Frontline staff motivation levels and health care quality in rural and urban primary health facilities:a baseline study in the Greater Accra and Western regions of Ghana

BackgroundThe population of Ghana is increasingly becoming urbanized with about 70 % of the estimated 26.9 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32.1 % of the national health sector workforce works. Doctor-patient ratio in a predominantly rural region is about 1:18,257 compared to 1:4,099 in an urban region. These rural–urban inequities significantly account for the inability of Ghana to attain the health related Millennium Development Goals (MDGs) before the end of 2015.PurposeTo ascertain whether or not rural-urban differences exist in health worker motivation levels and quality of health care in health facilities accredited by the National Health Insurance Authority in Ghana.MethodsThis is a baseline quantitative study conducted in 2012 among 324 health workers in 64 accredited clinics located in 9 rural and 7 urban districts in Ghana. Ordered logistic regression was performed to determine the relationship between facility geographic location (rural/urban) and staff motivation levels, and quality health care standards.ResultsQuality health care and patient safety standards were averagely low in the sampled health facilities. Even though health workers in rural facilities were more de-motivated by poor availability of resources and drugs than their counterparts in urban facilities (p < 0.05), quality of health care and patient safety standards were relatively better in rural facilities.ConclusionFor Ghana to attain the newly formulated sustainable development goals on health, there is the need for health authorities to address the existing rural–urban imbalances in health worker motivation and quality health care standards in primary healthcare facilities. Future studies should compare staff motivation levels and quality standards in accredited and non-accredited health facilities since the current study was limited to health facilities accredited by the National Health Insurance Authority

Design and implementation of community engagement interventions towards healthcare quality improvement in Ghana:a methodological approach

BackgroundNearly four decades after the Alma-Ata declaration of 1978 on the need for active client/community participation in healthcare, not much has been achieved in this regard particularly in resource constrained countries like Ghana, where over 70 % of communities in rural areas access basic healthcare from primary health facilities. Systematic Community Engagement (SCE) in healthcare quality assessment remains a grey area in many health systems in Africa, albeit the increasing importance in promoting universal access to quality basic healthcare services.Purpose/objectiveDesign and implement SCE interventions that involve existing community groups engaged in healthcare quality assessment in 32 intervention primary health facilities.MethodsThe SCE interventions form part of a four year randomized controlled trial (RCT) in the Greater Accra and Western regions of Ghana. Community groups (n = 52) were purposively recruited and engaged to assess non-technical components of healthcare quality, recommend quality improvement plans and reward best performing facilities. The interventions comprised of five cyclical implementation steps executed for nearly a year. Wilcoxon sign rank test was used to ascertain differences in group perceptions of service quality during the first and second assessments, and ordered logistic regression analysis performed to determine factors associated with groups’ perception of healthcare quality.ResultsHealthcare quality was perceived to be lowest in non-technical areas such as: information provision to clients, directional signs in clinics, drug availability, fairness in queuing, waiting times, and information provision on use of suggestion boxes and feedback on clients’ complaints. Overall, services in private health facilities were perceived to be better than public facilities (p < 0.05). Community groups dominated by artisans and elderly members (60+ years) had better perspectives on healthcare quality than youthful groups (Coef. =1.78; 95 % CI = [−0.16 3.72]) and other categories of community groups (Coef. = 0.98; 95 % CI = [−0.10 2.06]).ConclusionsNon-technical components of healthcare quality remain critical to clients and communities served by primary healthcare providers. The SCE concept is a potential innovative and complementary quality improvement strategy that could help enhance client experiences, trust and confidence in healthcare providers. SCE interventions are more cost effective, community-focused and could easily be scaled-up and sustained by local health authorities

Rural-Urban Differences in the Utilization of Maternal Healthcare in Ghana: The Case of Antenatal and Delivery Services

Although maternal health in Ghana has generally improved over the past two decades, the current MMR implies that Ghana‟s MMR is approximately 2.4 times higher than the set target in MDG 5. Using data from the Ghana Demographic and Health Survey 2008, an attempt is made in this study to investigate the rural-urban differences in maternal health care (antenatal and delivery care) service utilization in Ghana. Most previous studies focused more broadly on the utilization of MHC services either in the entire country or some parts of the country. This study fills the gap by looking at women from the rural and urban areas with varying standards of living and other socioeconomic attributes. The study also includes some women autonomy variables to find out their effect on MHC service utilization in both areas. Lastly, an attempt is also made to investigate the effect of informal education on the use of MHC services using a logistic regression model. The results from the rural sample show that, women with some degree of autonomy are more likely to use MHC services than their counterparts who lack such autonomy. Again, informal education through the media is more effective in the rural areas than in the urban areas, and wealth still remains an issue particularly in the urban areas

A Review of the National Health Insurance Scheme in Ghana:What Are the Sustainability Threats and Prospects?

BackgroundThe introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana.MethodsElectronic search was done for literature published between 2003–2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context.ResultsAbility of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients’ trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper.ConclusionsThe NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors

Design and implementation of community engagement interventions towards healthcare quality improvement in Ghana:a methodological approach

