Choice of Healthcare Providers among Insured Persons in Ghana

Since the introduction of the National Health Insurance Scheme in Ghana in 2003, there has been little evidence with regards the type of providers from whom these insured persons seek healthcare. This study examines the choice of healthcare providers under the National Health Insurance Scheme in Ghana, using nine hundred and eighty eight (988) insured persons. Stratified random sampling technique was employed in selecting respondents, while the multinomial logistic regression was employed. Factors such as cash amount paid, waiting time and proximity to facility were found to discourage the use of orthodox healthcare among insured persons. The study recommend that social and economic infrastructure such as roads, telecommunication, and health centres should be expanded and / or improved in some cases to make orthodox healthcare providers more accessible and affordable, at the same time, it reduce the demand for unorthodox healthcare among the insured persons. Keywords: Multinomial Logit, Insured Persons, NHIS, Ghan

Utilization of Reproductive Health Services in Ghana

Reproductive health is an essential part of general health that it sets the stage for health beyond the reproductive years and also affects the health of the next generation. In many developing countries, however, the availability as well as the consumption of reproductive health services is constrained by a combination of economic and social factors, an understanding of which can be instrumental in formulating and implementing policies that result in improved health. The current study therefore assesses utilization of reproductive health services in Ghana using a random sample of 200. The results of the probit analysis employed show that being married and income positively influence reproductive health services utilization, while price negatively affects it. In the light of the findings thus policy should target the unmarried, and also provide incentives to the poor in the form of price subsidy if the aim is to enhance utilization of the services. Keywords: Reproductive health, binary probit, marginal effect, utilization, Ghan

Wood Based Biomass Fuel Consumption in the Upper West Region of Ghana: Implications for Environmental Sustainability

Households' fuel consumption decisions are affected by a number of factors. But the choice of fuel can affect environmental sustainability, especially where wood based biomass fuel is preferred. This paper examines households' fuel consumption decisions with emphasis on biomass and its implications on environmental sustainability. In all, 200 heads of households were selected through a multistage sampling procedure. The binary logit model was used to examine the factors influencing households' decision to use wood based biomass fuel for their cooking needs. The major factors influencing such decisions are years of completed school by household head, household size, price of the fuel and household income. Given that the removal of wood based biomass from the land results in very negative consequences in the form of soil erosion, reduced moisture and soil nutrients, it is recommended that alternative livelihoods be found for the people to both help them move up the energy ladder to cleaner fuels and also increase their incomes

An analysis of customers’ loyalty to banks in Ghana

The increasing concern of banks about market share and customer equity in the light of unpredictable behaviour of customers has brought to the fore the pre-eminence of customer loyalty. This underscored the analysis of customers’ loyalty to banks in Ghana. This study fitted a binary probit model, utilizing cross-sectional data from 130 customers of banks in the Wa Municipality. The results of the regression showed that satisfaction, bank type, distance, ATM facility, time to transact, switch cost, loan commitment, other facilities and auxiliary banking are the significant determinants of customers’ loyalty to their main banks. Proximity to customers and infrastructure base of a bank are essential factors influencing customers’ loyalty. Banks should consider establishing branches and providing ATM services within and without the municipality, to get banking closer to customers, as a way of reducing customer defection. Keywords: Customer loyalty, banks, probit, customer satisfaction, Ghana

Wood Based Biomass Fuel Consumption in the Upper West Region of Ghana: Implications for Environmental Sustainability

Households' fuel consumption decisions are affected by a number of factors. But the choice of fuel can affect environmental sustainability, especially where wood based biomass fuel is preferred. This paper examines households' fuel consumption decisions with emphasis on biomass and its implications on environmental sustainability. In all, 200 heads of households were selected through a multistage sampling procedure. The binary logit model was used to examine the factors influencing households' decision to use wood based biomass fuel for their cooking needs. The major factors influencing such decisions are years of completed school by household head, household size, price of the fuel and household income. Given that the removal of wood based biomass from the land results in very negative consequences in the form of soil erosion, reduced moisture and soil nutrients, it is recommended that alternative livelihoods be found for the people to both help them move up the energy ladder to cleaner fuels and also increase their incomes

Effects of education and age on the experience of youth violence in a very low-resource setting: a fixed-effects analysis in rural Burkina Faso

Objective: The study aimed to investigate the effects of education and age on the experience of youth violence in low-income and middle-income country settings. Design: Using a standardised questionnaire, our study collected two waves of longitudinal data on sociodemographics, health practices, health outcomes and risk factors. The panel fixed-effects ordinary least squares regression models were used for the analysis. Settings: The study was conducted in 59 villages and the town of Nouna with a population of about 100 000 individuals, 1 hospital and 13 primary health centres in Burkina Faso. Participants: We interviewed 1644 adolescents in 2017 and 1291 respondents in 2018 who participated in both rounds. Outcome and exposure measures: We examined the experience of physical attacks in the past 12 months and bullying in the past 30 days. Our exposures were completed years of age and educational attainment. Results: A substantial minority of respondents experienced violence in both waves (24.1% bullying and 12.2% physical attack), with males experiencing more violence. Bullying was positively associated with more education (β=0.12; 95% CI 0.02 to 0.22) and non-significantly with older age. Both effects were stronger in males than females, although the gender differences were not significant. Physical attacks fell with increasing age (β=−0.18; 95% CI −0.31 to –0.05) and this association was again stronger in males than females; education and physical attacks were not substantively associated. Conclusions: Bullying and physical attacks are common for rural adolescent Burkinabe. The age patterns found suggest that, particularly for males, there is a need to target violence prevention at younger ages and bullying prevention at slightly older ones, particularly for those remaining in school. Nevertheless, a fuller understanding of the mechanisms behind our findings is needed to design effective interventions to protect youth in low-income settings from violence

