIS

Dual harm: an exploration of the presence and characteristics for dual violence and self-harm behaviour in prison

Objective: The study aimed to quantify the rate of dual-harm behaviour in comparison with sole self-harm or assault rates; with an analysis of the distinguishing features. Method: Official data on in-prison incidents, demographic and offending information was analysed for two prisons in England. Results: Proportions of up to 42% of offenders who assault others in prison will also engage in self-harm and vice versa. Dual harm prisoners will engage in a broader and greater frequency of prison incidents than either sole group; with dual-harm prisoners reflecting greater proportions of damage to property and fire setting. Connectedly, dual harm prisoners receive a far higher rate of adjudication. There were no differences in their time in prison, presence of serious violent offences or for the dual harm prisoners whether the first incident was self-harm or violence. An index offence of drug supply was less likely in the dual-harm group, with minor violence slightly more likely in longer sentence prisoners. Implications: In-prison behaviour can assist in the identification of prisoners at dual-risk of harm. Greater inclusion of in-prison behaviour and awareness of dual-harm in research methodologies may assist in improving risk management. A wider use of joint risk assessment and single case management approach is suggested for prisoners with dual-harm profile

Efficiency of private and public primary health facilities accredited by the National Health Insurance Authority in Ghana

Background: Despite improvements in a number of health outcome indicators partly due to the National HealthInsurance Scheme (NHIS), Ghana is unlikely to attain all its health-related millennium development goals before theend of 2015. Inefficient use of available limited resources has been cited as a contributory factor for this predicament.This study sought to explore efficiency levels of NHIS-accredited private and public health facilities; ascertain factorsthat account for differences in efficiency and determine the association between quality care and efficiency levels.Methods: The study is a cross-sectional survey of NHIS-accredited primary health facilities (n = 64) in two regionsin southern Ghana. Data Envelopment Analysis was used to estimate technical efficiency of sampled health facilitieswhile Tobit regression was employed to predict factors associated with efficiency levels. Spearman correlation testwas performed to determine the association between quality care and efficiency.Results: Overall, 20 out of the 64 health facilities (31 %) were optimally efficient relative to their peers. Out of the20 efficient facilities, 10 (50 %) were Public/government owned facilities; 8 (40 %) were Private-for-profit facilitiesand 2 (10 %) were Private-not-for-profit/Mission facilities. Mission (Coef. = 52.1; p = 0.000) and Public (Coef. = 42.9;p = 0.002) facilities located in the Western region (predominantly rural) had higher odds of attaining the 100 % tech‑nical efficiency benchmark than those located in the Greater Accra region (largely urban). No significant associationwas found between technical efficiency scores of health facilities and many technical quality care proxies, except inoverall quality score per the NHIS accreditation data (Coef. = −0.3158; p < 0.05) and SafeCare Essentials quality scoreon environmental safety for staff and patients (Coef. = −0.2764; p < 0.05) where the association was negative.Conclusions: The findings suggest some level of wastage of health resources in many healthcare facilities, especiallythose located in urban areas. The Ministry of Health and relevant stakeholders should undertake more effective needanalysis to inform resource allocation, distribution and capacity building to promote efficient utilization of limitedresources without compromising quality care standards

Association between health worker motivation and healthcare quality efforts in Ghana

AbstractBackground: Ghana is one of the sub-Saharan African countries making significant progress towards universal accessto quality healthcare. However, it remains a challenge to attain the 2015 targets for the health related MillenniumDevelopment Goals (MDGs) partly due to health sector human resource challenges including low staff motivation.Purpose: This paper addresses indicators of health worker motivation and assesses associations with quality care andpatient safety in Ghana. The aim is to identify interventions at the health worker level that contribute to qualityimprovement in healthcare facilities.Methods: The study is a baseline survey of health workers (n = 324) in 64 primary healthcare facilities in two regions inGhana. Data collection involved quality care assessment using the SafeCare Essentials tool, the National HealthInsurance Authority (NHIA) accreditation data and structured staff interviews on workplace motivating factors. TheSpearman correlation test was conducted to test the hypothesis that the level of health worker motivation is associatedwith level of effort by primary healthcare facilities to improve quality care and patient safety.Results: The quality care situation in health facilities was generally low, as determined by the SafeCare Essentials tooland NHIA data. The majority of facilities assessed did not have documented evidence of processes for continuousquality improvement and patient safety. Overall, staff motivation appeared low although workers in private facilitiesperceived better working conditions than workers in public facilities (P <0.05). Significant positive associations werefound between staff satisfaction levels with working conditions and the clinic’s effort towards quality improvement andpatient safety (P <0.05).Conclusion: As part of efforts towards attainment of the health related MDGs in Ghana, more comprehensive staffmotivation interventions should be integrated into quality improvement strategies especially in government-ownedhealthcare facilities where working conditions are perceived to be the worst

