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Chatio S.,Navrongo Health Research Center | Akweongo P.,University of Ghana
PLoS ONE | Year: 2017

Background The shortage of formal health workers has led to the utilization of Community-Based Health Volunteers (CBHV) to provide health care services to people especially in rural and neglected communities. Community-based health volunteers have been effective partners in health care delivery at the community level for many years. The challenge is how to retain these volunteers and also sustain their activities. This study explored factors affecting retention and sustainability of community-based health volunteers' activities in a rural setting in Northern Ghana. Methods This was a qualitative study comprising thirty-two in-depth interviews (IDIs) with health volunteers and health workers in-charge of health volunteers' activities. Purposive sampling technique was used to select study participants for the interviews. The interviews were transcribed and coded into themes using Nvivo 10 software. The thematic analysis framework was used to analyze the data. Results Study participants reported that the desire to help community members, prestige and recognition as doctors in community mainly motivated them to work as health volunteers. Lack of incentives and logistical supplies such as raincoats, torch lights, wellington boots and transportation in the form of bicycles to facilitate the movement of health volunteers affected the work. They suggested that lack of these things discouraged them from working as health volunteers. Most of the dropout volunteers said lack of support and respect from community members made them to stop working as health volunteers. They recommended that community support, incentives and logistical supplies such as raincoats, torch light, wellington boots, bicycles, awards to hard working volunteers are mechanisms that can help retain community-based health volunteers and also sustain their activities. Conclusion Providing means of transport and non-monetary incentives would help to retain communitybased health volunteers and also sustain their activities at the community level. © 2017 Chatio, Akweongo. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Akazili J.,Navrongo Health Research Center | Aikins M.,University of Ghana | McIntyre D.,University of Cape Town
Health Policy and Planning | Year: 2012

The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2012; all rights reserved.2012 © Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2012; all rights reserved.


de Vries J.,University of Cape Town | Tindana P.,Navrongo Health Research Center | Littler K.,Wellcome Trust Sanger Institute | Ramsay M.,University of Witwatersrand | And 4 more authors.
Trends in Genetics | Year: 2015

Human Heredity and Health in Africa (H3Africa) research seeks to promote fair collaboration between scientists in Africa and those from elsewhere. Here, we outline how concerns over inequality and exploitation led to a policy framework that places a firm focus on African leadership and capacity building as guiding principles for African genomics research. © 2015 The Authors.


Armah G.,University of Ghana | Akazili J.,Navrongo Health Research Center | Hodgson A.,Navrongo Health Research Center
Journal of Infectious Diseases | Year: 2010

Diarrhea caused by rotaviruses is one of the most frequent causes of hospitalization among pediatric patients in rural communities of developing countries in sub-Saharan Africa and Southeast Asia, and it is a major cause of death in these communities. The complexity of diarrhea and the increasing cost of treatment puts additional burden on the health sector. To demonstrate the economic burden of diarrhea to policy makers, this study was conducted to estimate the treatment cost of diarrhea in children <5 years old in Ghana using the World Health Organization protocol for cost data collection and estimation. The study was undertaken in Navrongo War Memorial Hospital in northern Ghana. Cost estimates were made for 3 treatment scenarios observed: (1) treatment by rehydration, (2) treatment by rehydration and antibiotics, and (3) treatment ofdiarrhea and other diseases. The average outpatient treatment costs for the 3 treatment scenarios were US$3.86, $4.10, and $4.35 respectively, and the average treatment costs for hospitalization (inpatient care) were $65.14, $97.40, and $133.86 respectively. The annual national treatment costs, based on the 3 treatment scenarios, ranged from $907,116 to $1,851,280 for outpatients clinic visits and from $701,833 to $4,581,213 for hospitalizations. The average length of stay for the inpatients ranged from 2.3 to 4.9 days. The study did not cover patient costs (ie, household costs). © 2010 by the Infectious Diseases Society of America. All rights reserved.


