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Government implemented education access policies occupy a prominent place in the discourse on access to education. Education access issues have, thus, been examined almost exclusively from macro-level structural perspective. The micro-politics that take place behind the scenes after structural access issues have been resolved is minimally broached. Drawing on qualitative data from first generation educated women in Ghana and their mothers, this paper addresses the dark underbelly of girls' access to education, and the resistance activities undertaken by women to ensure that girls who become causalities of non-enrolment decisions are enrolled. Thus, the paper is guided by two questions. How do girls who become casualties of non-enrolment decisions go to school? How does the resistance activities women take against such non-enrolment decisions enable access for girls? In presenting the roles played by different actors such as mothers and kins, this paper makes an argument that, through women's resistance activities such as subverting the norms, covert diplomacy, and infractions of gendered rules in decision-making, women resist structural distribution of norms that exclude them from decision-making before girls can go to school unimpeded. [ABSTRACT FROM AUTHOR]

AbstractUnsafe abortions contribute significantly to maternal mortality and morbidity in Ghana. To reduce this, in 1982 abortion laws in Ghana underwent reform to broaden the conditions under which abortion is accessed. Although, evidence in other contexts highlights the contribution of violence to women’s experience of unwanted pregnancy and abortion, such evidence is limited within the Ghanaian abortion literature. This study aims to fill that gap. Informed by phenomenology, interviews were conducted with 10 women who had experienced various forms of violence leading to unwanted pregnancy and unsafe abortions. Participants were recruited between June 2017 and March 2018 in the Ashanti region of Ghana where they sought hospital care for unsafe abortion related complications. Participants mentioned intimate partners as the main perpetrators of violence. Financial challenges were also identified as important in increasing women’s vulnerability to violence. Verbal abuse from health workers contributed to denying women access to safe abortion. This paper advances dialogue about the ways in which women’s experience of violence from intimate/non-intimate partners and healthcare workers impacts their overall abortion experience. It advocates the empowerment of women to enable them to leave violent relationships, and the retraining of health workers to enable them to adopt respectful and empathetic care practices. [ABSTRACT FROM AUTHOR]

Child Panels (CPs) are quasi-judicial bodies charged with administering alternative measures in accordance with the Juvenile Justice Act and the Children's Act in Ghana. This study set out to examine the functioning, relevance, efficiency, and sustainability of CPs. Drawing on qualitative research methods of observation, semi-structured interviews, and a case study, the major findings of this study include a lack of awareness of the concept and existence of CPs with only one functioning CP in 12 districts in the study area that were supposed to have them, and a general lack of training for members of the panel. Notwithstanding these findings, when researchers prodded, interviewees' responses pointed to tremendous support for the concept of CPs. The paper argues that implemented well, CPs have the potential to enhance access to justice for all children in the country considering their composition and requirement that they be formed by every municipal and district assembly in the country, which makes them more accessible to parents and their children everywhere in the country than other state agencies within the juvenile justice system. Hence, the paper recommends that CPs should be equipped to function efficiently. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) is a prevalent problem in many societies across the globe. There have been several discussions of the subject and attempts have been made to explain its incidence and find ways to prevent and/or control it. However, despite these efforts, the problem seems to persist in developing countries like Ghana with dire consequences for the children and society at large. This paper sought to glean insights about the persistence of the problem by focusing on the discourse surrounding the subject. Using Focus Group Discussions with adult members in the Ga communities in Accra namely La, Teshie, and James Town where the phenomenon is relatively pervasive, the paper sought to understand the reasoning and the implications of accusing children who were sexually abused in the Ga community of seducing the perpetrators and engaging in sex for money. The paper posits that the labeling of victims of CSA as “gbɛkɛfɔŋs” (children of bad character) disempowers children and perpetuates the abuse of children. Thus, introducing and situating this notion of “gbɛkɛfɔŋs” in the center of the discourse largely results in a victimization of the victims and a vicious cycle of CSA. The conclusions from this study point to the need for a reorientation of parental and communal roles and an empowering of children to identify and resist sexual abuse. [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]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