Contribution à la dépollution des eaux usées de textile par électrocoagulation et par adsorption sur des composés à base de fer et d’aluminium

Les ressources hydriques au monde sont rares et la demande en eau connaît une croissance continue en liaison avec l’évolution démographique et les activités consommatrices en eau, notamment les industries de textiles se voient dans l’obligation de recycler les eaux résiduaires et en particulier celles colorées. Dans ce travail, nous nous sommes intéressés à l’étude de l’élimination des matières organiques et colorantes de deux rejets provenant des industries de textile, un de teinture du tissu de polyester à pH acide et l’autre de teinture du tissu de coton à pH basique. Ces rejets ont été traités de deux manières. La première est par électrocoagulation en utilisant des plaques de fer et/ou d’aluminium. La deuxième est par adsorption sur des composés synthétiques à base de fer et d’aluminium préparés par électrocoagulation. Dans le cas du traitement par le procédé d’électrocoagulation, nous avons constaté que le rendement d’élimination en demande chimique en oxygène (DCO) du rejet de polyester atteint un rendement de DCO de 60% pour un temps de 7 min de réaction. Pour le rejet de coton, le rendement d’élimination, par les plaques de fer/aluminium et l’élimination des matières colorantes, atteint une valeur de 45% en terme de DCO, et ceci en utilisant des plaques d’aluminium seul et de fer/aluminium pour un temps de 12 et 15 min respectivement. Dans le cas du traitement par ajout des coagulants synthétiques préparés au laboratoire, nous pouvons observer que le meilleur rendement d’élimination en DCO du rejet de polyester est obtenu pour une valeur de 48%, pour la faible granulométrie avec une concentration de 5 g/l du composé à base de fer /aluminium. Le rendement d’élimination en DCO du rejet de coton augmente jusqu'à une valeur de 60% avec une concentration de 5 g/l de coagulants appliqués à base d’aluminium seul. Les résultats de la dépollution de ces rejets, ont montré que le rendement d'élimination des matières organiques et colorantes par le procédé d'électrocoagulation est important, et la durée de traitement est courte, mais l'inconvénient de ce procédé c'est la saleté des plaques après chaque utilisation et la fabrication d'une grande quantité des boues par rapport à l’adsorption sur des composés à base de fer /aluminium où on utilise des poudres peu solubles et stables avec un bon rendement d’élimination et faibles quantités de fer et d'aluminium dans le surnageant traité.Keywords: Colorant textile, électrocoagulation, adsorption, dépollution, fer, aluminiu

Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities:Evidence from Ghana

BackgroundPatient safety and quality care remain major challenges to Ghana’s healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed.PurposeThis paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities.MethodsA randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities.FindingsClinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment.ConclusionCommunity engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa

Detection and identification of pathogenic trypanosome species in tsetse flies along the Comoe River in Cote d'Ivoire

In order to identify pathogenic trypanosomes responsible for African trypanosomiasis, and to better understand tsetse-trypanosome relationships, surveys were undertaken in three sites located in different eco-climatic areas in Cote d'Ivoire during the dry and rainy seasons. Tsetse flies were caught during five consecutive days using biconical traps, dissected and microscopically examined looking for trypanosome infection. Samples from infected flies were tested by PCR using specific primers for Trypanosoma brucei s.l., T. congolense savannah type, T. congolense forest type and T. vivax. Of 1941 tsetse flies caught including four species, i.e. Glossina palpalis palpalis, G. p. gambiensis, G. tachinoides and G. medicorum, 513 (26%) were dissected and 60 (12%) were found positive by microscopy. Up to 41% of the infections were due to T. congolense savannah type, 30% to T. vivax, 20% to T. congolense forest type and 9% due to T. brucei s.l. All four trypanosome species and subgroups were identified from G. tachinoides and G. p. palpalis, while only two were isolated from G. p. gambiensis (T. brucei s.l., T. congolense savannah type) and G. medicorum (T. congolense forest, savannah types). Mixed infections were found in 25% of cases and all involved T. congolense savannah type with another trypanosome species. The simultaneous occurrence of T. brucei s.l., and tsetse from the palpalis group may suggest that human trypanosomiasis can still be a constraint in these localities, while high rates of T. congolense and T. vivax in the area suggest a potential risk of animal trypanosomiasis in livestock along the Comoe River