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Background: A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana.Methods: The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews.Results: The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p < 0.001). However, there were no significant differences in claims cost adjustment rate between healthcare facility types by the electronic-based (p = 0.0656) and by the paper-based reviews (p = 0.6484).Conclusions: The electronic-based review adjusted significantly higher claims cost than the paper-based claims review. Scaling up the electronic-based review to cover claims from all accredited care providers could reduce spurious claims cost to the scheme and ensure long term financial sustainability. [ABSTRACT FROM AUTHOR]

Background: The introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana. Methods: Electronic search was done for literature published between 2003–2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context. Results: Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients’ trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper. Conclusions: The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors. [ABSTRACT FROM AUTHOR]

Purpose - Actions of incumbent politicians and firms' managers during election years have been cited as sources of many problems that afflict economies and business entities. Given the controversies surrounding the impact of elections on firms' soundness, this paper poses a question of whether banks should be averse to elections. Specifically, this study aims to investigate the impact of elections on the profitability and efficiency of banks. Design/methodology/approach - Based on the authors' knowledge, this is maiden analysis in this context for Ghana where relatively advanced appropriate GMMtechnique has been used on annual data from 2012 to 2016. Findings - This study reveals that banks make higher returns in election years. Additionally, the authors report that government's economic policies in election years are detrimental to management efficiency, though insignificant. Practical implications - From an emerging economy perspective, this study would guide policymakers in designing policies that respond to, or minimize, the impact of elections on bank performance. The result of this analysis would also substantiate the market reaction to the changes in the economic, political and financial conditions. Originality/value - This analysis suggests that firms' performances in an election year depend on policies and political institutions in place. The authors argue that Ghana, with its exemplary democratic credentials and strong institutions, living alongside a high perception of corruption, is different. The contribution to literature is, first, by limiting this work to the banking sector of Ghana and, second, by incorporating the behaviors of incumbent governments and individuals in the regression specification model. [ABSTRACT FROM AUTHOR]

Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9–3.5) and 0.4% (95%CrI: 0.2–0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1–1.3) and 0.2% (0.0–0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps. [ABSTRACT FROM AUTHOR]

In the past four decades, there has been an increase in the occurrence of zoonotic diseases. Some outbreaks have been devastating because of the inability of individuals and health workers to identify the diseases early. Generally, most zoonotic diseases are heralded by a fever. While fevers are common, they are often the symptoms of different diseases. This paper explores how a population at potential risk of zoonotic diseases identify fevers, and what treatments they seek when they develop fevers. The data are from focus group discussions and a survey of three communities in the Brong Ahafo, Volta and Greater Accra regions in Ghana. The quantitative data were analysed using descriptive statistics while the qualitative data were analysed using thematic analysis. The findings indicate that the perceived causes of fever differ from the traditional biomedical view. While orthodox treatment was the preferred choice for most participants, rural dwellers utilised traditional medicine more than their urban counterparts. Though there is no record of bat-borne zoonotic disease in Ghana, our findings could be used as a proxy to indicate how populations at risk of exposure might respond in the event of a spillover event from a zoonosis. We recommend that educational campaigns on zoonotic diseases should target rural dwellers, especially farmers, who may be most at risk of zoonoses. [ABSTRACT FROM AUTHOR]

Background: The National Health Insurance Scheme (NHIS) was launched in Ghana in 2003 with the main objective of increasing utilisation to healthcare by making healthcare more affordable. Previous studies on the NHIS have repeatedly highlighted that cost of premiums is one of the major barriers for enrollment. However, despite introducing premium exemptions for pregnant women, older people, children and indigents, many Ghanaians are still not active members of the NHIS. In this paper we investigate why there is limited success of the NHIS in improving access to healthcare in Ghana and whether social exclusion could be one of the limiting barriers. The study explores this by looking at the Social, Political, Economic and Cultural (SPEC) dimensions of social exclusion.Methods: Using logistic regression, the study investigates the determinants of health service utilisation using SPEC variables including other variables. Data was collected from 4050 representative households in five districts in Ghana covering the 3 ecological zones (coastal, forest and savannah) in Ghana.Results: Among 16,200 individuals who responded to the survey, 54 % were insured. Out of the 1349 who sought health care, 64 % were insured and 65 % of them had basic education and 60 % were women. The results from the logistic regressions show health insurance status, education and gender to be the three main determinants of health care utilisation. Overall, a large proportion of the insured who reported ill, sought care from formal health care providers compared to those who had never insured in the scheme.Conclusion: The paper demonstrates that the NHIS presents a workable policy tool for increasing access to healthcare through an emphasis on social health protection. However, affordability is not the only barrier for access to health services. Geographical, social, cultural, informational, political, and other barriers also come into play. [ABSTRACT FROM AUTHOR]

