Local Revenue Mobilization Mechanisms: Evidence from the Abura-Asebu-Kwamankese District in Ghana

This paper examined the local revenue mobilization mechanisms in the Abura-Asebu-Kwamankese District in Ghana. A total of 214 respondents made up of 20 officials of the Assembly and 194 tax payers were involved in the study. The study demonstrated that despite the availability of other sources of local revenue, the Assembly was yet to take advantage of them. The strength of the Assembly’s local revenue collection measures included revenue collectors’ inclusion in tax decisions, house-to-house collection, and database. However, the weaknesses included poor taxpayer participation in tax decisions, inadequate personnel for revenue mobilization and poor cash management systems and accountability mechanisms at the Assembly. Some of the challenges the Assembly faced in improving local revenue generation were unwillingness on the part of the taxpayers to meet tax obligation, low pace of development and political considerations. It is recommended that the Assembly should put in place strong monitoring and supervisory mechanisms to check the revenue collectors, sanctions defaulting collectors, and also create room for private participation in local revenue collection. Keywords: Decentralization, revenue mobilization, subsidiarity principle, fiscal decentralizatio

Households' willingness to pay for reliable electricity services in Ghana

Access to reliable electricity is important in increasing the living standards of households and promoting sustainable development. However, Ghanaian households have had to grapple with frequent power outages and poor quality electricity services in recent times. This study examines the factors influencing households’ willingness to pay for reliable electricity services in Ghana. Using data collected from 950 households in the Cape Coast Metropolitan Area and the tobit regression technique, it was revealed that monthly income, prior notice on power outages, business ownership, separate meter ownership, household size and education significantly affect willingness to pay for reliable electricity services. On the average, households were prepared to pay 44 percent (GH¢6.8) more, relative to the mean monthly electricity bill in the sample, to improve electricity services. It is envisaged that the findings would be used by policy makers and utility companies to make electricity generation and distribution more sustainable and efficient

Households' willingness to pay for reliable electricity services in Ghana

Access to reliable electricity is important in increasing the living standards of households and promoting sustainable development. However, Ghanaian households have had to grapple with frequent power outages and poor quality electricity services in recent times. This study examines the factors influencing households’ willingness to pay for reliable electricity services in Ghana. Using data collected from 950 households in the Cape Coast Metropolitan Area and the tobit regression technique, it was revealed that monthly income, prior notice on power outages, business ownership, separate meter ownership, household size and education significantly affect willingness to pay for reliable electricity services. On the average, households were prepared to pay 44 percent (GH¢6.8) more, relative to the mean monthly electricity bill in the sample, to improve electricity services. It is envisaged that the findings would be used by policy makers and utility companies to make electricity generation and distribution more sustainable and efficient

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The link between remittance inflows and financial development in Ghana: Substitutes or complements?

AbstractThis empirical paper explores the link between remittance inflows and financial development in Ghana from 1980–2019. Empirical analyses are carried out using the ARDL VECM, DOLS, CCR and FMOLS techniques. Furthermore, the IRF and forecast FEVD analyses were employed to comprehend better financial development’s response to shocks to remittance inflows and other macroeconomic factors. The results demonstrate that the variables are cointegrated, and remittance was found to be beneficial to financial development in both the short and long run. Furthermore, from the IRF analysis, positive shocks to remittance have a favourable influence on financial development. The FEVD investigation suggests that shocks to migrant remittance accounted for almost 32% of the overall variations in financial development. The implication is that, from a policy perspective, well-structured strategies should be devised and executed to promote higher remittance flows via official conduits. This will stimulate economic growth, financial development, and other monetary benefits of remittance inflows to the nation

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc