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Migrants face several unmet health needs due to the inability of the healthcare system to address their healthcare challenges. As a result, they adopt coping strategies to overcome their healthcare needs. Consequences can include infrequent but severe adverse reactions, dangerous drug interactions, incorrect dosage etc. Little is known in Ghana about the role played by cultural and linguistic barriers in shaping migrants' access to formal healthcare and the coping mechanisms adopted by these migrants to overcome their healthcare challenges. Surprisingly, most of the studies that have been conducted have focused on financial barriers to care accessibility. This presents a loss opportunity for any health programme aimed at addressing this inequity. Thus, the purpose of this paper is to fill this gap by exploring the challenges of healthcare accessibility and coping strategies adopted by migrants to overcome their healthcare needs in the informal urban settlement of Madina, in the Greater Accra Region. The author employed a narrative type of qualitative research design. A purposive and then snowball sampling technique were used to select 20 participants to participate in the study after saturation was reached. Twelve in-depth interviews (IDIs) and six key informants' interviews (KIIs), as well as two focus group discussions (FGDs), were conducted. The study is consistent with the ecological model, which posits that health is determined by influences at multiple levels. The author found linguistic, cultural, stigmatisation and financial challenges as the main barriers to healthcare accessibility among the migrants. As a result, self-medication and the use of lay health personnel for addressing healthcare needs were more pronounced. The study also found other means of survival that posed a health risk to the migrants. Based on this, it was recommended that healthcare systems take into account the healthcare needs of migrants who are people with culturally and linguistically diverse backgrounds., (© 2022 John Wiley & Sons Ltd.)

Healthcare provider attitudes and perceptions of disability may influence the delivery of comprehensive quality care to patients with disabilities. The study was conducted to ascertain healthcare providers' perspectives on access to healthcare by disabled people in a peri-urban district of Ghana. We employed a qualitative approach and selected participants using the purposive sampling technique. Qualitative data were collected from 28 healthcare providers through face-to-face interviews using an interview guide. Data let thematic an alysis was employed to tease out the findings through categorisation and the main themes have been presented as findings with specific quotations to support them. We found that people with disabilities who visited healthcare facilities were perceived as individuals who are stressed up, selfish and inconsiderate, violent, having low self-esteem and also difficult to communicate with. This could affect the interactions between healthcare providers and people with disabilities who visit the facility and subsequently the quality of service provided. It is recommended that the Ministry of Education, Ministry of Health and the Ghana Health Service work closely with the various educational institutions to train healthcare professionals to improve their knowledge on disability issues to improve service delivery., (© 2021 John Wiley & Sons Ltd.)

Purpose: To describe the epidemiology and referral patterns of gastroschisis patients in northern Ghana., Methods: A hospital-based retrospective review was undertaken at Tamale Teaching Hospital (TTH) Neonatal Intensive Care Unit (NICU) between 2014 and 2019. Data from gastroschisis patients were compared to patients with other surgical diagnoses. Descriptive and inferential statistics were performed with SAS. Referral flow maps were made with ArcGIS., Results: From a total of 360 neonates admitted with surgical conditions, 12 (3%) were diagnosed with gastroschisis. Around 91% (n = 10) of gastroschisis patients were referred from other hospitals, traveling 4 h, on average. Referral patterns showed gastroschisis patients were admitted from three regions, whereas patients with other surgical diagnoses were admitted from eight regions. Only 6% (12/201) of expected gastroschisis cases were reported during the 6-year period in all regions. All gastroschisis deaths occurred within the first week of life., Conclusions: Improving access to surgical care and reducing neonatal mortality related to gastroschisis in northern Ghana is critical. This study provides a baseline to inform future gastroschisis interventions at TTH. Priority areas may include special management of low birth weight newborns, better referral systems, empowerment of community health workers, and increasing access to timely, affordable, and safe neonatal transport.

Purpose: This paper aims to evaluate Ghana's National Health Insurance Scheme (NHIS) on healthcare utilisation by exploring its heterogeneous effects based on residential status and wealth. Design/methodology/approach: The study used the Ghana Socioeconomic Panel Survey (GSPS) datasets. An instrumental variable strategy, specifically the two-stage residual inclusion (2SRI), was employed to control endogenous NHIS membership. Findings: Generally, the results show that NHIS improves healthcare utilisation (i.e. visits to a health facility and formal care). Concerning the heterogeneous effects of health insurance on healthcare utilisation, the results revealed that NHIS members are more likely to seek care, irrespective of their residence status. The results further indicate that the probability of visiting a health facility and utilising formal care increases for the poorest NHIS participants. Based on these, the authors conclude that NHIS provides equitable healthcare access and utilisation for its vulnerable populations, who are beneficiaries. Originality/value: To the best of the authors' knowledge, this paper is the first to explore the heterogeneous effects of NHIS on healthcare utilisation across residential and income subpopulations. Splitting the dataset by residential status to examine healthcare utilisation inequality is worthwhile. In addition, analysing utilisation in terms of health care type would show whether Ghana's NHIS may be viewed as welfare-enhancing through increased formal health care utilisation. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0330 [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to provide new insights into and offer potential solutions to the challenges encountered by mental health services working with remote, rural or underserved communities in the UK. Design/methodology/approach: In this paper, the authors reflect on the utility of integrating conventional clinical approaches, with preventive care and empowering work within the community, to provide culturally sensitive and accessible mental health services. The authors describe an example of community intervention from a mental health service in Ghana designed to enhance reach within remote and rural communities and identify potential lessons for practice in the UK. Findings: The partnership between community mental health services and the rural communities, including families and existing social frameworks, applies collaborative care to overcome the lack of resources and facilitate the acceptability of mental health services to the local population. There are a series of important lessons from this experience including the importance of understanding the culture of a community to optimise reach and the importance of working IN the community and WITH the community. Originality/value: This paper is novel because it provides learning from a model of care applied in the global south that has potential for implementation with underserved populations in the UK. The authors suggest a reframing of the notion of community care to encompass existing frameworks of community, not merely a biomedical conceptualisation. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to identify human rights violations of patients during the early periods of the COVID-19 pandemic in Ghana by investigating the experiences of people on how health-care professionals discharged their responsibilities during the time in question. Design/methodology/approach: Explanatory design of the mixed methods approach was adopted, with the intention of collecting both quantitative and qualitative data sequentially, and then integrating the results at the interpretation stage. The approach enriched the quality of data collected as it offered the advantage of shedding light on the primary motivations and reasons for attitudes and behaviours and helped to provide an in-depth understanding of how individuals interpret the happenings around them and their experiences. Thus, although some amount of quantitative method was used in the data collection, the core of this paper is based on the qualitative interpretations. Findings: The study reveals that health-care professionals, especially those in the Tema Metropolis, undermined certain fundamental human rights of patients during the early period of the COVID-19 pandemic. This includes failure to provide information to patients about treatment options and potential risks of medications; failure to seek the informed consent of patients before performing medical procedures; denial of access to medical files of patients for transfer; and inability or failure to provide medical ambulances services to patients on time. Originality/value: Although many publications on human rights dimensions and health protective issues on COVID-19 pandemic are available on a global scale, still little information pertaining to experiences of individuals with health-care professionals during the early days of the COVID-19 pandemic, especially in Ghana through the lens of patient's rights exists. This paper, therefore, fills an important gap in health-care management information, critical for policy decision-making processes regarding patient's rights in times of pandemic control. [ABSTRACT FROM AUTHOR]