A key policy strategy towards poverty reduction and ensuring food security in sub-Saharan Africa is to assist poor farmers who over-depend on rainfall to reduce variability in production and increase productivity through small-scale private pump irrigation. Despite the fact that the performances of large scale irrigation schemes have not been efficient and optimal in terms of anticipated economic benefits, not much evidence exist on small-scale private pump irrigation as an alternative investment option in smallholder agricultural production in Africa. Not much emphasis also has been put on the opportunity costs of family labor time in small-scale private pump irrigation, which happens to be one of the key ingredients in the decision making of smallholder farmers who engage in irrigation agriculture. This paper examines the economics of small-scale private pump irrigation and agricultural productivity using a survey data collected in four administrative regions of Ghana, including, the Northern, Upper East, Eastern, and Volta. Mixed method approach that combines both qualitative and quantitative analytical tools are employed in the study. The empirical approach involves estimating a production function in order to derive the shadow wages of family labor directly from the marginal agricultural productivity. Notably, the production functions of small-scale private motor pump irrigators using groundwater and surface water and small-scale private manual pump irrigators are estimated and compared with that of rainfed farmers and gravity flow irrigators after which, the implicit wages of family labor is computed for each irrigation farmer. The paper finds that among the entire small-scale private pumps irrigators, groundwater motor pump irrigators have significantly higher value-added output and tend to do better in terms of financial returns to small-scale private pumps irrigation. The empirical results indicate that small-scale private motor pump irrigators who use groundwater or surface water are able to generate the highest implicit wage rate of family labor, and concludes that small-scale private pump irrigation in sub- Saharan Africa would be successful if it is combined with the efficient use of inputs of production, including seeds, fertilizer, and chemical inputs. The paper contributes to expanding the existing debate on irrigation development in sub-Saharan Africa by highlighting on the potential of small-scale private pump irrigation in Ghana. Governments in sub-Saharan Africa should consider irrigation as part of a wider agricultural policy strategy by promoting farmer education and developing market infrastructure to enhance the returns to small-scale private irrigation and attract private sector investors into the irrigation sub-sector. [ABSTRACT FROM AUTHOR]

Background Economic evaluations have routinely understated the net benefits of vaccination by not including the full range of economic benefits that accrue over the lifetime of a vaccinated person. Broader approaches for evaluating benefits of vaccination can be used to more accurately calculate the value of vaccination. Methodology This paper reflects on the methodology of one such approach – the health investment life course approach – that looks at the impact of vaccine investment on lifetime returns. The role of this approach on vaccine decision-making will be assessed using the malaria health investment life course model example. Results We describe a framework that measures the impact of a health policy decision on government accounts over many generations. The methodological issues emerging from this approach are illustrated with an example from a recently completed health investment life course analysis of malaria vaccination in Ghana. Beyond the results, various conceptual and practical challenges of applying this framework to Ghana are discussed in this paper. Discussion and conclusions The current framework seeks to understand how disease and available technologies can impact a range of economic parameters such as labour force participation, education, healthcare consumption, productivity, wages or economic growth, and taxation following their introduction. The framework is unique amongst previous economic models in malaria because it considers future tax revenue for governments. The framework is complementary to cost-effectiveness and budget impact analysis. The intent of this paper is to stimulate discussion on how existing and new methodology can add to knowledge regarding the benefits from investing in new and underutilized vaccines. [ABSTRACT FROM AUTHOR]

