Data Accuracy and Completeness of Monthly Midwifery Returns Indicators of Ejisu Juaben Health Directorate of Ghana

The broad range of activities contained in the provision of Primary Health Care (PHC) places a burden on providers to make optimal use of limited resources to achieve maximal health benefit to the population served. All too often, ad hoc decisions and personal preferences guide PHC resource allocations, making accountability for results impossible. Problems constraining Routine Health Information System (RHIS) performance in low-income countries include: poor data quality; limited use of available information; weaknesses in how data are analyzed and poor RHIS management practices. This study sought to investigate these constraints. A non-experimental before and after study involving bassline assessment of data accuracy and completeness, application of innovative strategies such as mentoring and coaching of Health Information Officers in data quality improvement process. Coincidentally, the intervention improved both data accuracy and completeness performance significantly among the participating facilities. The outstanding performance may be attributed to management's new orientation and growing interest towards quality data. Engaging frontline staff in data quality improvement work and provision of regular feedback leads to improvement in data accuracy and completeness. This has implications for decision-making and resource allocation, especially in low-income countries, where the routine health information management system relies heavily on paper work

Factors that influence midwifery students in Ghana when deciding where to practice: a discrete choice experiment

Abstract Background Mal-distribution of the health workforce with a strong bias for urban living is a major constraint to expanding midwifery services in Ghana. According to the UN Millennium Development Goals (MDG) report, the high risk of dying in pregnancy or childbirth continues in Africa. Maternal death is currently estimated at 350 per 100,000, partially a reflection of the low rates of professional support during birth. Many women in rural areas of Ghana give birth alone or with a non-skilled attendant. Midwives are key healthcare providers in achieving the MDGs, specifically in reducing maternal mortality by three-quarters and reducing by two-thirds the under 5 child mortality rate by 2015. Methods This quantitative research study used a computerized structured survey containing a discrete choice experiment (DCE) to quantify the importance of different incentives and policies to encourage service to deprived, rural and remote areas by upper-year midwifery students following graduation. Using a hierarchical Bayes procedure we estimated individual and mean utility parameters for two hundred and ninety eight third year midwifery students from two of the largest midwifery training schools in Ghana. Results Midwifery students in our sample identified: 1) study leave after two years of rural service; 2) an advanced work environment with reliable electricity, appropriate technology and a constant drug supply; and 3) superior housing (2 bedroom, 1 bathroom, kitchen, living room, not shared) as the top three motivating factors to accept a rural posting. Conclusion Addressing the motivating factors for rural postings among midwifery students who are about to graduate and enter the workforce could significantly contribute to the current mal-distribution of the health workforce.http://deepblue.lib.umich.edu/bitstream/2027.42/112340/1/12909_2012_Article_752.pd

The African Philosophy of "Ubuntu" and correctional education in South Africa: a case study

The South African history and circumstances have resulted in many families in South Africa living on the edge of survival. Many young people who break the law have no basic education for employment and many have no source of livelihood and thus cannot make ends meet. While “prison” inmates have wronged other citizens through crimes, the African philosophy of “Ubuntu” (forgiveness and love) reflected in this article addresses the love and forgiveness values. The young and adult offenders are offered correctional education meant to equip them with knowledge and skills to show that, based on Ubuntu, they are forgiven and equipped with skills for livelihood. The article interrogates their perceptions on “prison” curriculum or correctional education offered in South African correctional centres, based on the African indigenisation principles. In establishing what curriculum issues are addressed through teaching and learning activities, the study used the qualitative research method to interview 9 inmates participating in formal, non-formal and informal correctional programmes offered in the three correctional facilities in Pretoria, South Africa. Underpinning the study is the “Ubuntu” ecological systems theory on the effectiveness of the indigenised curriculum practices for African and community-based needs. While the majority of offenders attach value to the correctional education offered, some believe the needs-based curriculum must emanate from their vocational and employment-based prerequisites. The study recommends that curriculum offered in correctional facilities in South Africa must promote the philosophy of “Ubuntu” to solve the African crime levels; thus, “it takes the whole village to raise a child”.ABET and Youth Developmen