This paper explores consumers' understanding and perception of the etiology of mental illness in community-based residential facilities in Ghana. Qualitative data involving in-depth interviews were used to collect data from 15 consumers of mental health services from two residential facilities. Thematic analysis was used to analyze the data. The study showed that mental illness is generally constructed within the medical and religious-cultural notion. The religious-cultural construction aligned mental illness to Ghanaian belief systems (supernatural forces, spirituality and traditional belief) and cultural practices (social norms and values) whilst the medical construction ascribed the etiology to biological, emotional and substance abuse issues. Although consumers had a positive perception of mental illness, they were doubtful about the presence of illness. The study concludes that the combination of medical, social and religious-cultural constructs and understanding of mental illness should be integrated into advocacy and awareness programmes to better educate consumers and clinicians. [ABSTRACT FROM AUTHOR]

The paper examines the hygiene practices and health risk perception of vegetable sellers in urban Ghana. Based on a qualitative in-depth study of vegetable sellers drawn from five purposively sampled markets in Kumasi Metropolis, the study found that the vegetable sellers have generally low risk perception. Consequently, the vegetable handling practices by these market women remain largely unsafe presenting potential health risks to consumers. Regular monitoring by relevant agencies and sustained public education are therefore key for reducing market contamination which is critical for maintaining a healthy population. [ABSTRACT FROM AUTHOR]

This paper examines Ghanaian young people's perceptions of the determinants of HIV- and AIDS-related stigma and discrimination, and how these perceptions may influence the de-stigmatisation process. Drawing on findings from an in-depth, multi-method qualitative study involving 104 school and street young people aged between 14 and 19 years, the paper presents young people's accounts of HIV and AIDS. The paper provokes discussion on how language and images associated with existing educational programmes on HIV and AIDS place young people in a dilemma. It also argues that fear and secrecy associated with the disease not only consolidate stigmatisation and discrimination, but also create the desire for retribution. It concludes by challenging health educators to pay particular attention to the language and images used in future educational programmes. [ABSTRACT FROM AUTHOR]

In Ghana, men who have sex with men (MSM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a biomedical intervention that reduces the risk of HIV infection but is not currently available in Ghana. This paper explores knowledge and acceptability of HIV PrEP among Ghanaian MSM. Qualitative content analysis was conducted on 22 focus group discussions (N = 137) conducted between March and June 2012 in Accra, Kumasi, and Manya Krobo. Overall, participants reported low knowledge of PrEP. However, once information about PrEP was provided, there was high acceptability. The primary reason for acceptability was that PrEP provided an extra level of protection against HIV. Acceptability of PrEP was conditioned on it having minimal side effects, being affordable and efficient in preventing HIV infection. No acceptability of PrEP was attributed to limited knowledge of side effects and perceived lack of effectiveness. The reasons provided to utilize PrEP and condoms were that condoms protect against other STIs, and sexual partner factors. This is the first known study to explore PrEP knowledge and acceptability among Ghanaian MSM. It is important that key stakeholders preemptively address potential barriers to PrEP acceptability, uptake, and adherence, especially among MSM, once PrEP becomes available in Ghana. [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]

The purpose of this paper is to gain a deeper understanding of Ghana's tourism positioning and whether a literature-derived positioning framework can further elaborate the latter. Using the face-to-face long interviews among key policy makers, marketing managers and experts, and observation techniques, data were collected and analyzed via the inductive reasoning approach. The results show that Ghana's tourism positioning aim is built around perceptions of a “competitive middle class tourist destination,” i.e., “profit and status” through the pursuit of “functional” positioning objective. Positioning strategies including “service”, “value for money”, “culture”, “selectivity”, “attractiveness”, “reliability”, “manpower development”, “quality controls” and “ecology” are pursued in order to achieve the aim and objectives. The latter are managed/positioned in the “primal” positioning life cycle stage. Conclusions, managerial implications, future research directions and limitations are noted. [ABSTRACT FROM PUBLISHER]