Even though cervical cancer is quite a prevalent disease in Ghana, there is hardly any study on this disease. This paper sought to explore the experiences of cervical cancer patients living with the disease with emphasis on their knowledge about the disease before and after the diagnosis. Qualitative data were collected through in-depth interviews with cervical cancer patients undergoing treatment in a specialised cancer treatment health facility in rural Ghana. Cervical cancer patients had inadequate knowledge about the disease, its symptoms, risk factors, treatment and prevention prior to being diagnosed of the disease. These patients were diagnosed late because they usually sought treatment elsewhere before reporting to health facilities. They experienced physical, psychological, economic and social disruptions in their daily lives, which affected their quality of life. It is evident that lack of knowledge about cervical cancer constitutes a threat to its prevention and treatment. Intensive health education through the mass media and community health promotion outreaches can be a sure way of creating adequate knowledge about cervical cancer in Ghana. Treatment and care for cervical cancer patients should incorporate counselling sessions, which should take into consideration the different levels of disruption the women experience and the implications for their wellbeing and management of the condition. [ABSTRACT FROM AUTHOR]

To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership. In this paper we therefore look beyond economic explanations of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In particular, we investigate whether social exclusion, as measured through a sociocultural, political and economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional survey of 4050 representative households conducted in Ghana in 2012. Household indices were created to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally, economically and politically excluded children are less likely to enrol in the NHIS. Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partially-enrolled (i.e. not all children enrolled within the household) than fully-enrolled. These results suggest that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to improve coverage by removing the remaining small, annually renewable registration fee, implementing and publicising the new clause that de-links premium waivers from parental membership, establishing additional scheme administrative offices in remote areas, holding regular registration sessions in schools and conducting outreach sessions and providing registration support to female guardians of children. Ensuring equitable access to NHIS will contribute substantially to improving child health and reducing child mortality in Ghana. [ABSTRACT FROM AUTHOR]

This paper examines the dynamic causal relationship between electricity consumption and economic growth in Ghana within a trivariate ARDL framework, for the period 1971-2012. The paper obviates the variable omission bias, and the use of cross-sectional techniques that characterise most existing studies. The results show that there is a distinct causal low from economic growth to electricity consumption: both in the short run and in the long run. This finding supports the growth-led electricity consumption hypothesis, as documented in the literature. The paper urges policy-makers in Ghana to resort to alternative sources of electric power generation, in order to reduce any future pressures on the current sources of electricity production. Appropriate monetary policies must also be put in place, in order to accommodate potential inflation hikes stemming from excessive demands for electricity in the near future. [ABSTRACT FROM AUTHOR]

Policy-makers world-wide are concerned about severe housing problems experienced in cities of the developing world. This paper examines the rental housing situation in Accra, Ghana. It presents findings of a qualitative investigation of the experiences of property owners (n = 21) and tenants (n = 23) in an informal private housing market that caters to the housing needs of an expanding section of Accra residents but lacks an institutional framework for regulating landlord/lady–tenant relations. The specific focus of the investigation is on perceptions of an intensifying tenancy management practice called the advance rent system. Overall, the findings reveal severe rental housing pressures and conflicting relations between renters and property owners rooted in asymmetrical perceptions regarding this system. The paper describes the conditions that shape landlords/ladies’ behaviours towards renters and their reactions to what are generally perceived as fraudulent tenure terms that property owners arbitrarily impose on tenants in this market. The paper concludes by suggesting policy recommendations to mitigate constraints plaguing a dysfunctional rental market system. [ABSTRACT FROM PUBLISHER]

Background: Ghana introduced capitation payment for primary care in 2012 with the view to containing escalating claims expenditure. This shift in provider payment method raised issues about its potential impact on patient-provider trust relationship and insured-patients' trust in the Ghana National Health Insurance Scheme. This paper presents findings of a study that explored insured-patients' perception about, and attitude towards capitation payment in Ghana; and determined whether capitation payment affect insured-patients' trust in their preferred primary care provider and the National Health Insurance Scheme in general.Methods: We adopted a survey design for the study. We administered closed-ended questionnaires to collect data from insurance card-bearing members aged 18 years and above. We performed both descriptive statistics to determine proportions of observations relating to the variables of interest and chi-square test statistics to determine differences within gender and setting.Results: Sixty-nine per cent (69 %) out of 344 of respondents selected hospital level of care as their primary care provider. The two most important motivations for the choice of a provider were proximity in terms of geographical access (40 %) and perceived quality of care (38 %). Eighty-eight per cent (88 %) rated their trust in their provider as (very) high. Eighty-two per cent (82 %) actively selected their providers. Eighty-eight per cent (88 %) had no intention to switch provider. A majority (91 %) would renew their membership when it expires. Female respondents (91 %; n = 281) were more likely to renew their membership than males (87 %; n = 63). Notwithstanding capitation payment experience, 81 % of respondents would recommend to their peers to enrol with the NHIS with rural dwellers (87 %; n = 156) being more likely to do so than urban dwellers (76 %; n = 188). Almost all respondents (92 %) rated the NHIS as (very) good.Conclusion: Health Insurance subscribers in Ghana have high trust in their primary care provider giving them quality care under capitation payment despite their negative attitude towards capitation payment. They are guided by proximity and quality of care considerations in their choice of provider. The NHIA would, however, have to address itself to the negative perceptions about the capitation payment policy. [ABSTRACT FROM AUTHOR]

