Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of primary health care? Perspectives of key stakeholders in northern Ghana

In 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana's health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC.; Using qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers. A stakeholders' workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from respondents for the achievement of the goals of UHC and PHC.; The key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS; inadequate coordination among stakeholders in PHC delivery; and inadequate funding for PHC, particularly on preventive and promotive services. Other areas are: the bypassing of PHC facilities due to lack of basic services at the PHC level such as laboratory services, as well as proximity to the district hospitals; and finally the lack of clear understanding of the national policy on PHC.; This study suggests that despite the progress that has been made since the establishment of the NHIS in Ghana, there are still huge gaps that need urgent attention to ensure that the goals of UHC and PHC are met. The key areas of misalignment identified in this study, particularly on the delays in reimbursements need to be taken seriously. It is also important for more dialogue between the NHIA and service providers to address key concerns in the implementation of the NHIS which is key to achieving UHC

Distribution of chemical forms of mercury in sediments from abandoned ponds created during former gold mining operations in Colombia

Total mercury (THg) and methylmercury (MeHg) were studied in sediments from 27 abandoned gold mining ponds (AGMPs) through small-scale artisanal gold mining in the district of San Juan in Chocó region of Colombia. The AGMPs were abandoned in the last century (1997) and were grouped into three distinct groups (2–6; 7–12; 13–20 years). Overall concentration (in ng g−1) pattern of THg in sediments varied from 39.06 to 1271.32 (avg. 209.57) with 174.81 (13–20 years), 205.56 (7–12 years) and 248.33 (2–6 years) respectively. MeHg concentrations accounted for 3.3–10.9% (avg. 6.5%) of THg and were significantly correlated with THg during all periods. Correlations between organic matter (OM) vs MeHg and THg were negative in the oldest pools, signifying a “dilution effect” or “natural burial” of THg and MeHg. Results for sequential extraction indicate that the fraction of elemental Hg (Hg-e) and organo chelated Hg (Hg-o) represent the main chemical forms of Hg in the sediments, regardless of the abandonment period, whereas the bioavailable fraction was only 0.12–1.65% of THg. The significant statistical relationship between MeHg, THg and OM suggests that these parameters control the distribution, mobility, toxicity and bioavailability of Hg in the sediments of these abandoned ponds. Evaluation of THg with sediment quality guidelines indicates that the values are on the higher side for Threshold effect concentration and Upper continental crust. Comparing of MeHg with many other regions outside Colombia is a worrying factor and needs immediate attention to protect the human health. © 2020 Elsevier Lt