Mental health remains a low priority in Ghana. No comprehensive studies have assessed the current status of mental health policy, legislation and services in Ghana. This paper presents the qualitative results of a situation analysis conducted as part of the first phase of the Mental Health and Poverty Project. The aim of this paper was to explore what a range of stakeholders perceive as the main challenges facing Ghana's mental health system and the primary ways of addressing them. A total of 81 interviews and seven focus groups were held with key stakeholders drawn from five of the 10 regions in Ghana. The major challenges identified included: inadequate implementation of mental health policy; legislative limbo; inadequate human and financial resource; widespread stigma; dominance of psychiatric hospitals; and insufficient human rights protections for the mentally ill. A range of policy, legislative and service-related recommendations were made for addressing the situation. The results revealed that mental health services in Ghana need to scaled-up to respond to unmet needs in ways that are cost-effective within the budget of a low-income country. Enacting the current mental health bill and identifying strategies for overcoming the barriers to policy implementation will mark significant steps forward. [ABSTRACT FROM AUTHOR]

Obeng-Odoom F. Real estate agents in Ghana: a suitable case for regulation?, Regional Studies. This paper uses a qualitative approach to examine whether regulation would improve the effectiveness of the Ghanaian estate agency market. Interviews with landlords, estate agents, clients, and officials of the Rent Control Department suggest that (1) most so-called 'problems with unlicensed agents' are actually landlord-related problems; (2) there is a camaraderie relationship between unlicensed agents and their clients which effectively provides a licence against fraud; and (3) regulation would exacerbate unemployment and increase agency fees. For these reasons, regulation in general may not be in the public interest. Alternative ways of improving effectiveness in the Ghanaian estate agency market are recommended. [image omitted] Obeng-Odoom F. Les agents immobiliers au Ghana: est ce qu'il y a de bonnes raisons pour les reguler?, Regional Studies. Cet article emploie une facon qualitative afin d'examiner si, oui ou non, la regulation ameliorerait l'efficacite du marche immobilier au Ghana. Des interviews menes aupres des proprietaires, des agents immobiliers, des clients et des employes du Rent Control Department (des controleurs de loyer) laissent supposer que, primo, la plupart des dits 'problemes avec des agents non-agrees' sont en fait des problemes qui se rapportent aux proprietaires; secundo, il existe une camaraderie entre les agents non-agrees et leurs clients, ce qui fournit en effet une licence contre la fraude; et tertio, la regulation aggraverait le chomage et augmenterait les honoraires des agents. Pour ces raisons-la, il se peut que la regulation generalisee ne soit pas dans l'interet du grand public. On propose d'autres moyens d'ameliorer l'efficacite du marche immobilier au Ghana. Licence Locataires Proprietaires Agents immobiliers Ghana Obeng-Odoom F. Immobilienmakler in Ghana: ausreichende Argumente fur eine Regulierung?, Regional Studies. In diesem Beitrag untersuchen wir mit Hilfe eines qualitativen Ansatzes, ob sich die Leistungsfahigkeit des Immobilienmarktes von Ghana durch eine Regulierung verbessern wurde. Aus Interviews mit Hausbesitzern, Immobilienmaklern, Kunden und Beamten der Mietkontrollbehorde geht Folgendes hervor: (1) die meisten sogenannten 'Probleme mit nicht lizenzierten Maklern' sind in Wahrheit Probleme mit Vermietern; (2) zwischen nicht lizenzierten Maklern und ihren Kunden besteht ein kameradschaftliches Verhaltnis, das gewissermassen einen Schutz vor Betrug bietet; (3) durch eine Regulierung wurden die Arbeitslosigkeit und Maklergebuhren steigen. Aus diesen Grunden liegt eine generelle Regulierung eventuell nicht im Interesse der Offentlichkeit. Es werden alternative Methoden zur Verbesserung der Leistungsfahigkeit des Immobilienmarktes von Ghana empfohlen. Lizenz Mieter Vermieter Immobilienmakler Ghana Obeng-Odoom F. Agentes inmobiliarios en Ghana: ¿hay suficientes argumentos para regularlo?, Regional Studies. En este articulo se utiliza un enfoque cualitativo para examinar si la regulacion mejoraria la eficacia del mercado de las agencias inmobiliarias en Ghana. Las entrevistas realizadas a propietarios, agentes inmobiliarios, clientes y funcionarios del Departamento de Control de Alquileres indican que (1) la mayoria de los denominados problemas con agentes no autorizados se deben en realidad a problemas que tienen que ver directamente con los propietarios; (2) existe una relacion de camaraderia entre los agentes no autorizados y sus clientes que ofrece una licencia eficaz contra el fraude; y (3) la regulacion agravaria el desempleo y haria aumentar las tasas de las inmobiliarias. Por estos motivos, la regulacion en general podria no ser de interes publico. Se recomiendan otros metodos para mejorar la eficacia del mercado de las agencias inmobiliarias en Ghana. Autorizacion Inquilinos Propietarios Agentes inmobiliarios Ghana [ABSTRACT FROM AUTHOR]