Background: Why issues get on the policy agenda, move into policy formulation and implementation while others drop off in the process is an important field of enquiry to inform public social policy development and implementation. This paper seeks to advance our understanding of health policy agenda setting, formulation and implementation processes in Ghana, a lower middle income country by exploring how and why less than three months into the implementation of a pilot prior to national scale up; primary care maternal services that were part of the basket of services in a primary care per capita national health insurance scheme provider payment system dropped off the agenda.Methods: We used a case study design to systematically reconstruct the decisions and actions surrounding the rise and fall of primary care maternal health services from the capitation policy. Data was collected from July 2012 and August 2014 through in-depth interviews, observations and document review. The data was analysed drawing on concepts of policy resistance, power and arenas of conflict.Results: During the agenda setting and policy formulation stages; predominantly technical policy actors within the bureaucratic arena used their expertise and authority for consensus building to get antenatal, normal delivery and postnatal services included in the primary care per capita payment system. Once policy implementation started, policy makers were faced with unanticipated resistance. Service providers, especially the private self-financing used their professional knowledge and skills, access to political and social power and street level bureaucrat power to contest and resist various aspects of the policy and its implementation arrangements - including the inclusion of primary care maternal health services. The context of intense public arena conflicts and controversy in an election year added to the high level political anxiety generated by the contestation. The President and Minister of Health responded and removed antenatal, normal delivery and postnatal care from the per capita package.Conclusion: The tensions and complicated relationships between technical considerations and politics and bureaucratic versus public arenas of conflict are important influences that can cause items to rise and fall on policy agendas. [ABSTRACT FROM AUTHOR]

Background: National health insurance schemes (NHIS) in developing countries and perhaps in developed countries as well is a considered a pro-poor intervention by helping to bridge the financial burden of access to quality health care. Perceptions of quality of health service could have immense impacts on enrolment. This paper shows how perception of service quality under Ghana's insurance programme contributes to health insurance subscription.Methods: The study used the 2014 Ghana Demographic and Health Survey (GDHS) dataset. Both descriptive proportions and binary logistic regression techniques were applied to generate results that informed the discussion.Results: Our results show that a high proportion of females (33 %) and males (35 %) felt that the quality of health provided to holders of the NHIS card was worse. As a result, approximately 30 % of females and 22%who perceived health care as worse by holding an insurance card did not own an insurance policy. While perceptions of differences in quality among females were significantly different (AOR = 0.453 [95 % CI = 0.375, 0.555], among males, the differences in perceptions of quality of health services under the NHIS were independent in the multivariable analysis. Beyond perceptions of quality, being resident in the Upper West region was an important predictor of health insurance ownership for both males and females.Conclusion: For such a social and pro-poor intervention, investing in quality of services to subscribers, especially women who experience enormous health risks in the reproductive period can offer important gains to sustaining the scheme as well as offering affordable health services. [ABSTRACT FROM AUTHOR]