Background: Community‐based health interventions have been implemented as a key strategy for achieving improved health outcomes in Ghana. Effectiveness, however, largely depends on the successful implementation of patient–public engagement (PPE). Although several PPE studies have been conducted in Ghana, little research has been done to understand the specific role of PPE in the context of implementing community‐based health programmes. This paper, therefore, examines the extent of PPE implementation in three selected community‐based health programmes (Community‐based Health Planning and Service [CHPS], Community‐based Maternal and Child Health and Buruli Ulcer) to understand their specific effects on health outcomes. Methods: Three focus groups, involving 26 participants, were held in three districts of the Ashanti region of Ghana. Participants were mainly health service users involving community health committee members/volunteers, residents and health professionals. They were invited to participate based on their roles in the design and implementation of the programmes. Participants focused on each of Rifkin's spider‐gram components. Data were transcribed and analysed descriptively using NVIVO 12 Plus. Results: PPE implementation was found to be extensive across the three programmes in specific areas such as organisation and resource mobilisation. PPE was more restricted in relation to community needs assessment, leadership and management, particularly for the CHPS and Buruli Ulcer programmes. Conclusion: Findings suggest that benefits from community‐based health interventions are likely to be greater if PPE can be widely implemented across all dimensions of the spider‐gram framework. [ABSTRACT FROM AUTHOR]

Since the adoption of the sustainable development goals (SDGs) by the United Nations (UN), the search has been on to identify interventions that have effects on multiple SDG-targets simultaneously. Like other developing countries, Ghana has a youthful population and would require creative, urgent, youth-focused interventions to be able to attain the SDGs by 2030. This paper describes the application of the accelerator model on data from a sample of Ghanaian adolescents to identify potential accelerators towards selected SDG targets involving youth. The data for 944 adolescents, 10–19 years (mean age 12.31 ± 3.51 years), extracted from two cross-sectional surveys on children and adolescents aged 6–19 years in Kumasi, Ghana, were analysed in this paper. Variables considered suitable proxies for SDG targets and potential accelerators were identified from the study instruments. Consequently, four aligned SDG targets (good mental health, access to ICT, school completion and no open defaecation) and five accelerators (cognitive stimulation, no relative poverty, low student–teacher ratio, high caregiver education and safe water) were extracted. Associations between accelerators and SDG targets were assessed using multivariable logistic regression adjusting for sociodemographic covariates and multiple testing. Cumulative effects were tested by marginal effects modelling. The three hypothesised accelerators identified were cognitive stimulation, low student–teacher ratio, and no relative poverty. A combination of all three accelerators was associated with a higher likelihood of adolescents having access to Information and Communication Technology (ICT) by +73% (CI 0.72–0.74), no open defecation by +44% (CI 0.43–0.46), school completion by +27% (CI 0.26–0.27) and good mental health by +9% (CI 0.08–0.10). Three hypothesized accelerators showed association across all four SDG aligned targets. The accelerator model has been further validated in this dataset from Ghana. Robust interventions designed around these accelerators may represent an opportunity for achieving the SDGs in Ghana. [ABSTRACT FROM AUTHOR]

Background: Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post‐stroke aphasia primarily falls within the purview of speech‐language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub‐Saharan Africa is associated with challenges. Aims: This study aimed to examine rehabilitation services for individuals with post‐stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post‐stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post‐stroke aphasia. Methods & Procedures: A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle‐Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech‐language pathology services, speech‐language pathology service delivery, access to speech‐language pathology services, challenges in both delivery and access to speech‐language pathology services and suggestions for improving speech‐language pathology services. In‐person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. Outcomes & Results: All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech‐language pathologists, lack of awareness of speech‐language pathology services for post‐stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech‐language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech‐language pathology services are currently available in only a few cities). Conclusions & Implications: These findings emphasised the need to improve post‐stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post‐stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated. WHAT THIS PAPER ADDS: What is already known on the subject: To address post‐stroke aphasia, evidence‐based speech‐language pathology services are provided. However, there is a paucity of studies on post‐stroke aphasia services in Ghana, preventing an accurate report of services and practices in the country. What this study adds: This study provides an overview of the existing rehabilitation services for post‐stroke aphasia in Ghana. It highlights challenges facing the existing services and suggested strategies to improve post‐stroke aphasia services. What are the clinical implications of this work?: The study created awareness among healthcare professionals and general public (study participants) about the importance of rehabilitation services for post‐stroke aphasia. Based on the study findings, appropriate stakeholders such as policy makers, researchers, and healthcare professionals can further design assessments and interventions to improve rehabilitation, including speech‐language pathology services, for post‐stroke aphasia in Ghana. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study explores the perspective of key informants (educators, preceptors and former students) of the Kintampo Project, on the perceived effectiveness, gains and challenges in delivering this large-scale training innovation in Ghana. The problem of mental health care neglect in Ghana is gradually improving. The Kintampo Project which trained mental health workers in Ghana has played a critical role in increasing access to mental health care. Design/methodology/approach: This qualitative study explored participants' perspectives on the Kintampo Project in three broad areas: perceived effectiveness, gains and challenges. In all, 17 interviews were conducted with former students, preceptors and educators from the project. The interviews were digitally audio-recorded, transcribed, coded and analysed using deductive and thematic methods. Findings: The participants perceived the project to have been successful in increasing the number of mental health workers in Ghana. The project provided a route for career progression for those involved. However, the Kintampo Project faced accreditation issues, low recognition, improper integration and remuneration of trained staff in the Ghana Health Service. This study points to the fact that the sustainability of mental health training in Ghana can be obstructed, because of this career path being less attractive. Further research is needed to explore how best to achieve sustainability of similar mental health innovations. Originality/value: This paper shares the views of participants in the Kintampo Project. [ABSTRACT FROM AUTHOR]

Aims: To explore the experiences of health professionals and families concerning supporting low‐birth weight (LBW) infants along the continuum of care (CoC) in Ghana with the goal to unveil new strategies to improve the quality of neonatal care. Design: A constructivist grounded theory. Method: Simultaneous data collection and analysis among health professionals alongside families with LBW infants from September 2020 to April 2021. The study used constructivist grounded theory strategies for data collection and analysis. Results: The analysis of 25 interviews resulted in a theoretical model describing 10 themes along the CoC for LBW infants, categorized into health and family systems drivers. In this paper, we focus on the latter. Early bonding and family involvement were empowering. Mothers needed assistance in balancing hope and confidence which enabled them to render special care to their LBW infants. Providing mothers with financial and domestic support as well as creating awareness on newborn health in communities were important. Conclusion: To achieve family involvement, a coordinated CoC must entail key players and be culturally inclusive. It must be applied at all levels in the CoC process in a non‐linear faction. This can help LBW infants to thrive and to reach their full developmental potential. Impact The theoretical model developed shows the importance of family involvement through family systems care for a comprehensive response in addressing needs of health professionals and families with LBW infants and bridging the fragmentations in the neonatal CoC in Ghana. Context‐tailored research on family systems care in the neonatal period is necessary to achieve a quality CoC for LBW infants and their families. Patient or Public Contribution: Caregivers and providers participated by granting in‐depth interviews. Care providers further contributed through their feedback on preliminary findings. [ABSTRACT FROM AUTHOR]

Equitable partnerships across borders, sectors and communities are integral in creating shared understanding, novel solutions and sustainable development. Sustainable development goal (SDG) 17: Partnerships for goals, focuses on strengthening global partnerships. This highlights the importance of partnership as a tool to support the achievement of all SDGs. Partnerships are particularly vital to creating sustainable and appropriate services to support people who experience communication or swallowing disability and their families, in under-served communities, where services and expert personnel may be limited and where innovative strategies are required for working with families and communities to improve service accessibility. To reflect on key principles underpinning the creation of a speech–language pathologists' (SLPs') community of practice, designed to support SLPs from high-, low- and middle-income countries to develop equitable partnerships, aimed at supporting people who experience communication or swallowing disability their families. We draw on the authors' experiences of building partnerships to enhance participation for people who experience communication or swallowing disability. We discuss the need for global partnerships and challenges with current funding mechanisms. We use the principles of the speech–language pathology community of practice and concepts from the Partnership Accelerator 2030 Agenda to frame reflections and recommendations. This commentary paper focuses on partnerships for the goals (SDG 17). [ABSTRACT FROM AUTHOR]