This study adopted a qualitative approach and analysed interviews from seven parents with children enrolled in nursery and kindergarten in Ghana. The interviews examined parents' descriptions of play and learning and how they perceive the value of play in children's learning. The findings revealed that the parents generally have doubts about the ability of play in bringing forth learning in the classroom. In general, they hold a narrow view of play as a break activity and a reward for learning, as well as viewing play and learning as mutually exclusive. The findings are discussed from a social and cultural perspective, drawing a picture of the ethno-theories about child development and the meanings of play and learning in Ghana. [ABSTRACT FROM AUTHOR]

Expanding access to sexual and reproductive health (SRH) services is one of the key targets of the Sustainable Development Goals. The extent to which sexual and reproductive health and rights (SRHR) targets will be achieved largely depends on how well they are integrated within Universal Health Coverage (UHC) initiatives. This paper examines challenges and facilitators to the effective provision of three SRHR services (maternal health, gender-based violence (GBV) and safe abortion/post-abortion care) in Ghana. The analysis triangulates evidence from document review with in-depth qualitative stakeholder interviews and adopts the Donabedian framework in evaluating provision of these services. Critical among the challenges identified are inadequate funding, non-inclusion of some SRHR services including family planning and abortion/post-abortion services within the health benefits package and hidden charges for maternal services. Other issues are poor supervision, maldistribution of logistics and health personnel, fragmentation of support services for GBV victims across agencies, and socio-cultural and religious beliefs and practices affecting service delivery and utilisation. Facilitators that hold promise for effective SRH service delivery include stakeholder collaboration and support, health system structure that supports continuum of care, availability of data for monitoring progress and setting priorities, and an effective process for sharing lessons and accountability through frequent review meetings. We propose the development of a national master plan for SRHR integration within UHC initiatives in the country. Addressing the financial, logistical and health worker shortages and maldistribution will go a long way to propel Ghana's efforts to expand population coverage, service coverage and financial risk protection in accessing essential SRH services. [ABSTRACT FROM AUTHOR]

Purpose: As cancers increase in Ghana and in many low-and middle-income countries, healthcare utilization has become critical for disease management and patients' wellbeing. There is evidence that medical pluralism is common among cancer patients in Ghana and many other African countries, which results in lack of adherence to and absconding from hospital treatments. The objective of this study was to examine ways in which beliefs in disease causation influence medical pluralism among Akan cancer patients in Ghana. Methods: A qualitative research approach was employed in this study. In-depth interviews were conducted for thirty (30) cancer patients who were purposively recruited from Komfo Anokye Teaching Hospital in Ghana. Thematic content analysis was used in analysing data. Results: Our findings revealed that cancer patients ascribed both physical and spiritual causality to their illness. As such, they combined orthodox treatment with spiritual healing and herbal medicine. Regarding the order of therapeutic search, patients reported to herbal and spiritual centres before going to the hospital, a phenomenon which contributes to the late reporting and diagnosis as well as bad prognosis of cancers in Ghana. Conclusion: The findings of this research elucidate the relationship between culture and health care choices of cancer patients in Ghana. Increased awareness creation is crucial in eradicating myths surrounding cancers in Ghana. [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. [ABSTRACT FROM AUTHOR]

Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women’s perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to “correct” disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman’s experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth. [ABSTRACT FROM AUTHOR]

We assessed the challenges facing 29 women in their quest for maternal health services in the Shai Osudoku District of Ghana. In-depth, semi-structured interviews with health professionals and focus-group discussions with women on uptake of maternal health services were conducted. Findings showed inadequate human resources and logistics for maternal health care and transportation problems. Women whose pregnancies required specialized care at district or regional hospitals deliberately reported late to the community clinics in an advanced stage of labor to avoid referrals. Findings have implications for health policymakers, implementers, and researchers. [ABSTRACT FROM AUTHOR]