Abstract: The key elements of integrated water resources management include a holistic integrated approach and the main principles of public participation, the role of gender and the notion of recognising the economic value of water. This paper investigates how these notions play out in the context of providing water to the rural communities in the Densu basin in Ghana. This investigation is based on a content analysis of the relevant policy documents and interviews with state agencies and local stakeholders. The paper concludes that there is a conflict between the IWRM goal of integrating all water uses and sectors in the management of water resources and focusing on the prioritisation of water delivery services. However, three of the IWRM principles can be used in implementing water delivery. While Ghana has adopted IWRM, it clearly prioritises water delivery. At basin level, the IWRM planning process does not take water delivery into account and water delivery is conducted independent of the IWRM process. Although the participatory and gender approaches are being implemented relatively successfully, if slowly, the ‘water as an economic good’ principle is given less priority than the notion of the human right to water as local communities pay only 5% of the capital costs of water delivery services. The impact of the rural water delivery services has been positive in the Densu basin in seven different ways; and if this helps the rural community out of the poverty trap, it may lead to economically viable water facilities in the long-term. [Copyright &y& Elsevier]

Purpose - This paper aims to investigate the presence of currency substitution in eight African countries. Design/methodology/approach - This study investigates the presence of currency substitution in eight African countries - Egypt, Morocco, Nigeria, Ghana, Kenya, South Africa, Tunisia and Zambia - for the period 1976 to 2005 using both regional and US dollar as anchor currencies. Findings - The paper finds that currency substitution is prevalent in Ghana and Nigeria when CFA franc is used as an anchor currency. However, when US dollar is used as an anchor currency there is no evidence of currency substitution in Ghana, but the presence of currency substitution in Nigeria is still observed. The paper also finds the presence of currency substitution in South Africa, but not in Egypt when the US dollar is the anchor currency. For Kenya, Tunisia and Zambia there is no evidence of currency substitution irrespective of the anchor currencies considered. In the case of Morocco, no evidence of currency substitution is observed when the Egyptian pound is used as anchor currency, but there is weak evidence of currency substitution when the US dollar is considered. Originality/value - This paper provides useful information on the presence of currency substitution in African countries. [ABSTRACT FROM AUTHOR]

Purpose — The paper seeks to estimate agricultural commodity supply response at three levels of aggregation namely, all commodities, food commodities and exports commodities. Design/methodology/approach — The study used cointegration and error correction modelling techniques with the aid of annual data. The aggregate price and quantity indices were constructed using the Tornqvist formula, which has been found more superior to the traditional Laspeyres approach of index construction. Findings — The producers were responsive to price incentives in the long-run for all three commodity aggregates but in the short-run only producers of export commodities were responsive to price incentives. Practical implications — Producers respond to price signals as predicted but structural features of the agricultural commodity sector that results in high transaction cost may account for the absence of price response in the short-run. Interventions in lowering transaction cost in agricultural commodity production has the potential of stimulating a faster and considerable response to price incentives. Originality/value — Despite the policy relevance of agricultural commodity supply response, the extent of the response in Ghana is largely unknown, and it is this gap that the present paper helps to bridge. [ABSTRACT FROM AUTHOR]

Adopting a critical theory framework, this paper is especially concerned with linking the economies, law, and politics and their concomitant mediations interconnections and contradictions. Specifically, the purposes of this paper are to: (a) analyze historically how law has been pliant to the needs of powerful interests or influences by unmasking the disciplinary nature of Ghanian labor laws. The historical origins and transformations of labor relations were not only the deliberate ambiguities of sanctions but also the conflicts waged by the state to secure the respective interests of the privileged; and, (b) specify the conditions under which labor was not free from domination. The conception of the labor-law nexus was based on struggle. The normative foundations that constitute the construction of labor, political, and economic relations contextualizes how social practices reproduce dominant forms of inequality, law, class, and social control. Consistent with critical theory, this paper upholds the significance of historical knowledge for social criticism and political change. Historical analysis enables us to grasp continuities and discontinuities with the past and to develop resources to change. This study demonstrates that law is not shaped by moral consensus but by the relative power of groups who use scarce resources to impose their economic preferences. Both legitimacy and coercion are persuasively achieved through law, economics, culture, and politics the foundations of Ghana's post-colonial developments. [ABSTRACT FROM AUTHOR]