Census politics in deeply divided societies

Population censuses in societies that are deeply divided along ethnic, religious or linguistic lines can be sensitive affairs – particularly where political settlements seek to maintain peace through the proportional sharing of power between groups. This brief sets out some key findings from a research project investigating the relationship between census politics and the design of political institutions in Bosnia and Herzegovina, Kenya, Lebanon and Northern Ireland

Using traditional agroecological knowledge to adapt to climate change and variability in the Upper East Region of Ghana

Ghana's susceptibility to climate change is well documented and the agricultural sector which is the backbone of the country's economy is one of the most vulnerable sectors to the adverse effects of climate change. This study employed both quantitative and qualitative research methods including household surveys and focus group discussions to examine the extent to which traditional agroecological knowledge is used to manage climate change in three selected communities (Gia, Gaani and Nyangua) of the Kassena Nankana Municipality in the Upper East Region of Ghana. The study specifically answers the following research questions: (i) What is the extent of rainfall and temperature changes in the municipality from 1983–2017? (ii) What is the perception of farmers on rainfall and temperature changes in the selected communities for the past three decades? (iii) What are the key adaptation practices used by farmers to reduce the threats of climate change? (iv) What are the traditional agroecological indicators used by farmers to predict rainfall in the study communities? Mann-Kendall trend test was used to assess rainfall and temperature trends over the study period. Results from the trend analysis indicated an inconsistent pattern in rainfall and an increasing trend in temperature in the municipality. Results also showed that farmers perceived decreasing trend in rainfall as well as increasing temperature. Farmers’ perception of decreased trend in rainfall was inconsistent with the analysed rainfall data as the trend of rainfall was statistically insignificant (p > 0.05) and Sen's slope confirmed a positive slope indicating that amounts of rainfall had increased in the municipality. The farmers employed a variety of on-farm and off-farm practices including the use of traditional agroecological knowledge, use of improved varieties of crops and temporary migration to adapt to the impacts of climate change in the study communities. The farmers predicted rainfall onset using a variety of traditional agroecological indicators including direction of wind, croaking of frogs, appearance of cattle egret and flowering and fruiting of local trees. The study recommends the putting in place of a framework that blends traditional agroecological knowledge and scientific knowledge to develop effective climate change adaptation strategies

Evaluation of equity in informal land development systems in two Nigerian cities

The informal land development system in Sub-Saharan Africa (SSA) is perceived to promote equity and could be leveraged to support sustainable urban development and management. However, scanty empirical evidence exists on the extent of the system’s provision of equity to support policy formulation and practice in the region. Based on stakeholder workshops, focus group discussions and questionnaire surveys, this study analyses the system’s provision of equity in Nigeria. The study finds all categories of people undertake informal developments. Consistent with literature, this finding reflects wide patronage of the informal land development system and its relevance. Nevertheless, contrary to the existing perception, the system’s provision of equity is low. The study recommends for the institution of pro-poor and gender sensitive land development and management policies and programmes to increase the levels of equity to support the achievement of the country’s sustainable urban development and management agenda

For money or service? a cross-sectional survey of preference for financial versus non-financial rural practice characteristics among ghanaian medical students

Abstract Background Health worker shortage and maldistribution are among the biggest threats to health systems in Africa. New medical graduates are prime targets for recruitment to deprived rural areas. However, little research has been done to determine the influence of workers' background and future plans on their preference for rural practice incentives and characteristics. The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana. Methods We asked fourth-year Ghanaian medical students to rank the importance of rural practice attributes including salary, infrastructure, management style, and contract length in considering future jobs. We used bivariate and multivariate ordinal logistic regression to estimate the association between attribute valuation and students' socio-demographic background, educational experience, and future career plans. Results Of 310 eligible fourth year medical students, complete data was available for 302 students (97%). Students considering emigration ranked salary as more important than students not considering emigration, while students with rural living experience ranked salary as less important than those with no rural experience. Students willing to work in a rural area ranked infrastructure as more important than students who were unwilling, while female students ranked infrastructure as less important than male students. Students who were willing to work in a rural area ranked management style as a more important rural practice attribute than those who were unwilling to work in a rural area. Students studying in Kumasi ranked contract length as more important than those in Accra, while international students ranked contract length as less important than Ghanaian students. Conclusions Interventions to improve rural practice conditions are likely to be more persuasive than salary incentives to Ghanaian medical students who are willing to work in rural environments a priori. Policy experiments should test the impact of these interventions on actual uptake by students upon graduation.http://deepblue.lib.umich.edu/bitstream/2027.42/112499/1/12913_2011_Article_1837.pd