Mills A.,London School of Hygiene and Tropical Medicine | Ataguba J.E.,University of Cape Town | Akazili J.,Navrongo Health Research Center | Borghi J.,London School of Hygiene and Tropical Medicine | And 8 more authors.
The Lancet | Year: 2012

Background Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of fi nancing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of diff erent fi nancing mechanisms, and patterns of service use. We report a whole-system analysis-integrating both public and private sectors-of the equity of health-system fi nancing and service use in Ghana, South Africa, and Tanzania. Methods We used primary and secondary data to calculate the progressivity of each health-care fi nancing mechanism, catastrophic spending on health care, and the distribution of health-care benefi ts. We collected qualitative data to inform interpretation. Findings Overall health-care fi nancing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefi ts in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries. Interpretation Analyses of the equity of fi nancing and service use provide guidance on which fi nancing mechanisms to expand, and especially raise questions over the appropriate fi nancing mechanism for the health care of people outside the formal sector. Physical and fi nancial barriers to service access must be addressed if universal coverage is to become a reality. Funding European Union and International Development Research Centre.


Zere E.,Washington | Kirigia J.M.,World Health Organization | Duale S.,Tulane University | Akazili J.,Navrongo Health Research Center
BMC Public Health | Year: 2012

Background: With the date for achieving the targets of the Millennium Development Goals (MDGs) approaching fast, there is a heightened concern about equity, as inequities hamper progress towards the MDGs. Equity-focused approaches have the potential to accelerate the progress towards achieving the health-related MDGs faster than the current pace in a more cost-effective and sustainable manner. Ghana's rate of progress towards MDGs 4 and 5 related to reducing child and maternal mortality respectively is less than what is required to achieve the targets. The objective of this paper is to examine the equity dimension of child and maternal health outcomes and interventions using Ghana as a case study. Methods. Data from Ghana Demographic and Health Survey 2008 report is analyzed for inequities in selected maternal and child health outcomes and interventions using population-weighted, regression-based measures: slope index of inequality and relative index of inequality. Results: No statistically significant inequities are observed in infant and under-five mortality, perinatal mortality, wasting and acute respiratory infection in children. However, stunting, underweight in under-five children, anaemia in children and women, childhood diarrhoea and underweight in women (BMI < 18.5) show inequities that are to the disadvantage of the poorest. The rates significantly decrease among the wealthiest quintile as compared to the poorest. In contrast, overweight (BMI 25-29.9) and obesity (BMI 30) among women reveals a different trend - there are inequities in favour of the poorest. In other words, in Ghana overweight and obesity increase significantly among women in the wealthiest quintile compared to the poorest. With respect to interventions: treatment of diarrhoea in children, receiving all basic vaccines among children and sleeping under ITN (children and pregnant women) have no wealth-related gradient. Skilled care at birth, deliveries in a health facility (both public and private), caesarean section, use of modern contraceptives and intermittent preventive treatment for malaria during pregnancy all indicate gradients that are in favour of the wealthiest. The poorest use less of these interventions. Not unexpectedly, there is more use of home delivery among women of the poorest quintile. Conclusion: Significant Inequities are observed in many of the selected child and maternal health outcomes and interventions. Failure to address these inequities vigorously is likely to lead to non-achievement of the MDG targets related to improving child and maternal health (MDGs 4 and 5). The government should therefore give due attention to tackling inequities in health outcomes and use of interventions by implementing equity-enhancing measure both within and outside the health sector in line with the principles of Primary Health Care and the recommendations of the WHO Commission on Social Determinants of Health. © 2012 Zere et al; licensee BioMed Central Ltd.


Tindana P.,Navrongo Health Research Center | De Vries J.,University of Cape Town
Annual Review of Genomics and Human Genetics | Year: 2016

Genomic research and biobanking are increasingly being conducted in the context of collaborations between researchers in high-income countries and those in low- and middle-income countries. Although these scientific advancements have presented unique opportunities for researchers to contribute to cutting-edge scientific projects and address important health problems, they have also challenged existing ethical and regulatory frameworks, particularly in sub-Saharan Africa. Broad consent is a model that allows the use of human biological samples and associated data in future research that may be unrelated to the original study. Drawing on emerging perspectives in low- and middle-income countries, we argue that broad consent is equivalent to consent to governance and that a robust governance framework for genomics and biobanking should seek to promote global health and research equity and take into account five key elements: respect, authentic community engagement and trust building, the preservation of privacy and confidentiality, feedback of results, and capacity strengthening. Copyright © 2016 by Annual Reviews. All rights reserved.