Pharmaceutical sector corruption undermines patient access to medicines by diverting public funds for private gain and exacerbating health inequities. This paper presents an analysis of UN Convention Against Corruption (UNCAC) compliance in seven countries and examines how full UNCAC adoption may reduce corruption risks within four key pharmaceutical decision-making points: product approval, formulary selection, procurement, and dispensing. Countries were selected based on their participation in the Medicines Transparency Alliance and the WHO Good Governance for Medicines Programme. Each country’s domestic anti-corruption laws and policies were catalogued and analysed to evaluate their implementation of select UNCAC Articles relevant to the pharmaceutical sector. Countries displayed high compliance with UNCAC provisions on procurement and the recognition of most public sector corruption offences. However, several countries do not penalise private sector bribery or provide statutory protection to whistleblowers or witnesses in corruption proceedings, suggesting that private sector pharmaceutical dispensing may be a decision-making point particularly vulnerable to corruption. Fully implementing the UNCAC is a meaningful first step that countries can take reduce pharmaceutical sector corruption. However, without broader commitment to cultures of transparency and institutional integrity, corruption legislation alone is likely insufficient to ensure long-term, sustainable pharmaceutical sector good governance. [ABSTRACT FROM AUTHOR]

Although healthy life expectancy is projected to be increasing among older people in Ghana, a high proportion and number of older people will live with functional disability, warranting their need for long‐term care. We explored the expressions used by older people to describe their needs and preference of care and support. Using the descriptive qualitative approach, 14 older people were engaged via semi‐structured interviews, and the data were analysed thematically. The study found that older people desired a decent accommodation, preferential healthcare, adequate nutrition, and an opportunity to interact with their peers at social functions. A provision of sufficient financial assistance, adequate healthcare, the periodic organisation of social and group events for older people, and the availability of home care and support could help older people address these needs. The paper reveals the need for interventional research on how a model incorporating social, health and environmental factors even during a pandemic can address older people's varying needs. [ABSTRACT FROM AUTHOR]

This paper examines factors that affect public policy implementation in developing world context, with some evidence from Ghana. It looks at how public policy design; organisational and individual factors affect implementation. Public policy implementation debate is along with top-down, bottom-up or mixed approaches. The health insurance scheme in Ghana is a home-based initiative of a developing country to provide health insurance cover for all persons resident in Ghana including those who cannot afford to pay-the poor and vulnerable groups. It utilises more qualitative comparative research approach and used public and private health organisations (hospitals/clinics) in analysing policy implementation process. The results show policy design and individual factors have more explanatory power than organisational factors. Also, results show more private health organisations received accreditation than the public ones. The public-private collaboration helped to increase policy beneficiaries' access to healthcare services. But, these implementation challenges exist over-billings, over prescriptions, disagreements over tariffs and no prompt payments for healthcare services. It concludes that the private organisations exhibited more of agency than stewardship in protecting their profit-oriented/external interests. [ABSTRACT FROM AUTHOR]

The health and wellbeing of older adults have taken center-stage in global policy agendas in recent times. In 2003, Ghana introduced an insurance exemption policy to eliminate financial barriers to healthcare for older adults and other vulnerable population groups. Embedded within the National Health Insurance Scheme (NHIS), this policy ostensibly guarantees free healthcare for older adults at publicly-funded facilities across the country. In this paper, we applied the implementation problem framework to identify gaps in the implementation of the exemptions policy and their impact on the healthcare experiences of older adults. Our data collection involved qualitative interviews with a purposive sample of community-residing older adults, health workers, community leaders, and policymakers. Our thematic data analysis identified resource, substantive, bureaucratic, political, and administrative constraints in the policy implementation process which, in turn, affected quality healthcare delivery. While most of these constraints are general challenges confronting the NHIS, they serve to undermine the intent of the scheme's exemptions policy. In particular, despite the exemptions, older adults continued to pay out-of-pocket for certain categories of treatments and medications, creating as yet financial barriers to healthcare. We present policy recommendations for addressing these implementation challenges, including suggestions to decentralize, depoliticize, and financially liberate the operations of the NHIS. Ghana's health insurance scheme has not eliminated financial barriers to healthcare for older adults. Older Ghanaians reported unmet healthcare needs, despite implementation of health insurance. Resource, substantive, bureaucratic, and political constraints impede the policy implementation process. Measures are needed to decentralize and depoliticize the NHIS implementation process. [ABSTRACT FROM AUTHOR]

Background: Improving child and maternal health remains a core objective of global health priorities, extending from the millennium development goal (MDG) era to the current focus on the Sustainable Development Goals (SGDs). This paper analyses the childhood morbidity effects of the Ghana Essential Heath Interventions Program (GEHIP), a community-based health systems strengthening in rural northern Ghana. GEHIP was a five-year embedded implementation science plausibility trial that implemented a set of health systems strengthening strategies and tested the proposition that their combined effect at the district, subdistrict and community levels could foster effective community engagement and thereby improve maternal and child health outcomes. Methods: A two stage random sample survey of reproductive-aged women residing in treatment and comparison districts at the GEHIP baseline and end line was used for Heckman Difference-in-differences (DiD) regression models for estimating the incremental effect of GEHIP exposure on three child morbidity conditions (diarrhea, fever and cough), as recalled by maternal respondents in the course of survey interviews. Results: After controlling for child age and gender, maternal age, education, marital status, health insurance status, religion, ethnicity, occupation and household wealth index, regression results show that GEHIP had a statistically significant 45% reduction in fever (OR = 0.55, CI = 0.31–0.98) and 47% reduction in cough (OR = 0.53, CI = 0.30–0.94), over and above temporal reductions that prevailed in study districts. Although not significant, GEHIP also had 38% reduction in the incidence of diarrhea. Conclusion: Previous research has shown that GEHIP had a pronounced positive effect with a reduction in mortality. Our results show that household location in GEHIP districts also led to a significant reduction in morbidity due to cough and fever among under-five children. This association is a likely outcome of GEHIP's impact on the accessibility of primary health care services. Results lend further support to the growing body of evidence that strengthening health systems in rural Africa through the provision of community-based strategies enhances prospects for achieving the United Nations child health SDGs. [ABSTRACT FROM AUTHOR]

Despite a growing burden of stroke in low-middle-income countries, research on patient's experiences and access to rehabilitation services remains limited. This study explores the experiences of stroke patients in relation to access and use of stroke rehabilitation services, coping strategies and strategies to improve care in Ghana. A cross-sectional study was conducted. A total of 136 adult stroke patients hospitalised and subsequently discharged in three major referral hospitals in Ghana participated in the study. A paper-based questionnaire was used to collect data. Data were inputted into STATA version 12, cleaned and analysed using descriptive statistics and Chi-Square tests. Findings showed that stroke patients experience stroke differently. Early detection (awareness) of stroke symptoms at onset was low (29.4%). Hypertension was the major (58.1%) predisposing risk factor for stroke, followed by diabetes (14.7%). Multiple barriers impede access to outpatient rehabilitation services: high cost of medications (43.4%), transportation constraints (10.3%), long waiting time (6.6%), forgetfulness about appointment (4.4%), limited education on rehabilitation (20.6%), lack of community support (12.5%) and ineffective communication with healthcare providers (5.2%). Recommended strategies to improve access to rehabilitation care included public education on stroke and its associated risk, reduction in the cost of drugs and increased stroke rehabilitation funding by the NHIS, especially for physiotherapy consultation and training support to caregivers on patient care. Given the difference in stroke experience and barriers in accessing rehabilitation care, multi-level health policy and service delivery reforms are needed to improve access to rehabilitation care, including national public awareness campaigns on early signs of stroke and subsidised cost of stroke rehabilitation., (© 2020 John Wiley & Sons Ltd.)