Diphtheria outbreak in Yemen: the impact of conflict on a fragile health system

Background: War in Yemen started three years ago, and continues unabated with a steadily rising number of direct and indirect victims thus leaving the majority of Yemen’s population in dire need of humanitarian assistance. The conflict adversely affects basic socioeconomic and health conditions across the country. Methods: This study analyzed the recent ongoing diphtheria outbreak in Yemen and in particular, the health system’s failure to ensure immunization coverage and respond to this outbreak. Data from the weekly bulletins of the national electronic Disease Early Warning System’s (eDEWS) daily diphtheria reports and district immunization coverage were analyzed. The number of diphtheria cases and deaths, and immunization coverage (DPT) were reviewed by district including the degree to which a district was affected by conflict using a simple scoring system. A logistic regression and bivariate correlation were applied using the annual immunization coverage per district to determine if there was an association between diphtheria, immunization coverage and conflict. Results: The study results confirm the association between the increasing cases of diphtheria, immunization coverage and ongoing conflict. A total of 1294 probable cases of diphtheria were reported from 177 districts with an overall case fatality rate of 5.6%. Approximately 65% of the patients were children under 15 years, and 46% of the cases had never been vaccinated against diphtheria. The risk of an outbreak increased by 11-fold if the district was experiencing ongoing conflict p < 0.05. In the presence of conflict (whether past or ongoing), the risk of an outbreak decreased by 0.98 if immunization coverage was high p > 0.05. Conclusion: The conflict is continuously devastating the health system in Yemen with serious consequences on morbidity and mortality. Therefore, the humanitarian response should focus on strengthening health services including routine immunization procedures to avoid further outbreaks of life-threatening infectious diseases, such as diphtheria

Patterns of healthcare seeking among people reporting chronic conditions in rural sub-Saharan Africa: findings from a population-based study in Burkina Faso.

OBJECTIVE: Non-communicable diseases are rapidly becoming one of the leading causes of morbidity and mortality in sub-Saharan Africa. Yet, little is known about patterns of healthcare seeking among people with chronic conditions in these settings. We aimed to explore determinants of healthcare seeking among people who reported at least one chronic condition in rural Burkina Faso. METHODS: Data were drawn from a cross-sectional population-based survey conducted across 24 districts on 52 562 individuals from March to June 2017. We used multinomial logistic regression to assess factors associated with seeking care at a formal provider (facility-based care) or at an informal provider (home and traditional treatment) compared to no care. RESULTS: 1124 individuals (2% of all respondents) reported at least one chronic condition. Among those, 22.8% reported formal care use, 10.6% informal care use, and 66.6% no care. The presence of other household members reporting a chronic condition (RRR = 0.57, 95%-CI [0.39, 0.82]) was negatively associated with seeking formal care. Wealthier households (RRR = 2.14, 95%-CI [1.26, 3.64]), perceived illness severity (RRR = 3.23, 95%-CI [2.22, 4.70]) and suffering from major chronic conditions (RRR = 1.54, 95%-CI [1.13, 2.11]) were positively associated with seeking formal care. CONCLUSION: Only a minority of individuals with chronic conditions sought formal care, with important differences due to socio-economic status. Policies and interventions aimed at increasing the availability and affordability of services for early detection and management in peripheral settings should be prioritised

Exploring the effects of the withdrawal of the capitation policy on Cesarean rates in public hospitals in Ghana: an interrupted time series analysis

Context and objectives. In Ghana, CS rates have increased by 2% since 2014 even though the World Health Organization has called for the procedure only for medically justifiable cases. Provider payment  mechanisms such as capitation have been used to moderate CS rates in some settings. We explored the effects of the withdrawal of the capitation policy on the Cesarean Surgery (CS) rate in public primary care hospitals together with vaginal delivery (VD) and antenatal care for women with 4+ visits (ANC4+) rates. Methods. An interrupted time-series analytical design was used to assess the effects of the withdrawal of capitation on selected variables from the secondary District Health Information Management System (DHIMS 2) of public hospitals between January 2015 and December 2019. Results: The results show that after the policy withdrawal, the trend and level of provision of CS and VD were not significantly altered. Significant declining trends of ANC4+ reversed with significant positive trends after the policy removal. Conclusion. We conclude that the withdrawal of the capitation policy may not have impacted the CS rate significantly in public hospitals. Enhanced capitation payment mechanisms and specific policies aimed at limiting CS are needed to curtail the rise in Ghana

What happens when performance-based financing meets free healthcare? Evidence from an interrupted time-series analysis.

In spite of the wide attention performance-based financing (PBF) has received over the past decade, no evidence is available on its impacts on quantity and mix of service provision nor on its interaction with parallel health financing interventions. Our study aimed to examine the PBF impact on quantity and mix of service provision in Burkina Faso, while accounting for the parallel introduction of a free healthcare policy. We used Health Management Information System data from 838 primary-level health facilities across 24 districts and relied on an interrupted time-series analysis with independent controls. We placed two interruptions, one to account for PBF and one to account for the free healthcare policy. In the period before the free healthcare policy, PBF produced significant but modest increases across a wide range of maternal and child services, but a significant decrease in child immunization coverage. In the period after the introduction of the free healthcare policy, PBF did not affect service provision in intervention compared with control facilities, possibly indicating a saturation effect. Our findings indicate that PBF can produce modest increases in service provision, without altering the overall service mix. Our findings, however, also indicate that the introduction of other health financing reforms can quickly crowd out the effects produced by PBF. Further qualitative research is required to understand what factors allow healthcare providers to increase the provision of some, but not all services and how they react to the joint implementation of PBF and free health care