HIV/AIDS-related stigma and HIV test uptake in Ghana: evidence from the 2008 Demographic and Health Survey

The study examined the association between HIV test uptake and socioeconomic characteristics of individuals, including HIV-related stigma behaviours. The study also investigated the socioeconomic determinants of HIV-related stigma in Ghana. Cross tabulations and logistic regression techniques were applied to data from the 2008 Ghana Demographic and Health Survey. The results showed significantly low HIV test uptake and some level of HIV-related stigma prevalence in Ghana. Higher wealth status, educational attainment and HIV-related stigma were significant determinants of HIV test uptake. Aside wealth status and education, rural place of residence and religious affiliation were positive and significant determinants of HIV-related stigma. The findings call for comprehensive HIV education including treatment, prevention and care. Legislations to discourage stigma and improve HIV-testing will be critical policy steps in the right direction.

Trend and determinants of contraceptive use among women of reproductive age in Ghana

The study examined the trend in contraceptive use among sexually active women of reproductive age in Ghana. The study also investigated the socioeconomic determinants of contraceptive use. Cross tabulations and logistic regression analyses were performed on data from the Ghana Demographic and Health Surveys 1988 - 2008. The results indicate low contraceptive use among women with marked variation in contraceptive use across various socioeconomic groups and administrative regions. Evidence from the logistic regressions suggests that improving education and reducing poverty are critical in improving contraceptive use and reducing unmet need for family planning. Child survival, access to family planning services and knowledge of contraceptive methods were also found to be significant determinants of contraceptive use. The importance of improving financial and infrastructural access to contraceptives was confirmed by the findings of the study.

Health expenditure and child health outcomes in Sub-Saharan Africa

This study sought to understand the relationship between child health outcomes and health spending while investigating lagged effects. The study employed panel data from 45 Sub-Saharan African countries between 1995 and 2011 obtained from the World Bank’s World Development Indicators. Fixed and Random effect models were estimated. Under-five, infant and neonatal mortality were used as child health outcomes while total health spending was disaggregated into public and private spending. The effects of one and two period lags of expenditure were estimated. The results show a positive and significant relationship between health expenditure and child health outcomes with elasticities of -0.11 for infant mortality, -0.15 (under-five mortality) and -0.08 (neonatal mortality). Public health expenditure was found to be relatively more significant than private expenditure. Positive and significant lagged effects were also estimated between health expenditure and child health. The findings suggest that, while health expenditure is crucial for the improvement of child health, it is equally important for this expenditure to be sustainable as it also has delayed effects.Keywords: Health expenditure; Child health outcomes; Lag effects; SSA

Estimating household vulnerability to poverty from cross section data: an empirical evidence from Ghana

Background In many developing countries, policies aimed at improving welfare through poverty reduction tend to target the current poor to the neglect of the vulnerable. An understanding of household susceptibility to future poverty will be crucial for sustainable growth and development. The objective of the study is to assess ex-ante welfare through vulnerability to poverty estimates among households in Ghana and to examine the effect of various socioeconomic characteristics on vulnerability to poverty. Method The study uses cross section data from the fifth round of the Ghana Living Standards Survey (GLSS) with a nationally representative sample of 8,687 households from all administrative regions in Ghana. The study employs a three step Feasible Generalized Least Squares (FGLS) estimation procedure to estimate vulnerability to poverty and to model the effect of household socioeconomic status on expected future consumption and variations in future consumption. Results The results show that, about 56% of households in Ghana are vulnerable to poverty and this is significantly higher than observed poverty level of about 28%. While the Eastern region was found to have the highest average vulnerability of approximately 73%, the Upper West region had the least vulnerability with about 21% average vulnerability to poverty. Other regions with relatively high incidence of vulnerability to poverty include the Western region (70%) and the Volta region (69%). Vulnerability to poverty was estimated to be 61% among urban households and 25% among rural households. Moreover, household health status, household size and education attainments significantly influence vulnerability to poverty. Male headed households were found to be less vulnerable to future poverty. Conclusion The results suggest that poverty and vulnerability to poverty are independent concepts. This implies that policies directed towards poverty reduction need to take into account the vulnerability of current non-poor households. Also, various household characteristics should be considered in developing poverty reduction strategies

On the efficiency of public health expenditure in Sub-Saharan Africa: Does corruption and quality of public institutions matter?

Health expenditure in Sub-Saharan Africa (SSA) has improved over the years with several recent efforts to improve resource commitments to the health sector. Health outcomes in the region have, however, seen little improvements over the years. Several reasons, including the efficiency of health expenditure, have been given to justify this mismatch. Studies on health expenditure efficiency have mainly focused on developed regions with little attention to SSA. The objective of the study was, therefore, to examine The effects of corruption and public institution quality on efficiency. The efficiency of health expenditure was also compared across selected SSA countries. Data for the study was sourced from the World Bank's World Development Indicators for 45 countries covering the period 2005 to 2011. The two-stage Data Envelopment Analysis (DEA) was employed for the analysis. The first stage computes efficiency scores while the second stage examines the determinants of efficiency using the Tobit model. Per capita health expenditure was used as input while infant, under-five mortality and crude death rates were used as outputs. The results show that health expenditure efficiency was low with average scores of approximately 0.5. This suggests that there exist significant potential for SSA countries to improve population health outcomes given the level of expenditure. There was significant variation across countries with Cape Verde, Eritrea and Mauritius among the efficient countries while Equatorial Guinea, Sierra Leone and Swaziland were relatively inefficient. High corruption and poor public sector institutions reduced health expenditure efficiency. The findings emphasize the fact that, while increased health spending is necessary, it is also important to ensure efficiency in resource use across SSA countries. This can be achieved by effective monitoring and evaluation programmes that ensure reduced corruption and improved public institutions