Families of children with disabilities experience stigma by association with their child. This article examines social and internalised stigma experienced in the family by caregivers who participated in a caregiver programme in Ghana. Stigma is pervasive, and gendered, with most mothers blamed for bringing disability into the home. Emotional distress, isolation and lack of support are common experiences. We argue that the mothers can experience forms of disablism. Stigma is multi-layered, and a range of factors intersect with disability-related stigma, including poverty. A support group model can have a positive impact on caregiver internalised stigma and begin to address isolation. This should be part of a wider package of support to address wider structural issues. Families can play an important role in mediating change, but first we need to better understand the social disruption caused by disability-related stigma at the familial level. Stigma amongst family members with a child with cerebral palsy, is very common in the Ghana context, and fuelled by traditional beliefs. Caregiving and disability-related stigma is gendered. The stigma of childhood disability is often associated with women's role in child bearing and rearing. Better engagement with fathers, and other key members of the family, is needed. Emotional distress, isolation and lack of support are common caregiver experiences in Ghana. A support group model for caregivers has an impact on how they feel about themselves, reducing levels of self-blame and feelings of isolation. We know that the quality of caregiving is really important in the early years of a child's development, so it is important to address any stigma. Factors, such as poverty, play a role in fuelling stigma. These other factors also need to be addressed if we want to reduce levels of stigma experienced by families. [ABSTRACT FROM AUTHOR]

Despite advances in human rights and treatments, stigma toward individuals diagnosed with mental illness is common across the African continent. This article explores experiences of stigma and social exclusion among individuals diagnosed with mental illness and receiving treatment in a psychiatric facility in Ghana. The study, based on in-depth, semi-structured interviews generated the following themes: beliefs in spiritual causes of mental illness; spirituality as a coping mechanism; mistreatment and abuse. The findings highlight the significance of social exclusion and spirituality as the main roots of stigma; also the importance of awareness-raising as tools for anti-stigma work in the global South. [ABSTRACT FROM AUTHOR]

Drawing on the insights of Bronfenbrenner's ecological systems and Lazarus' coping theories, this article highlights the challenges and coping strategies of women living with obstetric fistula in the Northern Region of Ghana. Employing the convenience sampling technique, 55 women were purposively recruited to participate in the study. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted to collect data. With the permission of participants, the FGDs and IDIs were audio-recorded and transcribed. The data were analyzed to identify emerging themes that addressed the objectives of the study. The findings indicated that participants encountered varied challenges (physiological issues; abandonment and divorce; psychological problems; financial constraints; and difficulty accessing healthcare). Furthermore, it was found that the women included in this study adopted both problem-focused and emotion-focused coping strategies. Evidence showed that the problem-focused strategies were begging for assistance and seeking support from the Fistula Kpandai support group. Maintaining personal hygiene and optimistic motivation were the emotion-focused strategies employed by the participants. Based on the findings of the study, implications are discussed. [ABSTRACT FROM AUTHOR]

Introduction: There is growing evidence that group-based mental health intervention programmes can encourage the development of peer support, psychosocial skills, and collaborative therapeutic relationships with longer lasting effects. This study explored participants' experiences of, perceived benefits of, and recommendations to improve a 10-session group-based multicomponent positive psychology intervention (mPPI)—the Inspired Life Programme (ILP)—designed to promote positive mental health and reduce symptoms of depression and negative affect in a sample of rural Ghanaian adults. Method: Face-to-face semi-structured individual interviews were conducted with 18 randomly selected programme participants three months after their participation in the ILP. Data were analysed thematically with an inductive approach. Results: Participants described their experience of the ILP as a forum for growth that granted them the opportunity to introspect, practicalise and situate everyday life challenges, connect with others, and to develop a sense of mutual accountability. Results indicate that the ILP led participants to develop a stronger sense of positivity and well-being, fructify their ideas, and to cultivate stronger social networks and relationships that led to increased vocational productiveness. Participants recommended that researchers include facets of physical health promotion in the programme and invite close relations of participants to participate in the programme. Conclusion: This study provides the first insight into participants' experiences of a group-based mPPI in Ghana. These findings may provide useful information to inform the design of context-appropriate community-based mental health interventions to fit participants' specific needs, capacities, and circumstances. [ABSTRACT FROM AUTHOR]