Drug use is one of the global public health issues, and its accompanying disorders have consequences on people's mental, physical, and environmental health. Nevertheless, the majority of people who use drugs have never been treated for drug dependence and other health conditions whilst others discontinue their treatment for drug use disorder. Using the health belief model, the study aimed at exploring facilitators and barriers to health-seeking among people who use drugs in the Sunyani Municipality of Ghana. A descriptive study design was used, employing a qualitative approach. In-depth interviews were conducted with a total of 22 participants, including two key informants (male and female). The first group of participants was recruited from the ghetto (an area in the municipality where people who use drugs are usually located). The other group of participants was recruited using hospital-based records. The interview data were transcribed, coded, and analysed for the generation of themes with the aid of Nvivo version 12 pro. The results showed that people who use drugs face health challenges such as drug dependence, malaria, lungs and breathing complications, cardiovascular complications, and skin complications. People who use drugs experienced poor perceived quality of life and low health status. Health-seeking behaviours of interviewees were influenced by the perceived benefit, perceived severity, cues to action, among others. Multiple sources of healthcare were used by the people who use drugs. Whereas ease of communication, perceived severity, benefit, among others were facilitators to their health-seeking behaviours, cost, dwindling social support, lack of knowledge of the condition, and fear of arrest by law enforcement agencies also served as barriers to seeking healthcare at the orthodox health facilities. This paper suggests a holistic approach to help improve the health and health-seeking behaviours of people who use drugs. The researchers wish to indicate that an earlier version of this manuscript has been presented at the University of Ghana as a thesis., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Abdul Cadri et al.)

Background: Homelessness among people with mental illness has grown to become a common phenomenon in many developed and developing countries. Just like in any other country, the living conditions of homeless people with mental illness in Ghana are unwholesome. Despite the increased population of these vulnerable individuals on the streets, not much is known about the perspectives of the general public towards this phenomenon in Ghana. Aim: This research was conducted to explore the perspectives of community members on homeless people with mental illness. The main study objectives were (a) to find out the impacts of the presence of persons with mental illness on the streets and (b) to ascertain the reasons accounting for homelessness among persons with mental illness. Method: Utilizing a qualitative research design, twenty community members were sampled from selected suburbs in Nsawam and interviewed with the use of a semi-structured interview guide. The audio data gathered from the interviews were transcribed verbatim and analysed thematically. Results: Majority of the participants asserted that homeless people with mental illness had no access to good food, shelter, and health care. They further stated that some homeless people with mental illness perpetrated physical and sexual violence against the residents. Moreover, the participants believed that persons with mental illness remained on the streets due to neglect by their family members, and limited access to psychiatric services. Conclusion: This paper concludes by recommending to government to make mental health services accessible and affordable to homeless persons with mental illness nationwide. [ABSTRACT FROM AUTHOR]

Most developing nations are facing rapid population aging with limited economic and social resources. In Ghana, a National Aging Policy (NAP) was promulgated by the government in 2010 to ensure the well-being of older adults. Since its passage, the NAP has yet to be funded and implemented. In this paper we synthesize key information on policies and programs targeted at older adults in Ghana and identify the challenges that are adversely impacting their welfare, including the non-implementation of the National Aging Policy. To give the NAP needed attention and promote its implementation, a national coordinating body exclusively devoted to older adults is an essential first step. Critical next steps are offered to promote the effective implementation of the NAP and ensure the well-being of older adults in Ghana. With its current foundation of support programs for older adults, Ghana has the opportunity to be the lead nation in Sub-Saharan Africa to establish a national level office dedicated to promoting older adults' well-being and including them in the nation's development efforts. [ABSTRACT FROM AUTHOR]

Health literacy offers an opportunity to effectively direct health information and services to poor and marginalised groups. However, minimal attempts have been made to understand the state and determinants of health literacy, and its association with health-related behaviours among street-involved youth (SIY). This paper explores the status and sociodemographic correlates of functional health literacy (FHL) among SIY in Kumasi in Ghana. It also assesses the relationship between FHL, sociodemographic factors and two of the commonest health-related behaviours—alcohol use and smoking—among SIY. The study purposively sampled 337 SIY, aged 12 to 24 years, from five suburbs in the central business district of Kumasi Metropolitan Area in Ghana. The mean age of participants was 18 years (± 3.3). About 48%, 37% and 15% of them had inadequate, problematic and sufficient FHL respectively. Approximately 37% consumed alcohol and 14% smoked. Sex (female) and ethnicity (Ewe) were associated with inadequate FHL. Also, having some education and having been involved with the streets for three years or more were associated with inadequate FHL. Furthermore, being older, having some education, ethnicity, traditional religious affiliation, being male, having health insurance and inadequate FHL were associated with alcohol use. Smoking was associated with age (being older) and having been involved with the streets for three years or more. The paper argues that relevant health interventions must compensate for the heterogeneity of SIY as regards their FHL and sociodemographic characteristics to curb deleterious health behaviours. [ABSTRACT FROM AUTHOR]

Background: To achieve the Sustainable Development Goal target 3.1, the World Health Organisation recommends that all pregnant women receive antenatal care (ANC) from skilled providers, utilise the services of a skilled birth attendant at birth and receive their first postnatal care (PNC) within the first 24 h after birth. In this paper, we examined the maternal characteristics that determine utilisation of skilled ANC, skilled birth attendance (SBA), and PNC within the first 24 h after delivery in Ghana., Methods: We used data from the 2014 Ghana Demographic and Health Survey. Women aged 15-49 with birth history not exceeding five before the survey were included in the study. A total of 2839 women were included. Binary logistic regression was employed at a 95% level of significance to determine the association between maternal factors and maternal healthcare (MCH) utilisation. Bivariate and multivariate regression was subsequently used to assess the drivers., Results: High proportion of women had ANC (93.2%) with skilled providers compared to the proportion that had SBA (76.9%) and PNC within the first 24 h after delivery (25.8%). Only 21.2% utilised all three components of MCH. Women who were covered by national health insurance scheme (NHIS) had a higher likelihood (AOR = 1.31, CI = 1.04 - 1.64) of utilising all three components of MCH as compared to those who were not covered by NHIS. Women with poorer wealth status (AOR = 0.72, CI = 0.53 - 0.97) and those living with partners (AOR = 0.65, CI = 0.49 - 0.86) were less likely to utilise all three MCH components compared to women with poorest wealth status and the married respectively., Conclusion: The realisation that poorer women, those unsubscribed to NHIS and women living with partners have a lower likelihood of utilising the WHO recommended MCH strongly suggest that it is crucial for the Ministry of Health and the Ghana Health Service to take pragmatic steps to increase education about the importance of having ANC with a skilled provider, SBA, and benefits of having the first 24 h recommended PNC.

Objective: Barriers to healthcare in Ghana are multifaceted. Many people, including patients and providers, face them at different levels. To address these barriers, there is a need to explore the role of an intercultural healthcare system. This paper explores and provides the first evidence on ways through which an intercultural healthcare system can reduce the sociocultural and economic barriers to healthcare in Ghana., Methods: Focus group discussions with 35 participants comprising 17 healthcare users, 11 formal healthcare providers and 7 alternative healthcare providers were conducted to gather data. Thematic analyses were performed on the transcribed data and presented based on a posteriori inductive reduction approach., Results: Findings reveal that an intercultural healthcare system in Ghana can help reduce barriers to healthcare, especially cultural, social and economic barriers, by fostering an enhanced relationship between culture and healthcare, promoting affordable healthcare and promoting effective communication between healthcare providers and users. Weak institutional support, lack of strong political will and commitment, lack of training to meet standards of practice, poor registration and regulatory measures, and lack of universal acceptance inhibit implementation of an intercultural healthcare system in Ghana., Conclusion: The support for intercultural healthcare system and the agreement on its perceived ability to reduce social, cultural and economic healthcare barriers for service users offer an opportunity for policymakers to demonstrate a stronger political will and improved commitment for effective education and training, enforcement of regulatory measures, inclusion of intercultural healthcare in medical school curricula across the country, and community engagement., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest., (Copyright © 2020 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.)