Multi-source statistics:Basic situations and methods

Many National Statistical Institutes (NSIs), especially in Europe, are moving from single‐source statistics to multi‐source statistics. By combining data sources, NSIs can produce more detailed and more timely statistics and respond more quickly to events in society. By combining survey data with already available administrative data and Big Data, NSIs can save data collection and processing costs and reduce the burden on respondents. However, multi‐source statistics come with new problems that need to be overcome before the resulting output quality is sufficiently high and before those statistics can be produced efficiently. What complicates the production of multi‐source statistics is that they come in many different varieties as data sets can be combined in many different ways. Given the rapidly increasing importance of producing multi‐source statistics in Official Statistics, there has been considerable research activity in this area over the last few years, and some frameworks have been developed for multi‐source statistics. Useful as these frameworks are, they generally do not give guidelines to which method could be applied in a certain situation arising in practice. In this paper, we aim to fill that gap, structure the world of multi‐source statistics and its problems and provide some guidance to suitable methods for these problems

Factors influencing job preferences of health workers providing obstetric care : results from discrete choice experiments in Malawi, Mozambique and Tanzania

BACKGROUND: Task shifting from established health professionals to mid-level providers (MLPs) (professionals who undergo shorter training in specific procedures) is one key strategy for reducing maternal and neonatal deaths. This has resulted in a growth in cadre types providing obstetric care in low and middle-income countries. Little is known about the relative importance of the different factors in determining motivation and retention amongst these cadres. METHODS: This paper presents findings from large sample (1972 respondents) discrete choice experiments to examine the employment preferences of obstetric care workers across three east African countries. RESULTS: The strongest predictors of job choice were access to continuing professional development and the presence of functioning human resources management (transparent, accountable and consistent systems for staff support, supervision and appraisal). Consistent with similar works we find pay and allowances significantly positively related to utility, but financial rewards are not as fundamental a factor underlying employment preferences as many may have previously believed. Location (urban vs rural) had the smallest average effect on utility for job choice in all three countries. CONCLUSIONS: These findings are important in the context where efforts to address the human resources crisis have focused primarily on increasing salaries and incentives, as well as providing allowances to work in rural areas

Enhanced Collateral Growth by Double Transplantation of Gene-Nucleofected Fibroblasts in Ischemic Hindlimb of Rats

BACKGROUND: Induction of neovascularization by releasing therapeutic growth factors is a promising application of cell-based gene therapy to treat ischemia-related problems. In the present study, we have developed a new strategy based on nucleofection with alternative solution and cuvette to promote collateral growth and re-establishment of circulation in ischemic limbs using double transplantation of gene nucleofected primary cultures of fibroblasts, which were isolated from rat receiving such therapy. METHODS AND RESULTS: Rat dermal fibroblasts were nucleofected ex vivo to release bFGF or VEGF165 in a hindlimb ischemia model in vivo. After femoral artery ligation, gene-modified cells were injected intramuscularly. One week post injection, local confined plasmid expression and transient distributions of the plasmids in other organs were detected by quantitative PCR. Quantitative micro-CT analyses showed improvements of vascularization in the ischemic zone (No. of collateral vessels via micro CT: 6.8±2.3 vs. 10.1±2.6; p<0.05). Moreover, improved collateral proliferation (BrdU incorporation: 0.48±0.05 vs. 0.57±0.05; p<0.05) and increase in blood perfusion (microspheres ratio: gastrocnemius: 0.41±0.10 vs. 0.50±0.11; p<0.05; soleus ratio: soleus: 0.42±0.08 vs. 0.60±0.08; p<0.01) in the lower hindlimb were also observed. CONCLUSIONS: These results demonstrate the feasibility and effectiveness of double transplantation of gene nucleofected primary fibroblasts in producing growth factors and promoting the formation of collateral circulation in ischemic hindlimb, suggesting that isolation and preparation of gene nucleofected cells from individual accepting gene therapy may be an alternative strategy for treating limb ischemia related diseases