In Ghana, some divorce cases are conducted through the courts, and the reasons for such cases are important to gauge the factors that account for the dissolution of marriages in Ghana. This study was conducted to explore in-depth, the factors that lead to divorce using court suits in Ghana. Data were obtained from 30 lawsuits consisting of 11 men and 19 women with an age range of 29–71 years. Reasons for marital dissolution were assembled from a 10-year period (2007–2017) cases of divorce from the Greater Accra Region of Ghana. Conventional content analysis identified six main factors as possible reasons for divorce: infidelity, abuse, financial support, intimacy, financial problems, third-party intrusion and gender-role ideology. Men were likely to seek for divorce at an older age compared to women. Women attributed reasons for divorce to lack of respect from the husband and gender-role ideology. Our findings underscore the need for pre-marital counseling psychologists to help would-be couples address pertinent issues which could lead to distress and ultimately divorce in their marriages. [ABSTRACT FROM AUTHOR]

In spite of the consistent evidence of cash transfers' (CTs) impact on the social determinants of health (SDoH) in low-and middle-income countries, and their potential for achieving health sector objectives, there is a growing concern that the health sector has not been actively involved in these programs. This study used a critical realist approach to examine the factors affecting health sector involvement in CTs in Ghana. In-depth semi-structured interviews were conducted with 20 health promoters comprising national policymakers, District Directors of Health Service, Regional/District Health Promotion Managers and health promotion academics between October 2017 and February 2018. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. In addition, policy documents concerning the Ghana CT program were reviewed. All the participants were aware of the CT program, but had limited or no involvement in it to date. The findings indicate that CTs' cross-cutting goals and health sector mandates and responsibilities constitute the key structures and powers with the potential to trigger a more substantive involvement of the health sector in the program. Factors found to shape health sector involvement in CTs included CT policymakers' understanding of the SDoH, national health sector leadership, evidence linking CTs to SDoH, intersectoral collaboration and politicisation of CTs. As CTs continue to adapt and expand across low-and middle-income countries, the findings from this study can help the health sector to take a more substantive role in the programs to optimise their impacts on the SDoH and health inequities. [ABSTRACT FROM AUTHOR]

Motherhood can be very challenging and overwhelming whether the individuals involved are teens or adults. Although there is a high prevalence of teenage mothers in urban cities in Ghana, little research has been done on the challenges associated with teen motherhood. This qualitative study was therefore conducted to explore the challenges that teenage mothers experience in Ghana. One-on-one interviews were conducted with 28 purposively selected teenage mothers between the ages of 15 and 19. Through thematic analysis, findings showed that challenges associated with teenage motherhood were strained interpersonal relationships, survival difficulties, educational disruption and steep transition to adulthood. These findings call for supportive programmes and interventions that would help address the contextual challenges of teenage mothers and also step up efforts to decrease the prevalence of teenage pregnancy in Ghana. [ABSTRACT FROM AUTHOR]

Child sexual abuse is increasingly becoming an issue of concern in most societies across the globe, including Ghana. This is a phenomenological study that sought to describe the lived experiences of victims of child sexual abuse in Ghana, using the Ga community as a case study. Purposive and snowball sampling techniques were used to identify 17 sexually abused children in the Ga Community. Using the interpretative phenomenological analysis (IPA), four main themes described the experiences of the victims: (a) forced sex (b) incest (c) joleying and (d) transactional sex. The findings illustrate the different circumstances in which children were sexually abused in the community studied. It also presents socio-cultural factors that normalizes the sexual abuse of children in the Ga Community. These findings underline the need for effective preventive programs and community interventions to protect children and support victims of child sexual abuse. [ABSTRACT FROM AUTHOR]

Social equality has emerged as one of the important ideals of human society, especially for development. Moreover, education has featured prominently among the many key drivers of equality. However, in developing nations like Ghana, education represents one of the areas in which gross inequality has eroded the country's potential for attaining equality and development. The aim of the current study was to explore adolescents' selfperceived barriers regarding access to quality education in the Northern Region of Ghana and provide suggestions on the way forward. A sample of 18 school-going adolescents from six secondary schools within the Northern Region of Ghana was purposively selected to participate in face-to-face interviews. The barriers identified included limited resources, gender disparities and a multi-dimension nature of poverty. Implications for policy and research are discussed. [ABSTRACT FROM AUTHOR]