Background : The United Nations 2030 Sustainable Development Goals have reaffirmed the international community's commitment to maternal, newborn, and child health, with further investments in achieving quality essential service coverage and financial protection for all. Objective : Using a modified version of the 1978 Tanahashi model as an analytical framework for measuring and assessing health service coverage, this paper aims to examine the system of care at the community level in Ghana's Volta Region to highlight the continued reforms needed to achieve Universal Health Coverage. Methods : The Tanahashi model evaluates health system coverage through five key measures that reflect different stages along the service provision continuum: availability of services; accessibility; initial contact with the health system; continued utilization; and quality coverage. Data from cross-sectional household and health facility surveys were used in this study. Immunization and antenatal care services were selected as tracer interventions to serve as proxies to assess systems bottlenecks. Results : Financial access and quality coverage were identified as the biggest bottlenecks for both tracer indicators. Financial accessibility, measured by enrollment in Ghana's National Health Insurance Scheme was poor with 16.94% presenting valid membership cards. Childhood immunization was high but dropped modestly from 93.8% at initial contact to 76.7% quality coverage. For antenatal care, estimates ranged from 65.9% at initial visit to 25.1% quality coverage. Conclusion : Results highlight the difficulty in achieving high levels of quality service coverage and the large variations that exist within services provided at the primary care level. While vertical investments have been prioritized to benefit specific health services, a comprehensive systems approach to primary health care needs to be further strengthened to reach Ghana's Universal Health Coverage objectives.

Introduction: A key element of the global drive to universal health coverage is ensuring access to needed health services for everyone, and to pursue this goal in an equitable way. This requires concerted efforts to reduce disparities in access through understanding and acting on barriers facing communities with the lowest utilisation levels. Financial barriers dominate the empirical literature on health service access. Unless the full range of access barriers are investigated, efforts to promote equitable access to health care are unlikely to succeed. This paper therefore focuses on exploring the nature and extent of non-financial access barriers. Methods: We draw upon two structured literature reviews on barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda. One review analyses access barriers identified in published literature using qualitative research methods; the other in published literature using quantitative analysis of household survey data. We then synthesised the key qualitative and quantitative findings through a conjoint iterative analysis. Results: Five dominant themes on non-financial access barriers were identified: ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education. The analysis highlighted that non-financial factors pose considerable barriers to access, many of which relate to the acceptability dimension of access and are challenging to address. Another key finding is that quantitative research methods, while yielding important findings, are inadequate for understanding non-financial access barriers in sufficient detail to develop effective responses. Qualitative research is critical in filling this gap. The analysis also indicates that the nature of non-financial access barriers vary considerably, not only between countries but also between different communities within individual countries. Conclusions: To adequately understand access barriers as a basis for developing effective strategies to address them, mixed-methods approaches are required. From an equity perspective, communities with the lowest utilisation levels should be prioritised and the access barriers specific to that community identified. It is, therefore, critical to develop approaches that can be used at the district level to diagnose and act upon access barriers if we are to pursue an equitable path to universal health coverage. [ABSTRACT FROM AUTHOR]

Background : Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving 'Health for All.' The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana's flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services. Objectives : This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved. Method : Three dimensions of access to CHPS care were investigated: geographic, social, and financial. Focus group data were collected in 40 sessions conducted in eight communities located in two districts each of the Northern and Volta Regions. Groups were comprised of 327 participants representing four types of potential clientele: mothers and fathers of children under 5, young men and young women ages 15-24. Results : Posting trained primary health-care nurses to community locations as a means of improving primary health-care access is emphatically supported by focus group participants, even in localities where CHPS is not yet functioning. Despite this consensus, comments on CHPS activities suggest that CHPS services are often compromised by cultural, financial, and familial constraints to women's health-seeking autonomy and by programmatic lapses constrain implementation of key components of care. Respondents seek improvements in the quality of care, community engagement activities, expansion of the range of services to include emergency referral services, and enhancement of clinical health insurance coverage to include preventive health services. Conclusion : Improving geographic and financial access to CHPS facilities is essential to UHC, but responding to community need for improved outreach, and service quality is equivalently critical to achieving this goal.

Traditional Birth Attendants (TBAs) have been a critical human resource in maternal health care delivery in Ghana. However, following the World Health Organization's directive for countries to discontinue using TBAs, the government of Ghana has since emphasized the use of skilled birth attendants. This policy shift created tensions between TBAs and Community Health Nurses. We examine this conundrum in this paper. We find that despite the ban, TBAs still attend a significant number of births - a situation which has produced intense contestations and continuous jostling for "functioning space" and clients between TBAs and nurses. We recommend a consensus-based partnership approach that promotes cultural competence and is sensitive to contextual cultural practices that underpin pregnancy and childbirth.

Background: Conditions that are amenable to surgery are found globally. However, surgery is not easily accessible for most people in low- and middle-income countries due to physical and financial barriers, among others. One-way of mitigating against this situation is through surgical outreach programmes.Patients and Methods: A paediatric surgical outreach in a teaching hospital in the Central Region of Ghana was carried out by a paediatric surgeon from Korle Bu Teaching Hospital. Data on the cases done from June 2011 to June 2014 were analysed.Results: A total of 185 patients had surgery during the study. There were 153 males with the mean age of 4.53 ± 3.67 years. Patients aged 1-5 years represented 51.9% of the patients. Twenty-four (13%) had major surgery and 161 (87%) had minor operations. The most common minor operation performed was inguinal herniotomy representing 47.2% of the cases. None of the patients had any complications.Conclusion: The need for paediatric surgical outreach programme has been shown in this paper as well as its cost-effectiveness. With the current rate of graduation of paediatric surgeons in Ghana, paediatric outreach programmes will be needed in Ghana in the foreseeable future. This outreach should be extended to other regions of the country to cover a larger percentage of children in Ghana. [ABSTRACT FROM AUTHOR]

Introduction: The importance of accessible mental health treatment is a global concern, particularly when one in five people will experience a mental health problem in their lifespan. This is no less important in Ghana; however, no studies have yet attempted to appraise and synthesise the potential enablers and barriers to accessing services in Ghana. The aim of this integrative review is therefore to identify and synthesise existing evidence on the barriers and enablers to accessing mental health services in Ghana.Methods: A search of the published literature was conducted using Medline, EMBASE, PsycINFO, CINAHL (EBSCO), Web of Science, and Scopus electronic databases. The search was limited to papers published in English and within 2000-2018. Using pre-defined inclusion and exclusion criteria, two reviewers independently screened the titles and abstracts of the retrieved papers. A data extraction form and a Critical Appraisal Checklist were used to extract and appraise data, respectively. The integrative review incorporates both qualitative and quantitative data into a single synthesis.Results: Out of 42 papers that met the inclusion criteria, 50% used qualitative methods, 33.3% used mixed methods and 16.7% used quantitative methods alone. The potential barriers in accessing mental health services were attitudinal, knowledge about services, treatment cost, transportation and geographical proximity, as well as perceived efficacy of medication. Similarly, the health systems factors contributing to barriers were low priority, limited funding sources, irregular medicine supply, limited services for marginalised groups and poor state of psychiatric facilities, together with poor management of mental health cadres. The potential enablers for service users involved increased decentralisation and integration, task-shifting and existing support services.Conclusion: The existing evidence on mental health in Ghana is skewed towards weaknesses in the systems and stigma, with rationally little, or no, evidence or emphasis on the effectiveness, or quality of mental health services. These attributes largely neglect the provision of psychiatric services for marginalised mental health service user groups, including children, adolescents, people with disabilities and the elderly. [ABSTRACT FROM AUTHOR]

Background: Ghana in 1999 adopted the Community-based Health Planning and Service (CHPS) policy to enhance access to primary health care (PHC) service. After two decades of implementation, there remains a considerable proportion of the country's population, especially women who lack access to basic health care services., Aim: The aim of this paper is to understand the contribution of Ghana's CHPS policy to women's access to PHC services in the Upper West Region (UWR) of Ghana., Methods: A logistic regression technique was employed to analyse cross-sectional data collected among women (805) from the UWR., Findings: We found that women who resided in CHPS zones (OR = 1.612; P ≤ 0.01) were more likely to have access to health care compared with their counterparts who resided in non-CHPS zones. Also, rural-urban residence, distance to health facility, household wealth status and marital status predicted access to health care among women in the region. Our findings underscore the need to expand the CHPS policy to cover many areas in the country, especially rural communities and other deprived localities in urban settings.