Akazili J.,Navrongo Health Research Center | Gyapong J.,Ghana Health Service | McIntyre D.,University of Cape Town
International Journal for Equity in Health | Year: 2011

Background: Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Methods. Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Results: Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. Conclusion: For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced. © 2011 Akazili et al; licensee BioMed Central Ltd.


Ataguba J.E.,University of Cape Town | Akazili J.,Navrongo Health Research Center | McIntyre D.,University of Cape Town
International Journal for Equity in Health | Year: 2011

Background: Inequalities in health have received considerable attention from health scientists and economists. In South Africa, inequalities exist in socio-economic status (SES) and in access to basic social services and are exacerbated by inequalities in health. While health systems, together with the wider social determinants of health, are relevant in seeking to improve health status and health inequalities, those that need good quality health care too seldom get it. Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. However, these studies are based on selected disease conditions and only consider a single point in time. Trend analyses have yet to be produced. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s. Methods. Several rounds (2002, 2004, 2006, and 2008) of the South African General Household Surveys (GHS) data were used, with standardized and normalized self-reported illness and disability concentration indices to assess the distribution of illness and disability across socio-economic groups. Composite indices of socio-economic status were created using a set of common assets and household characteristics. Results: This study demonstrates the existence of socio-economic gradients in self-reported ill-health in South Africa. The burden of the major categories of ill-health and disability is greater among lower than higher socio-economic groups. Even non-communicable diseases, which are frequently seen as diseases of affluence, are increasingly being reported by lower socio-economic groups. For instance, the concentration index of flu (and diabetes) declined from about 0.17 (0.10) in 2002 to 0.05 (0.01) in 2008. These results have also been confirmed internationally. Conclusion: The current burden and distribution of ill-health indicates how critical it is for the South African health system to strive for access to and use of health services that is in line with need for such care. Concerted government efforts, within both the health sector and other social and economic sectors are therefore needed to address the significant health inequalities in South Africa. © 2011 Ataguba et al; licensee BioMed Central Ltd.


Dalinjong P.A.,Navrongo Health Research Center | Laar A.S.,National Health Insurance Authority Operations
Health Economics Review | Year: 2012

Background: Prepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. Hence Ghana implemented the National Health Insurance Scheme (NHIS) to help promote access to health care services for Ghanaians. The study examined the influence of the NHIS on the behavior of health care providers in their treatment of insured and uninsured clients. Methods: The study took place in Bolgatanga (urban) and Builsa (rural) districts in Ghana. Data was collected through exit survey with 200 insured and uninsured clients, 15 in-depth interviews with health care providers and health insurance managers, and 8 focus group discussions with insured and uninsured community members. Results: The NHIS promoted access for insured and mobilized revenue for health care providers. Both insured and uninsured were satisfied with care (survey finding). However, increased utilization of health care services by the insured leading to increased workloads for providers influenced their behavior towards the insured. Most of the insured perceived and experienced long waiting times, verbal abuse, not being physically examined and discrimination in favor of the affluent and uninsured. The insured attributed their experience to the fact that they were not making immediate payments for services. A core challenge of the NHIS was a delay in reimbursement which affected the operations of health facilities and hence influenced providers' behavior as well. Providers preferred clients who would make instant payments for health care services. Few of the uninsured were utilizing health facilities and visit only in critical conditions. This is due to the increased cost of health care services under the NHIS. Conclusion: The perceived opportunistic behavior of the insured by providers was responsible for the difference in the behavior of providers favoring the uninsured. Besides, the delay in reimbursement also accounted for providers' negative attitude towards the insured. There is urgent need to address these issues in order to promote confidence in the NHIS, as well as its sustainability for the achievement of universal coverage. © 2012 Dalinjong and Laar; licensee Springer.

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