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While the role of evidence-based public health in improving health outcomes is frequently touted, there remains a dearth of research examining the use of evidence in public health service particularly in low- and middle-income countries. Therefore, the aim of this research was to examine the use of evidence in local public health service in Ghana, a lower middle-income country. Semi-structured in-depth interviews were conducted with local health managers from 11 District Directorates of Health in Ashanti Region. Three organising themes emerged from the interview transcripts: understanding of evidence-based public health; the process of using evidence; and the value of evidence in public health practice. The study suggests that though evidence-based practice was not new to the local health managers, its application was very low. The process of using evidence commenced with making a decision about the direction of a programme which had been already prioritised and planned by other high-level actors and then various sources of information, including available research evidence, were used to justify the decision. The study has revealed that there is an urgent need for pre-service and in-service training programmes that build and maintain common skill sets and language among local public health practitioners in Ghana to accomplish evidence-based public health goals. Similarly, giving local health managers flexibility to prioritise and make decisions would result in increased uptake of evidence in local public health service. [ABSTRACT FROM PUBLISHER]

Disabled young people in many low and middle-income countries experience significant levels of educational exclusion due to disabling social and physical environments and are more likely to be illiterate than their non-disabled peers. Most social sciences and development literature, however, tends to homogenise the educational trajectories of disabled young people and focuses predominantly on the perspectives of educationalists, development experts and carers in assessing educational needs and institutions. Consequently, the experiences of young people across multiple categories of social difference, and their agency in shaping their own educational trajectories, remain largely unknown. This article contributes to filling this gap by exploring the educational narratives of young people with different impairments in mainstream, special and integrated schools in Ghana. The article shows how exploring individual narratives provides new insights into the educational needs of and ‘appropriate’ education for disabled young people in the Global South. [ABSTRACT FROM PUBLISHER]

The article discusses the study that determined perinatal depression (PND) awareness or expression in Ghana. Topics discussed include distress largely attributed by women to poverty, lack of social support, and domestic problems, help sought by women through family and religious organizations instead of through medical services, and nearly universal complaint of problems in producing breast milk or breastfeeding, suggesting significant impact on infant health.

The purpose of this research is to state that ethical governance is important, because it concerns the right thoughts (values) and elements (mechanisms) needed for a successful anti-corruption crusade. Trust is strongly linked to performance; ethical governance can help in actualizing anti-corruption agencies’ expected or desired performance. The subjects of the comparative research are the anti-corruption agencies of Cameroon, Ghana, and Nigeria. A qualitative analysis of documents and interviews and a triangulation approach are used in arriving at research results, because policies and procedures are studied through anti-corruption agencies documents and public trust is investigated through expert interview. Ghana represents the strong case and best practices, because it has anti-corruption policies and procedures that agree more with ethical governance, followed by Nigeria, which is the moderate case, before Cameroon, which is the weak case. “Independence” as an ethical mechanism occupies the strongest position to achieving result in anti-corruption related crusade. [ABSTRACT FROM PUBLISHER]

Adding to the growing body of literature on outcomes for children living in orphanages and children's homes, this qualitative study explored the perceptions of institutional personnel – caregivers, staff members, supervisors, and administrators – about organizational factors affecting their ability to care for orphaned and vulnerable children living in institutions in the Ashanti Region of Ghana. The participants in this study consisted of 59 caregivers, 7 supervisors, 10 administrators, 4 cooks, 4 teachers, 1 social worker, 1 security guard/driver, and 6 women classified as house helpers. Individual interviews were conducted using an English-written and stated semistructured interview guide the researchers had created. The data from the 92 interviews were transcribed and coded using inductive methodologies. The results revealed concerns from the personnel about their institutions' lack of adequate funding for essential items, including food and medicine for the children. The personnel were also concerned about the lack of appropriate workplace standards to ensure the sustainability of a viable workplace environment, including inadequate training, supervision, communication procedures, and staffing patterns, and collaborative partnerships and associations with other public or private community-based institutions. The findings from this study have considerable policy, practice, and research implications for social workers. [ABSTRACT FROM AUTHOR]

