Evaluation of community perspectives on national health insurance policy to health service delivery in Ghana

The paper aims to examine National Health Insurance Scheme (NHIS) policy from the perspective of local communities. Qualitative data from nine key informant interviews and seventy-two community respondents in nine focus group discussions (FGD) were conducted. The FGDs took place in seven different communities in seven regions of Ghana. The data were analysed using thematic network approach. The findings noted a disconnection between NHIS policy and community life. More so, the findings showed an explicit link between equity and access with its impacts on health outcomes. The qualitative results indicated lack of voice and understanding as features limiting people from accessing the NHIS facilities. Understanding of equity as a key theme revealed: first, lack of stakeholder engagement and consultation or participation in the NHIS decision making process. Second it was established that while the policy indicated a will to include all the core poor for an equitable NHIS, there is lack of willingness to implement this aim fully. Finally, despite being a pro- poor intervention by name, practical management of the NHIS is transmitted down vertical silos from the national level, with the lack of joined-up government at the centre undermining local partnerships. Thus, not only are national expectations being dashed locally, local expectations are dashed nationally. The paper proposes that community viewpoints should be given higher priority given that NHIS has since its inception been associated with medical treatments and biomedical paradigm. Promoting community participation, understanding and voices should be recognised to shape the future NHIS policy and practice

Andrological, pathologic, morphometric, and ultrasonographic findings in rams experimentally infected with Brucella ovis

AbstractBrucella ovis is considered the most important infectious cause of reproductive disorders in sheep. The disease is characterized by epididymitis, subfertility and infertility in rams. B. ovis occasionally results in abortion in ewes, as well. The aim of this study was to evaluate kinetic changes in the reproductive organs of rams experimentally infected with B. ovis. Nine rams were experimentally inoculated intrapreputially with 2mL of a suspension containing 1.2×109CFU (colony-forming units)/mL of B. ovis (strain ATCC25840). In addition, 50μL of a suspension containing 1.2×1010CFU/mL of the same B. ovis strain was inoculated into each conjunctival sac, resulting in 3.6×109CFU total per ram. Six of nine infected rams had developed clinical changes in the tail of the epididymis at 30 days post-infection (dpi), but these changes regressed in 50% of these rams. Ultrasound demonstrated an increase in the area of the tail of the epididymis (P<0.001), reduction in the area of the testes (P<0.001), and an increased length and width of the seminal vesicles (P<0.001) during the course of infection. A sperm granuloma was diagnosed on the basis of ultrasonography findings. Microscopically, there was epididymitis, testicular degeneration, and seminal vesiculitis. Inflammatory cells were detected in the semen even before the development of epididymitis. Moreover, inflammatory cells were also found in the semen of asymptomatic rams, indicating that the presence of leukocytes in the ejaculate is a valuable method for screening potential carriers of infections in the genital tract

Corrosion behaviour of PEEK or β-TCP-impregnated Ti6Al4V SLM structures targeting biomedical applications

This work was supported by FCT through the grants PD/BD/140202/2018, SFRH/BD/140191/2018 and SFRH/BD/128657/2017, and the projects PTDC/EMSTEC/ 5422/2014 and NORTE-01-0145-FEDER-000018-HAMaBICo. Additionally, this work was supported by FCT with the reference project UID/EEA/04436/2019. F. TOPTAN is grateful for the financial support through the M-ERA-NET/0001/2015 project (FCT).Ti6Al4V cellular structures were produced by selective laser melting (SLM) and then filled either with beta-tricalcium phosphate (β-TCP) or PEEK (poly-ether-ether-ketone) through powder metallurgy techniques, to improve osteoconductivity and wear resistance. The corrosion behavior of these structures was explored considering its importance for the long-term performance of implants. Results revealed that the incorporation of open cellular pores induced higher electrochemical kinetics when being compared with dense structures. The impregnation of β-TCP and PEEK led to the creation of voids or gaps between the metallic matrix and the impregnated material which also influenced the corrosion behavior of the cellular structures.info:eu-repo/semantics/publishedVersio

Community health impact assessment in Ghana: contemporary concepts and practical methods