The International Lipid‐Based Nutrient Supplements (iLiNS) Project began in 2009 with the goal of contributing to the evidence base regarding the potential of lipid‐based nutrient supplements (LNS) to prevent undernutrition in vulnerable populations. The first project objective was the development of acceptable LNS products for infants 6–24 months and for pregnant and lactating women, for use in studies in three countries (Burkina Faso, Ghana and Malawi). This paper shares the rationale for a series of decisions in supplement formulation and design, including those related to ration size, ingredients, nutrient content, safety and quality, and packaging. Most iLiNS supplements have a daily ration size of 20 g and are intended for home fortification of local diets. For infants, this ration size is designed to avoid displacement of breast milk and to allow for dietary diversity including any locally available and accessible nutrient‐dense foods. Selection of ingredients depends on acceptability of flavour, micronutrient, anti‐nutrient and essential fatty acid contents. The nutrient content of LNS designed to prevent undernutrition reflects the likelihood that in many resource‐poor settings, diets of the most nutritionally vulnerable individuals (infants, young children, and pregnant and lactating women) are likely to be deficient in multiple micronutrients and, possibly, in essential fatty acids. During ingredient procurement and LNS production, safety and quality control procedures are required to prevent contamination with toxins or pathogens and to ensure that the product remains stable and palatable over time. Packaging design decisions must include consideration of product protection, stability, convenience and portion control. [ABSTRACT FROM AUTHOR]

In the heat of severe global macroeconomic volatility, monetary authorities in the developing world are faced with the challenge of identifying the sources of such volatilities in their countries. Previous studies on developed countries have attributed home country macroeconomic shocks to monetary policy shocks in foreign countries. Consequently, it was suspected that interest rate shocks in trading partner countries such as the United States might be contributing to macroeconomic shocks in Ghana. Hence, the need to replicate such studies on Ghana becomes imperative. Therefore, this paper aims at (i) ascertaining whether Ghana's interest rate respond to the interest rate shocks in USA (ii) finding out if interest rate shocks in USA affect other basic macroeconomic variables of the Ghanaian economy. Data on four Ghanaian variables of real gross domestic product, consumer price index, exchange rate and interest rate were collected. Data on U.S variables (federal fund rate and the world consumer price index) were also collected. All data series were annual and span the period, 1983 to 2011. A VAR model of the Ghanaian economy was specified assuming the U.S variables to be exogenous, affecting the vector of endogenous Ghanaian variables contemporaneously. To automatically resolve the problem of unit root found in our series when the mean reversion status of the series were checked, a VECM of the VAR model was estimated. The study further generated the impulse responses (IR) of the Ghanaian variables to variables of the United States. The impulse response analysis of our VAR model shows that in general, interest rate shocks in the United States as well as shocks in the global consumer prices led to insignificant fluctuations in the Ghanaian macro economy. While the countries' real gross domestic product, interest rates and consumer price indices responded insignificantly to shocks originating from the United States (the upper standard error band fluctuated between 0.00 and 0.50 and the lower standard error band fluctuated between -0.00 and -0.40), its exchange rate responded significantly to shocks from U.S exchange rates (the upper standard error band took off from 0.00, went down to -0.03 before going up to 0.02 while its lower standard error band fluctuated between -0.00 and -0.4). By implication, macroeconomic shocks in Ghana are mostly home-made. To avoid being misled into wrong policy decisions, policy makers in Ghana were therefore advised to always strike a balance between imported and home-made shocks when allocating their policy making resources. [ABSTRACT FROM AUTHOR]

Livelihoods approaches emerged from a broad range of efforts to understand how people live in particular places. They have since cohered into often instrumentally applied frameworks that rest on the broadly held assumption that livelihoods are principally about the management of one’s material circumstances. This assumption limits the explanatory power of livelihoods approaches by shifting a range of motivations for livelihoods decisions outside the analytic frame. This article extends efforts to recover a broader lens on livelihoods decisions and outcomes by conceptualising livelihoods as forms of intimate government, local efforts to shape conduct to definite, shifting, and sometimes contradictory material and social ends. By employing a Foucault-inspired analytics of government to the study of livelihoods in Ghana’s Central Region, the paper presents a systematic, implementable approach to the examination of livelihoods and their outcomes in light of this reframing, one where material outcomes are one of many possible ends of intimate government, instead oftheend. By opening the analytic lens in this manner, we can explain a much wider set of livelihoods outcomes and decisions than possible under contemporary approaches. [ABSTRACT FROM PUBLISHER]