Introduction: Countries with high maternal and newborn mortality can benefit from national facility level data that describe intra-facility emergency referral patterns for major obstetric complications. This paper assesses the relationship between referral and facilities' readiness to treat complications at each level of the health system in Ghana. We also investigate other facility characteristics associated with referral., Methods: The National Emergency Obstetric and Newborn Care Assessment 2010 provided aggregated information from 977 health facilities. Readiness was defined in a 2-step process: availability of a health worker who could provide life-saving interventions and a minimum package of drugs, supplies, and equipment to perform the interventions. The second step mapped interventions to major obstetric complications. We used descriptive statistics and simple linear regression., Results: Lower level facilities were likely to refer nearly all women with complications. District hospitals resolved almost two-thirds of all complicated cases, referring 9%. The most prevalent indications for referral were prolonged/obstructed labor and antepartum hemorrhage. Readiness to treat a complication was correlated with a reduction in referral for all complications except uterine rupture. Facility readiness was low: roughly 40% of hospitals and 10% of lower level facilities met the readiness threshold. Facilities referred fewer women when they had higher caseloads, more midwives, better infrastructure, and systems of communication and transport., Discussion: Understanding how deliveries and obstetric complications are distributed across the health system helps policy makers contextualize decisions about the pathways to providing maternity services. Improving conditions for referral (by increasing access to communication and transport systems) and the management of obstetric complications (increasing readiness) will enhance quality of care and make referral more effective and efficient.

The need for the poor, the marginalised and socially excluded to live healthier and longer lives has in recent times become paramount in the development literature and policy discussions seeking to achieve the Millennium Development Goals (MDGs). In response to this, attempts are being made to redirect the research focus to examine socio-economic factors underpinning disease occurrence and ill health for health planning policies and practices to benefit the poor and vulnerable in society. Tliis paper explores the relationship between socio-economic conditions and health outcomes. It identifies and examines through participatory rural assessment techniques, basic socio- economic factors acting as significant pathways through which poverty increases the susceptibility of rural households to diseases. It seeks to address the reasons why the poor are poorer in health in rural communities of the Amansie West district of Ghana. This paper thus emphasises how social stratification and inequalities could affect quality of life of people in any given society, hence supporting the theory of social suffering and its implications on societal health. [ABSTRACT FROM AUTHOR]

The need to improve the sexual and reproductive health (SRH) and rights of women with disabilities is increasingly acknowledged. Unfortunately, women with disabilities in low- and middle-income settings, including Ghana, face several barriers (including structural, financial, physical, social and attitudinal) to accessing SRH services and care. This paper explores the enablers and barriers to accessing SRH services and care among visually impaired women in the Ashanti and Brong Ahafo Regions of Ghana. Qualitative data from in-depth interviews and focus group discussions were collected from 21 visually impaired women, selected through purposive and snowballing sampling techniques. Thematic analysis was used to develop codes, and data were further grouped into emerging themes. The barriers to accessing SRH services and care were financial difficulties and lack of preferential treatment. The enablers which facilitated access to SRH services and care were the support provided by caregivers and friendly relationships with health providers. To address these challenges and promote access, SRH related policies, services and programmes should be inclusive of the needs of visually impaired women, and measures to remove financial challenges to service utilisation and foster positive relationships with health workers, church and community members should be adopted.

Introduction: Financing access to healthcare services in developing countries remains a major challenge despite recent advances towards implementation of various health insurance policies in many low and middle-income countries. The use of health insurance is considered an important means to achieve universal health coverage. However, uptake of health insurance in most developing countries remains low as a result of several challenges. Empirical evidence of factors restraining enrolment is rare in many developing countries including Ghana. This paper therefore sought to investigate the factors associated with the uptake of health insurance products and the implications thereof for policy, using Awutu Senya West District of Ghana as case study., Methods: A logit model was used to analyze data from 178 respondents randomly selected from two microfinance groups operating in the study area., Results: The results indicate that insurance uptake is higher among younger people, but lower among women. Older women are however more likely to take up health insurance compared to older men. In addition, the study reveals that insurance uptake increases with level of education but decreases with household size., Conclusion: The study concludes that even though the premium on health insurance coverage in Ghana is arguably low, socio-demographic characteristics such as age, sex, literacy level and household size affect the decision to enroll. Adequate public sensitization on the benefits of the scheme and decreasing the statutory age for exemption from premium payment, especially in rural localities, are some of the measures suggested to enhance health insurance uptake in Ghana and other developing countries., Competing Interests: The authors declare no competing interests.

Social protection, which includes cash transfers, is a policy response addressing poverty and vulnerability. This paper examines the effects of cash transfers, in particular Ghana's LEAP Programme, on the Sustainable Development Goals (SDGs). The paper examines the transformative potential of cash transfers by focusing on subjective, relational and psychosocial effects in addition to the reduction in poverty and vulnerability. The paper argues that giving the LEAP cash alone is not sufficient to address long-term poverty, but it is a necessary condition to serve as an instrument for social and economic transformation. Using a qualitative exploratory research design involving 20 in-depth interviews and seven focus group discussions, participants reported that LEAP cash had made them better off in both material and psychological dimensions of poverty, increased food security and nutrition and removed financial barriers to access health care. The cash capacitated women in decision-making, and strengthened peaceful co-existence both at family and community level. However, the LEAP may engender intra-community tensions emanating from sentiments of jealousy and perceived unfairness in the selection of beneficiaries. [ABSTRACT FROM AUTHOR]

