Socio-economic Differentials in Health Care Seeking Behaviour and Out-Of-Pocket expenditure for OPD Services in Madina Township

The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 in an effort to address issues of inequities in financial access to health care. The aim of this study was to determine the trends of health care seeking behaviour by socio-economic status (SES) and out-of-pocket expenditure of OPD visits in Madina Township in Ghana. A population-based, cross-sectional household survey was carried out in Madina Township in the Ga-East Municipal, Accra, Ghana, using structured questionnaires to obtain information from a random sample of 378 household heads using a two-week recall period. The study found NHIS enrolment levels in Madina Township to be far below expectations (27.5%). There were disparities in waiting times indicating higher delays of insured patients. Despite the financial protection that the NHIS offers, poor households continue to incur significant costs on health care services. In addition, household perceptions regarding not only costs but also quality of service, severity of illness and proximity were found to influence choice of health services. Household SES continues to exert influence on choice of health services despite the introduction of NHIS. Efforts to improve enrolment and health service utilization must take cognizance of the broader range of factors that may challenge or even erode gains, if just the costs of health care are addressed as an isolated item. Key Words: OPD visit, insured, non-insured, out-of-pocket expenditure, socio-economic status, Ghana

Barriers to obstetric care at health facilities in sub-Saharan Africa - a systematic review protocol

Background: Since the launch of the Millennium Development Goals (MDGs) by the United Nations in 2000, the global community has intensified efforts to reduce adverse maternal health outcomes, especially, in sub-Saharan Africa. Despite these efforts, there is an increasing concern that the decline in maternal deaths has been less than optimal, even for women who receive birthing care in health facilities. High maternal deaths have been attributed to a variety of issues such as poor quality of care, inadequate resources, poor infrastructure, and inaccessibility to healthcare services. In other words, even in settings where they are available, many women do not receive life-saving obstetric care, when needed, despite the fact that basic and comprehensive obstetric care is widely recognized as a key to meeting maternal health goals. It is important to understand the common challenges that this developing region is facing in order to ensure a more rapid decline in adverse maternal health outcomes. The aim of this review is to synthesize literature on barriers to obstetric care at health institutions which focuses on sub-Saharan Africa, the region that is most affected by severe maternal morbidity and mortality.Methods: This review follows guidelines by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. An electronic search of published literature will be conducted to identify studies which examined barriers to health facility-based obstetric care in sub-Saharan Africa. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases will be searched. Published articles in English, dated between 2000 and 2014, will be included. Combinations of search terms such as obstetric care, access, barriers, developing countries, and sub-Saharan Africa will be used to locate related articles, and eligible ones retained for data abstraction. A narrative synthesis approach will be employed to synthesize the evidence and explore relationships between included studies.Discussion: Information on the barriers to obstetric care is needed to inform policies for the improvement of maternal health. This review will contribute to providing related vital evidence to facilitate removal of barriers to maternal health services and interventions

Millennium development Goal 5: Progress and challenges in reducing maternal deaths in Ghana

BACKGROUND: High maternal deaths in developing countries are recognised as a public health issue. To address this concern, targets were set as part of the Millennium Development Goals, launched in 2000 by the United Nations General Assembly. However, despite focused efforts, the maternal health targets in developing regions may not be achieved by 2015. DISCUSSION: We highlight progress and challenges in reducing maternal deaths, with a particular focus on Ghana. We discuss key issues like the free maternal healthcare package, transportation and referral concerns, human resources challenges, as well as the introduction of direct-entry midwifery training and the Community-based Health and Planning Services rolled out to specifically help curb poor maternal health outcomes. SUMMARY: A key contribution to the country’s slow progress towards achieving Millennium Development Goal 5 is that policy choices have often been in response to emergency or advancing problems rather than the use of preventive measures. Ghana can benefit greatly from long-term preventive strategies, the development of human resources, infrastructure and community health education

Management and Referral of Obstetric Complications: a Study in the Upper East Region of Ghana

Women in West and Central Africa have the highest lifetime risk of maternal death of 1 in 27, compared to a ratio of 1 in 180 globally, and 1 in 2,000 in Central and Eastern Europe. Like many West African countries, Ghana made insufficient progress in efforts to meet the Millennium Development Goals. In 2015, Ghana’s maternal mortality ratio was 319 per 100,000 live births with a lifetime risk of maternal death of 1 in 74. This PhD study examined the management and referral of obstetric complications in the Upper East Region of Ghana

Additional file 4: of Access barriers to obstetric care at health facilities in sub-Saharan Africa—a systematic review

PRISMA 2009 Checklist. PRISMA checklist for reporting of systematic review. (DOC 65 kb

Additional file 2: of Access barriers to obstetric care at health facilities in sub-Saharan Africa—a systematic review

Quality assessment using the mixed methods appraisal tool (MMAT). Quality assessment of included studies. (DOC 160 kb