Persistence of the inverse care law in maternal health service utilization: An examination of antenatal care and hospital delivery in Ghana

The gap in maternal health outcomes, access and utilization between the haves and have-nots continues to be a challenge globally despite improvements over the past decade. Though Ghana has experienced steady gains in maternal health access and utilization over the years, maternal outcomes, on the other hand, remain poor. In this regard, it is essential to know how various groups in the population achieved improvements and whether some women continue to be disproportionately disadvantaged. The paper performs an analysis of cross-sectional data from the 2017 Ghana maternal health survey to examine the existence of the inverse care law in maternal health services in Ghana. Using descriptive techniques and multivariate logistic regression models the study reveals a pro-rich and pro-urban gradient in the use of hospital facilities for delivery and antenatal care attendance — also, regions known for their high levels of poverty feature significantly lower rates of hospital deliveries. The paper concludes by stressing that unless policies are changed to accommodate these groups, overall gains in maternal health will continue to be incremental

Spatial dimensions of health inequities in a decentralised system: evidence from Ghana

Philosophiae Doctor - PhDDecentralisation has been considered by many as one of the most important strategies in public sector reform in several of the developing countries. Both donors and governments have regarded decentralisation as a tool for national development through the realisation of the objectives of enhancing popular participation in development and the management of development at the regional or local level. Countries are expected to reap the benefits of decentralisation through improved service delivery, namely, through bringing service delivery closer to the consumers, improving the responsiveness of the central government to public demands and,thereby,reducing poverty and inequalities, improving the efficiency and quality of the public services and empowering lower levels of government to feel more involved and in control. However, decentralisation also has the potential to widen the gap in fiscal resources at the sub-national leveland this may, in turn, result in inequities in service delivery tocitizens of the same countryanddepending on where they live. Over the years Ghana has experimented with amix of decentralisation reforms with the current policy integrating elements of political, administrative and economic decentralisation. The current system of local government in Ghana is based on a decentralisation programme that was launched in 1988 with the introduction of district assemblies (DAs) by the Provisional National Defence Council (PNDC) government. Nevertheless, years after the launch of the decentralisation process there are still significant disparities and inequities between districts and regions in Ghana as regards health variables. This study set out to investigate the link between decentralisation and health inequities by exploring the spatial dimensions of health equities in Ghana. The thesis used a concurrent mixed method approach by combining a quantitative inequality indices analysis and a qualitative analysis of interviews with policy makers in both the health sector and the decentralised system. The analysis used household level data from the Ghana Demographic and Health Survey 2003 and 2008 to construct inequality curves and indices in order to illustrate the existing inequities across and within regions in Ghana after an increase in the intensity of decentralisation. The study then decomposed the indices to determine the extent to which these inequities were accounted for by variations both within the regions and between the regions. The thesis also used available data from the common fund records of district assemblies to assess the level of inequities in selected health resources across districts. The thesis then investigated the micro-foundations of health decentralisation using the qualitative and quantitative descriptive analyses. The analysis conducted revealed that inequities in maternal health utilisation decreased between 2003 and 2008‒the two data points used based on theresearch design. However,these inequities were attributed primarily to within region inequities as the level of between regions inequities was significantly lower for both the concentration index and the Theil’s index. However, although, at the regional level the general trend revealed that inequities had also decreasedbetween 2003 and 2008, some individual region s had recorded increases. The concentration index, which provided information on the gradient of the inequities, revealed that the health inequities in Ghana‒the total health inequities and also for both years between and within regions‒were pro rich. In the instances of the regional inequities these inequities generally manifested a pro rich nature, with the exception of the Upper East region which had showed pro poor inequities in 2008. The analysis of the district level inequities in selected health resources and as regards health facilities, doctors and nurses indicated that the distribution of these facilities favoured the richer districts as the inequities revealed a pro rich gradient. The inequities in the health facilities at the district level were highest in respect of the nurses, followed by doctors and health facilities with scores of 0.32, 0.29 and 0.084 respectively. The analysis of the qualitative data corroborated the results of the quantitative analysis as it emerged that policy makers at all levels believed that, over the years since the decentralisation, inequities had reduced, albeit marginally. The policy makers highlighted the high levels of the inequities in health resources,especially human resources,as a major area of concern. However, they also raised major concerns regarding inequities within regions, arguing that a number of factors, includingthe nature of the decentralisation regime in Ghana, the variations in the economic strength of districts and certain political factors,continued to cause inequities within the decentralised system. They argued that these factors impacted on the ability of both districts and regions to address inequities at a local level. In addition, they also pointed to the need to re-examine the definition of inequities in the Ghana health sector, inequities which result from focusing the attention on a number of regions and areas to the detriment of others