BackgroundNearly four decades after the Alma-Ata declaration of 1978 on the need for active client/community participation in healthcare, not much has been achieved in this regard particularly in resource constrained countries like Ghana, where over 70 % of communities in rural areas access basic healthcare from primary health facilities. Systematic Community Engagement (SCE) in healthcare quality assessment remains a grey area in many health systems in Africa, albeit the increasing importance in promoting universal access to quality basic healthcare services.Purpose/objectiveDesign and implement SCE interventions that involve existing community groups engaged in healthcare quality assessment in 32 intervention primary health facilities.MethodsThe SCE interventions form part of a four year randomized controlled trial (RCT) in the Greater Accra and Western regions of Ghana. Community groups (n = 52) were purposively recruited and engaged to assess non-technical components of healthcare quality, recommend quality improvement plans and reward best performing facilities. The interventions comprised of five cyclical implementation steps executed for nearly a year. Wilcoxon sign rank test was used to ascertain differences in group perceptions of service quality during the first and second assessments, and ordered logistic regression analysis performed to determine factors associated with groups’ perception of healthcare quality.ResultsHealthcare quality was perceived to be lowest in non-technical areas such as: information provision to clients, directional signs in clinics, drug availability, fairness in queuing, waiting times, and information provision on use of suggestion boxes and feedback on clients’ complaints. Overall, services in private health facilities were perceived to be better than public facilities (p < 0.05). Community groups dominated by artisans and elderly members (60+ years) had better perspectives on healthcare quality than youthful groups (Coef. =1.78; 95 % CI = [−0.16 3.72]) and other categories of community groups (Coef. = 0.98; 95 % CI = [−0.10 2.06]).ConclusionsNon-technical components of healthcare quality remain critical to clients and communities served by primary healthcare providers. The SCE concept is a potential innovative and complementary quality improvement strategy that could help enhance client experiences, trust and confidence in healthcare providers. SCE interventions are more cost effective, community-focused and could easily be scaled-up and sustained by local health authorities

Subscribers' perception of quality of services provided by Ghana's National Health Insurance Scheme - What are the correlates?

BackgroundGhana’s National Health Insurance Scheme (NHIS) has witnessed an upsurge in enrollment since its inception in 2003, with over 40% of the Ghanaian population actively enrolled in the scheme. While the scheme strives to achieve universal health coverage, this quest is derailed by negative perceptions of the quality of services rendered to NHIS subscribers. This paper presents an analysis on perceptions of service quality provided to subscribers of Ghana’s NHIS with emphasis on rural and urban scheme policy holders, using a nationally representative data.MethodsThe study used data from the 2014 Ghana Demographic and Health Survey. Ordered logistic regressions were estimated to identify the correlates of perceived quality of care of services rendered by the NHIS. Also, chi-square statistics were performed to test for significant differences in the proportions of subscribers in the two subsamples (rural and urban).ResultsRural subscribers of the NHIS were found to identify more with better perception of quality of services provided by the NHIS than urban subscribers. Results from the chi-square statistics further indicated that rural subscribers are significantly different from urban subscribers in terms of the selected socioeconomic and demographic characteristics. In the full sample; age, out-of-pocket payment for healthcare and region of residence proved significant in explaining perceived quality of services rendered by the NHIS. Age, out-of-pocket payment for healthcare, region of residence, wealth status, and access to media were found to be significant predictors of perceived quality of services provided to both rural and urban subscribers of the NHIS. The significance of these variables varied among men and women in rural and urban areas.ConclusionDifferent factors affect the perception of quality of services provided to rural and urban subscribers of Ghana’s NHIS. Health financing policies geared toward improving the NHIS-related services in rural and urban areas should be varied

Alcohol Consumption Among Ghanaian Women of Child Bearing Age – What are the Correlates?

Abstract This paper examines the demographic and socio-economic correlates of alcohol consumption and drinking frequency among Ghanaian women aged 15-49 years. The study utilizes the 2008 Ghana Demographic and Health Survey data, which remains the most recent DHS for studying the phenomenon in Ghana. Using logistic regression, our findings indicate that alcohol consumption among Ghanaian women is influenced by age, education, and wealth status. In addition, while health insurance ownership significantly affects alcohol consumption among urban women, employment status is reported to be a significant determinant among rural women. Results from the ordered logistic regression show that age, wealth status, pregnancy status, and place of residence are significant predictors of alcohol drinking frequency among Ghanaian women. Moreover, while secondary educational attainment is significant among urban women, primary educational attainment is significant among rural women. The study concludes that the predictors of alcohol consumption and drinking frequency among women of childbearing age in Ghana vary by place of residence (i.e., rural vs urban)

The effect of fertility and education on female labour force participation in Ghana

This study examines the forces behind female labour force participation (flfP) in Ghana by focusing on the role played by fertility and education, for both urban and rural dwellers. Applying a logistic regression to the fifth round of the Ghana Living standards survey (Glss 5) we established that women with basic and tertiary education have a higher propensity of participation compared with those with no education. The results further indicate significant positive marginal effects for women with children, suggesting that having more children increases the likelihood of participation. This observation was more pronounced in the rural urban estimates. The paper suggests that women’s labour force participation and home production are complements rather than substitutes considering the dominance of women in self-employment and/or informal sector where women are able to combine work and home production. moreover, the study established a positive relationship between females in good health and the level of participation, and discusses some policy recommendations to encourage participation of women in the Ghanaian labour force

The Ghanian economy: and Overview

The Ghanaian economy has been on an upward trajectory over the past three decades, yet a number of challenges bedevil growth, redistribution and sustainability. After 56 years of independence, the need for a formal academic and practitioner forum for engaging minds on the past, present and future state of the economy has been lurking in the background. The birth of the Ghanaian Journal of Economics is a response to this urgent quest, providing a platform for cutting edge research on the Ghanaian economy and similar other economies to inform policy design and implementation. As the maiden issue, this review article seeks to retrace developments in the economy a few steps back to bring readers up to date on current state of research. The review is historical, and the scope is to synthesize the diverse developments in the Ghanaian economy within the confines of a relatively brief article. This article is thus not an exhaustive treatment of the topic, and it does not cover all the esoteric details of the Ghanaian economy. In the end, however, we hope to offer some perspectives on the literature for readers of the journal, investors, managers of the economy, regulators and academics while also providing a roadmap for future research endeavours