A qualitative analysis of 28 in-depth interviews with adolescent boys aged between 12 and 15 years in the Akwapim highlands of Ghana reveals that the traditional practice of bridewealth exchange—called the customary rites among the Akwapim—fuels adolescent boys' expectations of increased male authority in marriage. Although the available literature on bridewealth argues that the traditional marriage practice of bridewealth exchange in sub-Saharan Africa gives men rights over women's sexual and reproductive capacities, as well as their household labor (Fortes, 1962), the findings of this article suggest that bridewealth payments influence not only these areas but male expectations for broader control over, and obedience from, their wives. [ABSTRACT FROM AUTHOR]

This study examines employment relations in small- and medium-sized enterprises (SMEs) in Ghana. This is done through in-depth case studies of three private firms in the service sector. A review of the extant literature on SMEs revealed a dearth of knowledge on employment relations in SMEs in Africa. Previous research into SMEs in developing countries - and Africa in particular - has focused on economic policy initiatives, problems in raising capital and obstacles to the development of SMEs. In an attempt to fill the gap in the literature, this study uses recruitment, selection and retention, remuneration, discipline and welfare practices to explore the nature of employment relations, the factors that influence and shape them, and the extent of informality involved. The findings cast doubt on the stereotype: small implies/equals informal employment relations in SMEs in Ghana. The study also identifies the factors that influence employment relations and, in addition, reveals that under competitive pressures, SMEs have developed employment relations systems that enable them to have a competitive advantage in their product market/service delivery. [ABSTRACT FROM AUTHOR]

One major set back to the success of TB control globally is the stigma attached to the disease in most societies. This article explores community's understanding of, and attitudes and behaviours towards TB and examines the implications for disease control efforts. Individual in-depth interviews and focus groups were held with community members and the generated data analysed using Grounded Theory techniques and procedures. At the core of feelings towards TB in the community is the fear of infection leading to imposition of socio-physical distance and participatory restrictions on those suffering from the disease. Because of fear of infection, most of the community members were of the view that TB patients should not be part of the society and said they will not marry a TB patient or encourage any family member to enter such a relationship. They also pointed out that TB patients should not sell in the community and would not be allowed to represent them at any public function because they can infect others. Whenever it becomes unavoidable for the community members to interact with someone with TB, they indicated that they would cover their mouth with a handkerchief, turn their head or sit in the opposite direction of the wind from the TB patient to avoid inhaling the air. When a TB patient joins the community members at any function, he/she is expected to abide by certain 'codes of conduct'. The stigmatising attitudes and behaviours of the community members towards the disease and its sufferers may lead individuals with very obvious signs and symptoms of TB to attribute it to other non-stigmatising conditions or hide the diagnosis from others as well as default from treatment. [ABSTRACT FROM AUTHOR]

Background: Many current debates about global mental health have increasingly called for collaboration between biomedical and traditional medical health systems. Despite these calls, not much has been written about the variables that would influence such collaboration. To a large extent, collaboration dialogues have considered biomedicine on the one hand, and a wide range of traditional and faith-based treatments on the other hand. However, this dualistic bifurcation does not reflect the plurality of healing systems in operation in many contexts, and the diverse investments that different non-biomedical healing approaches may have in their own power to heal. Objective: We set out to explore the diversity of different healers' perceptions of power, and the relationship between that power and the perceived power of biomedical approaches. Methods: Through a qualitative design, and using the case of medical pluralism in urban Ghana as an example, we conducted interviews among different categories of traditional and alternative medicine (TAM) practitioners living and/or working in the Greater Accra Region of Ghana. Results: Through thematic analyses, differences in the notions about collaboration between the different categories of healers were identified. Their perceptions of whether collaboration would be beneficial seemed, from this study, to co-occur with their perceptions of their own power. Conclusions: We suggest that an important way to move debates forward about collaboration amongst different sectors is to examine the notions of power and positioning of different categories of TAM healers in relation to biomedicine, and the attendant implications of those notions for integrative mental healthcare. [ABSTRACT FROM AUTHOR]