Background: Persons with disabilities have often been overlooked in the context of HIV and AIDS risk prevention and service provision. This paper explores access to and use of HIV information and services among persons with disabilities. Methods: We conducted a multi-country qualitative research study at urban and rural sites in Uganda, Zambia, and Ghana: three countries selected to exemplify different stages of the HIV response to persons with disabilities. We conducted key informant interviews with government officials and service providers, and focus group discussions with persons with disabilities and caregivers. Research methods were designed to promote active, meaningful participation from persons with disabilities, under the guidance of local stakeholder advisors. Results: Persons with disabilities emphatically challenged the common assumption that persons with disabilities are not sexually active, pointing out that this assumption denies their rights and – by denying their circumstances – leaves them vulnerable to abuse. Among persons with disabilities, knowledge about HIV was limited and attitudes towards HIV services were frequently based upon misinformation and stigmatising cultural beliefs; associated with illiteracy especially in rural areas, and rendering people with intellectual and developmental disability especially vulnerable. Multiple overlapping layers of stigma towards persons with disabilities (including internalised self-stigma and stigma associated with gender and abuse) have compounded each other to contribute to social isolation and impediments to accessing HIV information and services. Participants suggested approaches to HIV education outreach that emphasise the importance of sharing responsibility, promoting peer leadership, and increasing the active, visible participation of persons with disabilities in intervention activities, in order to make sure that accurate information reflecting the vulnerabilities of persons with disabilities is accessible to people of all levels of education. Fundamental change to improve the skills and attitudes of healthcare providers and raise their sensitivity towards persons with disabilities (including recognising multiple layers of stigma) will be critical to the ability of HIV service organisations to implement programs that are accessible to and inclusive of persons with disabilities. Discussion: We suggest practical steps towards improving HIV service accessibility and utilisation for persons with disabilities, particularly emphasising the power of community responsibility and support; including acknowledging compounded stigma, addressing attitudinal barriers, promoting participatory responses, building political will and generating high-quality evidence to drive the continuing response. Conclusions: HIV service providers and rehabilitation professionals alike must recognise the two-way relationship between HIV and disability, and their multiple overlapping vulnerabilities and stigmas. Persons with disabilities demand recognition through practical steps to improve HIV service accessibility and utilisation in a manner that recognises their vulnerability and facilitates retention in care and adherence to treatment. In order to promote lasting change, interventions must look beyond the service delivery context and take into account the living circumstances of individuals and communities affected by HIV and disability. Persons with disabilities are vulnerable to HIV infection but have historically been excluded from HIV and AIDS services, including prevention education, testing, treatment, care and support. Fundamental change is needed to address practical and attitudinal barriers to access, including provider training. Rehabilitation professionals and HIV service providers alike must acknowledge the two-way relationship between HIV and disability: people with disability are vulnerable to HIV infection; people with HIV are increasingly becoming disabled. Peer participation by persons with disabilities in the design and implementation of HIV services is crucial to increasing accessibility. Addressing political will (through the National Strategic Plan for HIV) is crucial to ensuring long-term sustainable change in recognizing and responding to the heightened vulnerability of people with disability to HIV. [ABSTRACT FROM AUTHOR]

Background: While most studies on HIV/AIDS often identify stigmatization and patients' unwillingness to access health care as critical problems in the control of the pandemic, very few studies have focused on the possible consequences of accessing health care by sero-positives. This paper examines the socio-psychological trauma patients experience in their desire to access health care in two health facilities in the Ashanti Region of Ghana.Methods: Through participant observation, informal conversation and in-depth interviews, data were collected from health workers and clients of the voluntary counselling (VCT) and antiretroviral therapy units in the two hospitals. The data gathered were analysed and categorized into themes and supported with illustrative quotes obtained from health workers and clients.Results: The study found that the mere presence of a person at the HIV counselling centre or clinic is enough for the person to be labelled as or suspected to be HIV patient. It demonstrates that stigmatization may occur not only in the community but also overtly or covertly, in the health facility itself. Consequently, for many HIV/AIDS patients, access to antiretroviral therapy and treatment of related nosocomial infections are problematic. Besides, the study found that many clients and potential users of services were uncomfortable with the quality of care given by some health workers, especially as they overtly and covertly breached confidentiality about their clients' health status. This has compelled many patients and potential users of the services to adopt a modus vivendi that provides them access to some care services while protecting their identity.Conclusion: The paper argues that by examining issues relating to privacy and confidentiality in the provision of care for and use of services by seropositives, more light will be shed on the whys of the limited uptake of HIV-related health care services in Ghana. [ABSTRACT FROM AUTHOR]

Background: The importance of men's involvement in facilitating women's access to skilled maternal healthcare in patriarchal societies such as Ghana is increasingly being recognised. However, few studies have been conducted to examine men's involvement in issues of maternal healthcare, the barriers to men's involvement, and how best to actively involve men. The purpose of this paper is to explore the barriers to and opportunities for men's involvement in maternal healthcare in the Upper West Region of Ghana. Methods: Qualitative focus group discussions, in-depth interviews and key informant interviews were conducted with adult men and women aged 20-50 in a total of seven communities in two geographic districts and across urban and rural areas in the Upper West Region of Ghana. Attride-Stirling's thematic network analysis framework was used to analyse and present the qualitative data. Results: Findings suggest that although many men recognise the importance of skilled care during pregnancy and childbirth, and the benefits of their involvement, most did not actively involve themselves in issues of maternal healthcare unless complications set in during pregnancy or labour. Less than a quarter of male participants had ever accompanied their wives for antenatal care or postnatal care in a health facility. Four main barriers to men's involvement were identified: perceptions that pregnancy care is a female role while men are family providers; negative cultural beliefs such as the belief that men who accompany their wives to receive ANC services are being dominated by their wives; health services factors such as unfavourable opening hours of services, poor attitudes of healthcare providers such as maltreatment of women and their spouses and lack of space to accommodate male partners in health facilities; and the high cost associated with accompanying women to seek maternity care. Suggestions for addressing these barriers include community mobilisation programmes to promote greater male involvement, health education, effective leadership, and respectful and patient-centred care training for healthcare providers. Conclusions: The findings in this paper highlight the need to address the barriers to men's involvement, engage men and women on issues of maternal health, and improve the healthcare systems -- both in terms of facilities and attitudes of health staff - so that couples who wish to be together when accessing care can truly do so. [ABSTRACT FROM AUTHOR]

This study examines the effects of various factors, including socioeconomic status, built environment, access to healthcare, educational level, social participation, and economic stability, on older adults' psychological health. The current study analyzed a nationally representative sub-sample of 2,577 respondents aged 50 and above from the World Health Organization's Study on Global AGEing and Adult Health (WHO SAGE) Wave 2. WHO SAGE Wave 2 is cross-sectional data collected via in-person structured interviews. Ordinal least square (OLS) was used to measure the average effect of social determinants of health (SDoH), and quantile regression analysis was used to determine the effects of SDoH on older adults' psychological health at different quantiles, specifically 10th, 50th, and 90th percentiles. Significant determinants of psychological health across all quantiles included age, healthcare access, marital status, economic stability, and neighborhood and built environment. However, the degrees of significance for residence, gender, educational level, chronic diseases, and social participation varied between quantiles, showing differing effects on older adults with high or low psychological health. Religion was insignificant across all quantiles. This study highlights the need for governments and public health agencies to develop targeted interventions and strategies that support the psychological well-being of older adults in the country. [ABSTRACT FROM AUTHOR]

Background: Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region. Methods: Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers. Results: Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents' utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services. Conclusion: In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care. [ABSTRACT FROM AUTHOR]

Refugees and asylum seekers bring with them a plurality of cultures, traditions, and values that could prove crucial in influencing perceived health needs, requests for intervention, or willingness to undergo specific health treatments. Although studies have focused on the health consequences of forced migration, in recent years, there has been a lack of information on how refugees and asylum seekers represent their experiences of perceived health needs and elements that influence well-being, in a community context. This study aims to explore the experience of refugees and asylum seekers in an Italian multicultural community about perceived health needs. A qualitative phenomenological study was conducted with an interpretive approach. The data were collected using a semi-structured face-to-face interview. The interviews were transcribed, read thoroughly, and analyzed. Nineteen refugees and asylum seekers were interviewed. Three main themes were extracted: (1) the centrality of the family to feel healthy; (2) feeling part of a community; and (3) stability and security. The results confirm that health needs, experiences, and different cultural representations of health and illness should be read and addressed with a culturally competent vision. This study was not registered. [ABSTRACT FROM AUTHOR]

Background: Population ageing presents considerable challenges for the attainment of universal health coverage (UHC), especially in countries where such coverage is still in its infancy. Ghana presents an important case study on the effectiveness of policies aimed at achieving UHC in the context of population ageing in low and middle-income countries. It has witnessed a profound recent demographic transition, including a large increase in the number of older adults, which coincided with the development and implementation of a National Health Insurance Scheme (NHIS), designed to help achieve UHC. The objective of this paper is to examine the community, household and individual level determinants of NHIS enrolment among older adults aged 50-69 and 70 plus. The latter are exempt from NHIS premium payments., Methods: Using the Ghanaian Living Standards Survey from 2012 to 2013, determinants of NHIS enrolment for individuals aged 50-69 and 70 plus living in rural Ghana are examined through the application of multilevel regression analysis., Results: Previous studies have mainly focused on the enrolment of young and middle aged adults and considered mainly demographic and socio-economic factors. The novel inclusion of spatial barriers within this analysis demonstrates that levels of NHIS enrolment are determined in part by the community provision of healthcare facilities. In addition, the findings imply that insurance enrolment increases with household expenditure even for those aged 70 plus who are exempt from the NHIS premium payment., Conclusion: Adequate and appropriate infrastructure as well as health insurance is vital to ensure movement to UHC in low and middle income countries. Overall, the results confirm that there remain significant inequalities in enrolment by expenditure quintile that future policy reform will need to address.