This paper argues that there is ethical and practical necessity for including women's needs, perspectives, and expertise in international climate change negotiations. I show that climate change contributes to women's hardships because of the conjunction of the feminization of poverty and environmental degradation caused by climate change. I then provide data I collected in Ghana to demonstrate effects of extreme weather events on women subsistence farmers and argue that women have knowledge to contribute to adaptation efforts. The final section surveys the international climate debate, assesses explanations for its gender blindness, and summarizes the progress on gender that was made at Copenhagen and Cancun in order to document and provoke movement toward climate justice for women. [ABSTRACT FROM AUTHOR]

The ecological, economic and socio-cultural roles of forests are under threat in Ghana due to the high rate of deforestation. Efforts are being made to combat this problem through rehabilitation measures. However, the costs of deforestation and restoration benefits are not adequately estimated. This paper fills in the gap in knowledge by providing an empirical estimation of the cost of deforestation in monetary terms. Primary data collected regarding timber, non-timber forest products and soils in semi-deciduous forests were analyzed using opportunity cost and replacement cost techniques. The results emphasize differences in the value of these forest goods and services lost annually. The largest losses were in stumpage fees, edible fruits, and avoided carbon emissions values. The results show that US$133,650,000 gross revenue, equivalent to 2.6% of the 2008 agricultural sector Gross Domestic Product, is lost annually. It can be concluded that restoring the degraded forest lands would bring benefits particularly to the local communities through increased stumpage revenues and harvest of non-timber forest products, as well as additional funds from carbon credits. It is recommended that stakeholders of forest resources are made aware of these costs in order to raise awareness of what they are losing through deforestation. [Copyright &y& Elsevier]

This article describes and explains the impact of the donor-driven Poverty Reduction Strategy Paper (PRSP) and the aid modalities surrounding it in Ghana. It focuses on the period in which the New Patriotic Party (NPP) government was in power from 2001 until 2008, but places this within the broader context of aid dependence in Ghana since the 1980s. It is argued that the PRSP documents produced by the government had little impact on implementing policy actions, but rather their function was to secure debt relief and the continuation of foreign aid from official donors. The article examines what was actually implemented during the NPP government and the factors that influenced those actions. More generally it highlights the constraints Ghanaian governments have faced in pursuing economic transformation within contemporary domestic and international contexts. [ABSTRACT FROM AUTHOR]

Researchers have generally assumed that housing policies of the colonial and the immediate post-colonial governments were shaped solely by social and political considerations. From a social perspective, some have argued that governments intervened in the housing field purely on health grounds to create good sanitary conditions and prevent the spread of diseases, especially amongst the colonizers and indigenous educated elites. From a political perspective, writers have argued that the key goal for most housing programmes was to prevent unrest and ensure political longevity. Even though each of these arguments has some merit, little, if any, consideration has been given to the economic logic of housing policies and programmes. Indeed, researchers have generally assumed that colonial and immediate post-colonial governments never considered the economic significance of housing. This assumption is incorrect. Through surveying published and archival sources, this paper aims to rectify the neglect of the economic logic of housing policies by demonstrating that economic implications were considered in the implementation of housing policies and programmes. As will be shown, housing was seen not only as a necessary tool to secure labour and improve productivity, but also as an essential element for the success of economic development projects, especially industrialization programmes. [ABSTRACT FROM AUTHOR]

The question of the optimal spread between bank lending rates and rates that banks pay on deposits, which is fair to bankers, depositors and borrowers, has dogged economies for some time. In Ghana, there is widespread perception that the spread is too wide. Bankers, on the other hand justify the spread on the basis of economic variables that affect them. This paper contributes to the literature by identifying, in the case of Ghana, the short-run response of the net interest margin of banks to changes in bank-specific, industry-specific and macroeconomic variables within the broad framework of Ho and Saunders (1981) . We find that increases in the following factors significantly increase net interest margin — bank market power (or concentration), bank size, staff costs, administrative costs, extent of bank risk aversion and the rate of inflation. On the other hand, increases in the following variables decrease net interest margin significantly — bank excess cash reserves, the central bank lending rate, management efficiency and the passage of time. To help reduce interest rate margins, we recommend that banks should not get too big, the central bank should consider lowering the capital adequacy ratio and banks should be required to pass on to borrowers the full extent of reductions or increases in the central bank lending rate. Continued efforts at keeping inflation at bay will also help. [ABSTRACT FROM AUTHOR]