It has long been recognised that health and its determinants are strongly influenced by policies, programmes and projects outside of the healthcare sector. Few countries have introduced health impact assessments (HIA) to try and ensure that probable impacts on health are considered. An appropriate health impact assessment regime will identify negative and positive impacts of proposed health policies and programmes on health, enable the interpretation of health risk and potential health gain, and present the information to assist in decision making. These HIAs are often generic and rapid desk-based appraisals characterised by the use of information and evidence that is already available or easily accessible and generally undertaken by administrators in an organisation to gain a snapshot of the health impacts to inform proposal direction. Rapid and generic desk-based assessments require less-intensive effort and resources and draws on existing data sources from scientific peer-reviewed and grey literature to analyse potential health impacts. However, both sources can also be used to determining whether a more detailed review is necessary. The Community HIA model proposed by this work departs from the generic and rapid desk- based appraisals and is intended to provide practical evidence to give higher priority to people’s viewpoints, promote participation, understanding and incorporate community voices to help shape future policy, programmes and practice. A comprehensive review of Ghana’s National Health Insurance Scheme (NHIS) was carried out using the generic desk based HIA approach. This was followed by a practical qualitative community field work. In this research we have demonstrated how community HIA is to be conducted through an actual case study in the Ghanaian West African context. The scope of this work is wide and incorporates the consideration of key concepts and possible methods for carrying out HIA at the community level

Understanding qualitative and community indicators of poverty for national health insurance scheme exemptions in Ghana

The exemptions of the National Health Insurance Scheme (NHIS) for poor people in Ghana have not been sufficiently explored. Using a qualitative approach that involved gathering and analysing viewpoints from the community, this paper investigates the factors that are used to determine NHIS exemptions in Ghana. Focus group discussions (FGDs) and interviews of key informants (KIs) were conducted during the period (August 2015 to August 2016) within the Ashanti and Greater Accra regions in Ghana. Nine FGDs were conducted in nine different communities with 72 respondents. Nine KIs, including local and national policy-makers, civil servants and local community members were also interviewed. A sampling method was adopted to capture a range of understandings of community indicators of poverty for NHIS exemptions. Community perceptions of the indicators of poverty included interconnected themes of income, employment, education, assets, and social marginalisation. The findings highlight contextual and community descriptions associated with exemptions, of which poverty is a predictor, and discovered that to identify the indigent for exemptions based only on income and quantitative measures is not enough. The results are significant for a number of reasons including poor fit with official measures and the neglect of lay perspectives. For practice implications, our findings show that communities should be principal stakeholders for describing the disadvantaged groups that require exemptions

Deriving a preference-based utility measure for cancer patients from the European Organisation for the Research and Treatment of Cancer's Quality of Life Questionnaire C30: a confirmatory versus exploratory approach

Background: Multi attribute utility instruments (MAUIs) are preference-based measures that comprise a health state classification system (HSCS) and a scoring algorithm that assigns a utility value to each health state in the HSCS. When developing a MAUI from a health-related quality of life (HRQOL) questionnaire, first a HSCS must be derived. This typically involves selecting a subset of domains and items because HRQOL questionnaires typically have too many items to be amendable to the valuation task required to develop the scoring algorithm for a MAUI. Currently, exploratory factor analysis (EFA) followed by Rasch analysis is recommended for deriving a MAUI from a HRQOL measure. Aim: To determine whether confirmatory factor analysis (CFA) is more appropriate and efficient than EFA to derive a HSCS from the European Organisation for the Research and Treatment of Cancer’s core HRQOL questionnaire, Quality of Life Questionnaire (QLQ-C30), given its well-established domain structure. Methods: QLQ-C30 (Version 3) data were collected from 356 patients receiving palliative radiotherapy for recurrent/metastatic cancer (various primary sites). The dimensional structure of the QLQ-C30 was tested with EFA and CFA, the latter informed by the established QLQC30 structure and views of both patients and clinicians on which are the most relevant items. Dimensions determined by EFA or CFA were then subjected to Rasch analysis. Results: CFA results generally supported the proposed QLQ-C30 structure (comparative fit index =0.99, Tucker–Lewis index =0.99, root mean square error of approximation =0.04). EFA revealed fewer factors and some items cross-loaded on multiple factors. Further assessment of dimensionality with Rasch analysis allowed better alignment of the EFA dimensions with those detected by CFA. Conclusion: CFA was more appropriate and efficient than EFA in producing clinically interpretable results for the HSCS for a proposed new cancer-specific MAUI. Our findings suggest that CFA should be recommended generally when deriving a preference-based measure from a HRQOL measure that has an established domain structure

Convergence of the critical attractor of dissipative maps: Log-periodic oscillations, fractality and nonextensivity

For a family of logistic-like maps, we investigate the rate of convergence to the critical attractor when an ensemble of initial conditions is uniformly spread over the entire phase space. We found that the phase space volume occupied by the ensemble W(t) depicts a power-law decay with log-periodic oscillations reflecting the multifractal character of the critical attractor. We explore the parametric dependence of the power-law exponent and the amplitude of the log-periodic oscillations with the attractor's fractal dimension governed by the inflexion of the map near its extremal point. Further, we investigate the temporal evolution of W(t) for the circle map whose critical attractor is dense. In this case, we found W(t) to exhibit a rich pattern with a slow logarithmic decay of the lower bounds. These results are discussed in the context of nonextensive Tsallis entropies.Comment: 8 pages and 8 fig