Does Subsistence Farming Ameliorate Hunger in Urban Areas? A Quantitative Examination of Urban Areas in South Africa

Africa, with its growing urban population, faces the problem of increased demand for food in urban areas and pressure on urban food systems. Lack of employment opportunities, rising levels of urban poverty and food costs further compounds the urban food problem resulting in high levels of urban hunger and consequently food insecurity. Using the General Household Surveys from 2015 to 2017, we examine the association between subsistence farming practices and hunger in urban South Africa. We estimate three models for hunger at the household level; child hunger, adult hunger and hunger in either adult or child. The findings reveal that female-headed households are more likely to engage in subsistence farming. Women, children and the unemployed are at risk of hunger. We find no association between subsistence farming and hunger in urban areas. Measures of economic welfare; incomes, employment and a household member receiving a social grant are significantly associated with the absence of hunger. The results point to the fact that new urban residents as a matter of necessity need the means to earn an income as this is critical in safeguarding them from hunger

Putting Children First: New Frontiers in the Fight Against Child Poverty in Africa

Despite important strides in the fight against poverty in the past two decades, child poverty remains widespread and persistent, particularly in Africa. Poverty in all its dimensions is detrimental for early childhood development and often results in unreversed damage to the lives of girls and boys, locking children and families into intergenerational poverty. This edited volume contributes to the policy initiatives aiming to reduce child poverty and academic understanding of child poverty and its solutions by bringing together applied research from across the continent. With the Sustainable Development Goals having opened up an important space for the fight against child poverty, not least by broadening its conceptualization to be multidimensional, this collection aims to push the frontiers by challenging existing narratives and exploring alternative understandings of the complexities and dynamics underpinning child poverty. Furthermore, it examines policy options that work to address this critical challenge.Comparative Research Programme on Poverty (CROP) at the University of Bergen.publishedVersio

Assessment of Environmental Exposure Factors on Child Diarrhea and Systemic Inflammation in the Eastern Cape

Poor environmental technologies and gastrointestinal illnesses have been hypothesized to be a primary cause to the lack of impact of child health programs on child stunting rates (low height-for-age) in South Africa. This study assessed correlations between environmental exposures (water source, water treatment, sanitation, refuse), diarrheal occurrences, and systemic inflammation proxies among female and male children under five years of age in the Eastern Cape. A conceptual model was hypothesized using structural equation (SE) modeling and two sex-specific (female and male) datasets were subsequently generated from the data and applied to the hypothesized SE model. Results suggested that environmental exposure variables associated with diarrhea and systemic inflammation proxies were different between females and males. For diarrheal occurrences among females, an increase in local authority management of refuse (compared to household management) (0.161, p-value (p) = 0.007), sharing sanitation facilities (0.060, p = 0.023), and a decrease in the frequency of the treatment of drinking water (−0.043, p = 0.025) were correlated with an increase in diarrhea. For males, an increase in household use of flush toilets (as compared to ventilated pit latrines) was correlated with an increase in diarrhea (0.113, p = 0.027). For systemic inflammation among both sexes, an increase in household use of water pumped into the premises (as compared to a public water tap) and an increase in diarrheal occurrences were correlated with an increase in systemic inflammation. The data support an increased focus on sex and gender specific factors among field practitioners and policy makers working in the environmental health field in South Africa

Putting Children First: New Frontiers in the Fight Against Child Poverty in Africa

Despite important strides in the fight against poverty in the past two decades, child poverty remains widespread and persistent, particularly in Africa. Poverty in all its dimensions is detrimental for early childhood development and often results in unreversed damage to the lives of girls and boys, locking children and families into intergenerational poverty. This edited volume contributes to the policy initiatives aiming to reduce child poverty and academic understanding of child poverty and its solutions by bringing together applied research from across the continent. With the Sustainable Development Goals having opened up an important space for the fight against child poverty, not least by broadening its conceptualization to be multidimensional, this collection aims to push the frontiers by challenging existing narratives and exploring alternative understandings of the complexities and dynamics underpinning child poverty. Furthermore, it examines policy options that work to address this critical challenge