This paper investigates the factors that influence market participation in rural economies. This is based on the premise that participation in the market is an important channel through which the global economy impacts on the rural areas and can have a positive impact on poverty reduction through increased incomes. A case study approach is adopted using four rural communities in three ecological zones of Ghana. [ABSTRACT FROM AUTHOR]

Neo-liberal policies increasingly affect African agricultural production and the influence and power of transnational agro-food companies have deepened substantially since the turn of the century. As a consequence the conditions of transactions of many African export crops have been modified or changed completely. This paper examines the changes and emerging patterns of transnational buyers’ sourcing practices within four of Ghana's perennial crop sectors: cocoa, pineapple, oil palm and shea nut. The findings suggest that transnational sourcing practices are primarily determined by the need for immediate processing of the crop after harvest and that control over this process is essential for value adding via product differentiation. Different transnational sourcing practices have distinctive spatial outcomes reflected by new patterns of rural transformation within privately regulated territories. [ABSTRACT FROM AUTHOR]

Unemployment is more prevalent in urban than rural Ghana, while underemployment is pervasive in rural Ghana. The paper analyses trends in these two forms of human resource underutilization and examines their major determinants. It is found that a positive association exists between the underemployment rate and the incidence of poverty in specific industries. The data supports the importance of demographics, education and firm sizes as major determinants of unemployment. Furthermore, these factors together with type of employment are the factors influencing underemployment. To reduce the level of unemployment and underemployment, the government should provide support for: (1) growth of private sector firms and informal sector activities; and (2) rural alternatives to agricultural activities. These implications are also relevant to other African countries trying to combat the twin problems of unemployment and underemployment. [ABSTRACT FROM AUTHOR]

This paper investigates the consequences of using different economic status proxies on the estimated impact of economic status and other determinants of fertility. Using micro survey data from Ghana and Peru, we find that the proxies for income that best predict fertility are a principal components score of the ownership of consumer durable goods and a simple sum of ownership of these durable goods, Furthermore, the choice of the proxy generally has a minor influence on the predicted effects of the control variables. We compare the results from using a restricted set of proxies, such as those available in the Demographic and Health Surveys, with the results obtained using a lengthier set of proxies. Our results suggest implications beyond fertility analyses by providing researchers with an awareness of the sensitivity of microanalyses to the treatment of economic status. Our results also suggest practical recommendations for the collection of survey data. [ABSTRACT FROM AUTHOR]

This study investigates the effect of macroeconomic variables on the Ghanaian stock market returns using monthly data over period January 1992 to December, 2008. Macroeconomic variables used in this study are consumer price index (as a proxy for inflation), crude oil price, exchange rate and 91 day Treasury bill rate (as a proxy for interest rate). The study employs the Johansen Multivariate Co-integration Procedure. The empirical results reveal that there is co-integration between the four macroeconomic variables and stock returns in Ghana indicating long run equilibrium relationship. Further, the results reveal that; in the short run, Treasury Bill Rate significantly influences the stock returns, with and an elasticity of 0.005, implying that a 1% rise in the Treasury bill rate will lead to a 0.005% rise in the stock returns. The inflation rate is also significant at 1% with elasticity -0.135744, implying that a 1% increase in inflation rate will decrease stock returns by 0.14 %. The residual value of 0.785548 of the Error Correction Model indicates that about 79% of the deviations of the stock returns are corrected in the short run, which is quite high and encouraging for an emerging market like the Ghana Stock Exchange. In the long run, however, the stock returns are significantly influenced by Inflation rate, Crude oil prices, Exchange rate, and Treasury bill rate, with elasticities of 0.5479, -0.03021, 0.05213, and 0.00322 respectively. Crude oil price is negatively related to stock returns; 1% rise in Crude oil prices will decrease returns by 0.03%. Also a 1% increase in inflation rate increases stock returns by 0.54%; and a 1% rise in exchange rate increases stock returns by 0.052%. The effect of Treasury bill rate is highly inelastic with elasticity of 0.003. In both the short run and the long run results, inflation rate appears to be the most influential macroeconomic variable affecting stock market returns in Ghana. The results also reveal that investors are not compensated for inflationary increases in the short run, but are compensated in the long run. These results have implications for financial analysts, fund managers and policy makers. [ABSTRACT FROM AUTHOR]