Communities and individuals in many sub-Saharan African countries often face limited access to healthcare. Hence, many rely on social networks to enhance their chances for adequate health care. While this knowledge is well-established, little is known about the nuances of how different population groups activate these networks to improve access to healthcare. This paper examines how rural and urban dwellers in the Ashanti Region in Ghana distinctively and systematically activate their social networks to enhance access to healthcare. It uses a qualitative cross-sectional design, with in-depth interviews of 79 primary participants (28 urban and 51 rural residents) in addition to the views of eight community leaders and eight health personnel. It was discovered that both intimate and distanced social networks for healthcare are activated at different periods by rural and urban residents. Four main stages of social networks activation, comprising different individuals and groups were observed among rural and urban dwellers. Among both groups, physical proximity, privacy, trust and sense of fairness, socio-cultural meaning attached to health problems, and perceived knowledge and other resources (mainly money) held in specific networks inherently influenced social network activation. The paper posits that a critical analysis of social networks may help to tailor policy contents to individuals and groups with limited access to healthcare.

Objectives: Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients' perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana. Design: Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data. Results: Emergent themes included patients' perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes. Conclusions: This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management. [ABSTRACT FROM AUTHOR]

Background: This paper explored the health beliefs and behaviours of families towards the health needs of children with intellectual and developmental disabilities (IDD) in Accra, Ghana. The aim was to inform health promotion strategies for the children and their families. Method: Twenty‐two parents of children with IDD participated in this study. Semi‐structured interviews were the primary means of data collection. The interviews were analysed using constant comparison. Results: The signs that alerted the parents that the children might be ill included high temperature, vomiting and excessive sleep. The parents explained that some children expressed feelings of ill‐health through verbal or non‐verbal communication. Most of the parents self‐prescribed medication for the children or waited for symptoms to persist for a while before accessing health care because they experienced difficulties managing the behavioural challenges associated with the IDD of the children in public and attitudinal barriers when accessing health care. The parents did not often patronise health facilities in their neighbourhoods due to private health insurance requirements for accessing care at designated facilities, poor confidence in neighbourhood facilities and long‐term established relationships with facilities elsewhere. Further, many parents did not patronise religious interventions for the children. However, some parents explained that in addition to seeking medical care to address the physical symptoms of the children's disabilities and/or illnesses, they sought religious interventions because they believed that there could be a spiritual dimension to the situation. Conclusion: The findings highlight key areas to address in health promotion for children with IDD and their families in Accra, Ghana. [ABSTRACT FROM AUTHOR]

Background: This paper presents results of baseline data on the determinants of contraceptive use in 7 districts in northern Ghana where there is an ongoing integrated primary health care systems strengthening project known as the Ghana Essential Health Intervention Project (GEHIP). Methods: We used a household survey data conducted within 66 randomly sampled census enumeration areas in seven rural districts of the Upper East Region of northern Ghana where health systems strengthening interventions are currently ongoing in three of the districts with four of the districts serving as comparison districts. This survey was conducted prior to the introduction of interventions. Data was collected on various indices included geographic information systems (GIS) and contraceptive use. The data was analyzed using survey design techniques that accounts for correct variance estimation. Categorical variables were summarized as proportions and associations between these variables and contraceptive use tested using Chi-square test. Uni-variable and multivariable logistic regression techniques were used to assess the effects of the selected covariates on contraceptive use. All tests were deemed to be statistically significant at 5% level statistical significance. Results: Results show that contraceptive use is generally low (about 13 per cent) and use is nearly evenly for spacing and stopping purposes. Factors associated with the use of contraceptives include exposure to integrated primary healthcare services, the level of education, and socioeconomic status, couple fertility preference, marital status, and parity. For instance, the odds of contraceptive use among 15-45 year old women who live 2 km or more from a CHPS compound is 0.74 compared to women who live less than 2 km from a CHPS compound (p-value = 0.035). Conclusion: The findings suggest that rapid scale up of the Community based Health Planning and Services (CHPS) program accompanied with improved door-to-door health services would kindle uptake of modern contraceptive use, reduce unwanted pregnancies and hasten the attainment of MDG 4 & 5 in Ghana. [ABSTRACT FROM AUTHOR]

This paper examines community perceptions on the provision of quality health care in the Kassena-Nankana District in Ghana. The paper examines the relationship between Ghana's National Health Insurance Scheme (NHIS) and the provision of quality health care, given that quality health care is an important determinant of access to health. Using a mixed methods research design, the researchers compared the perceptions of the insured and the uninsured people with respect to their perceived quality of health care received at health facilities. While the results of the household survey suggest that there is no statistically significant difference between the quality of health care received by either the insured or the uninsured, the focus group discussions indicate that the uninsured are attended to more quickly and are given more respect. The results highlight the perception that quality drugs are unavailable. The researchers recommend adequate supplies of good quality drugs to encourage utilisation of health services. [ABSTRACT FROM AUTHOR]

Objective: Problematic access to and use of sexual and reproductive health (SRH) services potentially endanger the well-being of adolescents and retards progress towards attainment of United Nations health-related Sustainable Development Goals. Drawing on a qualitative research approach, this paper examines the level of SRH-related knowledge, service access and use among school-going adolescents in Kumasi Metropolis, Ghana.Methods: We conducted 12 focus group discussions and 18 in-depth interviews with 132 in-school adolescents and six healthcare providers in the metropolis. A thematic analytical framework was used to analyse the data.Results: Findings suggest that the majority of adolescents had good knowledge about the available SRH services, with an emphasis on the different forms of contraceptives. However, the use of the various SRH services was challenging and reduced to counselling services. Adolescents were faced with various difficulties in their bid to access SRH services, including social stigma, attitude of service providers, fear of teachers and the anticipated negative response of parents due to the complex socio-cultural structure of Ghanaian society. Discussion with elders about SRH issues was considered a taboo.Conclusion: Whilst social negotiation with parents, teachers and SRH service providers as well as school curricula alignment could arrest the barriers to adolescents’ access to SRH services, eHealth services such as the ‘Bisa’ Health App could potentially provide easy and cost-effective access to SRH information among in-school adolescents. [ABSTRACT FROM AUTHOR]

Despite the double burden of infectious and chronic non-communicable diseases in Africa, health care expenditure disproportionately favours infectious diseases. In this paper, we examine quantitatively the extent of this disproportionate access to diagnoses and treatment of diabetes, hypertension and malaria in Ghana. A total of 220 health facilities was surveyed across the country in 2011. Findings indicate that diagnoses and treatment of infectious diseases were more accessible than NCDs. In terms of treatment, 78% and 87% of health facilities had two of the recommended malaria drugs while less than 35% had essential diabetes and hypertension drugs. There is a significant unmet need for diagnoses and treatment of NCDs in Ghana. These inequities have implications for high morbidity and mortality from NCDs. We recommend the use of task shifting as a model to increase the delivery of NCD services. [ABSTRACT FROM AUTHOR]