Estimating household vulnerability to poverty from cross section data: an empirical evidence from Ghana

Background In many developing countries, policies aimed at improving welfare through poverty reduction tend to target the current poor to the neglect of the vulnerable. An understanding of household susceptibility to future poverty will be crucial for sustainable growth and development. The objective of the study is to assess ex-ante welfare through vulnerability to poverty estimates among households in Ghana and to examine the effect of various socioeconomic characteristics on vulnerability to poverty. Method The study uses cross section data from the fifth round of the Ghana Living Standards Survey (GLSS) with a nationally representative sample of 8,687 households from all administrative regions in Ghana. The study employs a three step Feasible Generalized Least Squares (FGLS) estimation procedure to estimate vulnerability to poverty and to model the effect of household socioeconomic status on expected future consumption and variations in future consumption. Results The results show that, about 56% of households in Ghana are vulnerable to poverty and this is significantly higher than observed poverty level of about 28%. While the Eastern region was found to have the highest average vulnerability of approximately 73%, the Upper West region had the least vulnerability with about 21% average vulnerability to poverty. Other regions with relatively high incidence of vulnerability to poverty include the Western region (70%) and the Volta region (69%). Vulnerability to poverty was estimated to be 61% among urban households and 25% among rural households. Moreover, household health status, household size and education attainments significantly influence vulnerability to poverty. Male headed households were found to be less vulnerable to future poverty. Conclusion The results suggest that poverty and vulnerability to poverty are independent concepts. This implies that policies directed towards poverty reduction need to take into account the vulnerability of current non-poor households. Also, various household characteristics should be considered in developing poverty reduction strategies

Socioeconomic inequalities in maternal health care utilization in Ghana

BACKGROUND: Improving maternal and child health remains a public health priority in Ghana. Despite efforts made towards universal coverage, there are still challenges with access to and utilization of maternal health care. This study examined socioeconomic inequalities in maternal health care utilization related to pregnancy and identified factors that account for these inequalities. METHODS: We used data from three rounds of the Ghana Demographic and Health Surveys (2003, 2008 and 2014). Two health care utilization measures were used; (i) four or more antenatal care (ANC) visits and (ii) delivery by trained attendants (DTA). We first constructed the concentration curve (CC) and estimated concentration indices (CI) to examine the trend in inequality. Secondly, the CI was decomposed to estimate the contribution of various factors to inequality in these outcomes. RESULTS: The CCs show that utilization of at least four ANC visits and DTA were concentrated among women from wealthier households. However, the trends show the levels of inequality decreased in 2014. The CI of at least four ANC visits was 0.30 in 2003 and 0.18 in 2014. Similarly, the CIs for DTA was 0.60 in 2003 and 0.42 in 2014. The decomposition results show that access to National Health Insurance Scheme (NHIS) and women's education levels were the most important contributors to the reduction in inequality in maternal health care utilization. CONCLUSIONS: The findings highlight the importance of the NHIS and formal education in bridging the socioeconomic gap in maternal health care utilization

Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys.

BackgroundSocioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh.MethodsThis study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities.ResultsWe find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014.ConclusionThis study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh

Fiscal space for health in Sub-Saharan African countries: an efficiency approach

The study argues that potential savings from efficiency could be effective alternative to increasing health system financing in SSA. Health system efficiency estimates were derived from the Data Envelopment Analysis and Stochastic Frontier Analysis and used to compute potential gains from efficiency. Data was sourced from the World Bank's world development indicators for 45 SSA countries in 2011. The results reveal that average potential saving in health expenditure from improved efficiency was 0.10% and 0.75% of GDP per capita in the DEA and SFA models, respectively. The results also showed that a 1% increase in efficiency of health expenditure reduced infant mortality rate by 0.91% compared to 0.40% reduction in infant mortality if health expenditure increased by 1%. The results imply that in the face of significant economic challenges and burden on government budget, improving health expenditure efficiency to create some fiscal space will be an important step

Fiscal space for health in Sub-Saharan African countries: an efficiency approach

The study argues that potential savings from efficiency could be effective alternative to increasing health system financing in SSA. Health system efficiency estimates were derived from the Data Envelopment Analysis and Stochastic Frontier Analysis and used to compute potential gains from efficiency. Data was sourced from the World Bank's world development indicators for 45 SSA countries in 2011. The results reveal that average potential saving in health expenditure from improved efficiency was 0.10% and 0.75% of GDP per capita in the DEA and SFA models, respectively. The results also showed that a 1% increase in efficiency of health expenditure reduced infant mortality rate by 0.91% compared to 0.40% reduction in infant mortality if health expenditure increased by 1%. The results imply that in the face of significant economic challenges and burden on government budget, improving health expenditure efficiency to create some fiscal space will be an important step