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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]

Background: Social Health Insurance (SHI) is widely used by countries attempting to move toward Universal Health Coverage (UHC). While evidence suggests that SHI is a promising strategy for achieving UHC, low-income countries often struggle to implement and sustain SHI systems. It is therefore important to understand how SHI enrollees use health insurance and how it affects their health-seeking behavior. This paper examines how SHI affects patient decision-making regarding when and where to seek care in Kenya and Ghana, two countries with established SHI systems in sub-Saharan Africa.Methods: This paper draws from two datasets collected under the African Health Markets for Equity (AHME) program. One dataset, collected in 2013 and 2017 as part of the AHME qualitative evaluation, consists of 106 semi-structured clinic exit interviews conducted with patients in Ghana and Kenya. This data was analyzed using an inductive, thematic approach. The second dataset was collected internally by the AHME partner organizations. It derives from a cross-sectional survey of social franchise clients at three social franchise networks supported by AHME. Data collection took place from February - May 2018 and in December 2018.Results: Many clients appreciated that insurance coverage made healthcare more affordable, reported seeking care more frequently when covered with SHI. Clients also noted that the coverage gave them access to a wider variety of providers, but rarely sought out SHI-accredited providers specifically. However, clients sometimes were charged for services that should have been covered by insurance. Due to a lack of understanding of SHI benefits, clients rarely knew they had been charged inappropriately.Conclusions: Clients and providers would benefit from education on what is included in the SHI package. Providers should be monitored and held accountable for charging clients inappropriately; in Ghana this should be accompanied by reforms to make government financing for SHI sustainable. Since clients valued provider proximity and both Kenya and Ghana have a dearth of providers in rural areas, both countries should incentivize providers to work in these areas and prioritize accrediting rural facilities into SHI schemes to increase accessibility and reach. [ABSTRACT FROM AUTHOR]

Background: Vasectomy is one of the safest and inexpensive modern contraceptive methods but it remains relatively 'invisible' in Ghana. Support of women may be a significant incentive in influencing their partners to adopt vasectomy. Objective: To examine the perspectives of women on vasectomy as a contraceptive option. Materials and Methods: A cross-sectional survey was conducted among 298 women accessing long-term or permanent family planning methods at health facilities in three selected districts in the Central Region of Ghana. Pearson's Chi-square was used to test associations between variables and the attitudes of women towards vasectomy. A p-value of less than 0.05 was considered to be statistically significant. Results: Awareness of vasectomy was low (32%). About 66% of the women who became aware of vasectomy during the study would prefer their partners to go for vasectomy compared with 50% of those who were aware prior to the study. Women who would either not prefer vasectomy or support their partner's choice of vasectomy cited fear of impotency (39.6%). There was a statistically significant association (p<0.05) between ethnicity, previous contraceptive use, awareness of male methods, and preference for vasectomy instead of bilateral tubal ligation (BTL). A statistically significant association (p<0.05) was also found between age of participant, duration of marriage, religious affiliation, and the willingness of women to support their partner's choice of vasectomy. Conclusion: There is, therefore, the need for the involvement of women in the promotion of vasectomy through vigorous publicity and education. [ABSTRACT FROM AUTHOR]