Browsing by Author "Bawah, A."
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Item Contraceptive Use and Method Mix Dynamics in Sub-Saharan Africa(University of Ghana, 2019-02-14) Bawah, A.Method mix refers to the distribution of contraceptive use among the sexually active population. The subject of contraceptive method mix has become of specific importance because it provides perspectives on both the demand and supply side determinants of contraceptive prevalence. This paper proposes to conduct extensive analysis of trends in contraceptive use and method mix dynamics in sub-Saharan Africa. The study examines how contraceptive method mix dynamics have changed over time, assesses trends by marital status, and investigates determinants of method choice and their changes over time. Preliminary findings and their implications are discussed.Item Estimating indices of health system readiness: an example from rural northern Ghana(2015) Boyer, C.; Jackson, E.; Bawah, A.; Schmitt, M.; Awoonor-Williams, J.; Phillips, J.Background There is growing recognition that stronger health systems are necessary to accelerate progress towards the Millennium Development Goals (MDGs). However, a departure from disease-specific programmes and interventions requires the development of a new empirical framework for programme evaluation that focuses on indicators of health system strengthening. Service provision assessment (SPA) surveys provide a wealth of data about health system resources, but they often include too many indicators to provide useful insight into general systems strength or service readiness. To improve the usefulness of such data, we have applied multidimensional statistical data reduction techniques to SPA data with the aim of developing robust measures of health system capabilities. Methods Data for the construction of indices were derived from the 2010 Ghana Emergency Obstetric and Newborn Care (EmONC) survey published by the Ghanaian Ministry of Health. This survey included a saturated sample of 147 health facilities in the Upper East Region. The instrument assessed facility readiness and performance using 3872 service and outcome indicators of: infrastructure; human resources; availability of drugs, equipment, and supplies; and knowledge of essential procedures. Of those indicators, 872 were identified as corresponding to one of the six WHO health system building blocks. Dimensionality reduction was done using principal component analysis. Where appropriate, we reorganised binary indicators into ordinal categorical variables, as is commonly done in the socioeconomic status literature. We also assessed the external validity of the new index. Findings Results from the principal component analysis of the 872 health systems indicators suggest that a single component (PC1) explains more than 30% of the common variance among the health facilities surveyed. An index composed of the factor loadings from PC1 showed marked variation between facilities (SD 13·077) with easily identifiable clusters of facility type (hospital, health centre, clinic, community compound). The distribution of PC1 also suggested concentration of resources among a few high-level facilities (Gini 0·508). Compared with EmONC signal functions, the index scores were better predictors of the number of deliveries (R2 0·61 vs R2 0·31) and the number of low birthweight babies (0·68 vs 0·26) as well as maternal deaths (0·81 vs 0·34) and neonatal deaths (0·79 vs 0·36). Interpretation Our findings suggest that an index of health system readiness that captures a large portion of facility variance can be constructed from SPA data using principal component analysis. In practice, such an index could be used to monitor progress towards stronger health systems. However, further research is needed to determine how an increase in index score which is input-focused, affects population health. Particular attention must also be paid to the performance determinants that maximise the efficient use of health system inputs. Funding Support for this study was provided by the African Health Initiative with funding from the Doris Duke Charitable Foundation.Item The evolving demographic and health transition in four low- and middle-income countries: Evidence from four sites in the INDEPTH Network of longitudinal health and demographic surveillance systems(Public Library of Science, 2016) Bawah, A.; Houle, B.; Alam, N.; Razzaque, A.; Streatfield, P.K.; Debpuur, C.; Welaga, P.; Oduro, A.; Hodgson, A.; Tollman, S.; Collinson, M.; Kahn, K.; Toan, T.K.; Phuc, H.D.; Chuc, N.T.K.; Sankoh, O.; Clark, S.J.This paper contributes evidence documenting the continued decline in all-cause mortality and changes in the cause of death distribution over time in four developing country populations in Africa and Asia. We present levels and trends in age-specific mortality (all-cause and cause-specific) from four demographic surveillance sites: Agincourt (South Africa), Navrongo (Ghana) in Africa; Filabavi (Vietnam), Matlab (Bangladesh) in Asia. We model mortality using discrete time event history analysis. This study illustrates how data from INDEPTH Network centers can provide a comparative, longitudinal examination of mortality patterns and the epidemiological transition. Health care systems need to be reconfigured to deal simultaneously with continuing challenges of communicable disease and increasing incidence of non-communicable diseases that require long-term care. In populations with endemic HIV, long-term care of HIV patients on ART will add to the chronic care needs of the community.Item The Evolving Demographic and Health Transition in Four Low- and Middle-Income Countries: Evidence from Four Sites in the INDEPTH Network of Longitudinal Health and Demographic Surveillance Systems.(2016) Bawah, A.; Houle, B.; Alam, N.; Razzaque, A.; Streatfield, P.K.; Debpuur, C.; Welaga, P.; Oduro, A.; Hodgson, A.; Tollman, S.; Collinson, M.; Kahn, K.; Toan, T.K.; Phuc, D.H.; Chuc, N.T.K.; Sankoh, O.; Clark, S.J.This paper contributes evidence documenting the continued decline in all-cause mortality and changes in the cause of death distribution over time in four developing country populations in Africa and Asia. We present levels and trends in age-specific mortality (all-cause and cause-specific) from four demographic surveillance sites: Agincourt (South Africa), Navrongo (Ghana) in Africa; Filabavi (Vietnam), Matlab (Bangladesh) in Asia. We model mortality using discrete time event history analysis. This study illustrates how data from INDEPTH Network centers can provide a comparative, longitudinal examination of mortality patterns and the epidemiological transition. Health care systems need to be reconfigured to deal simultaneously with continuing challenges of communicable disease and increasing incidence of non-communicable diseases that require long-term care. In populations with endemic HIV, long-term care of HIV patients on ART will add to the chronic care needs of the community.Item Identifying deprived ‘‘slum” neighbourhoods in the Greater Accra Metropolitan Area of Ghana using census and remote sensing data(World Development, 2023) Tavish, R.M.; Agyei-Mensah, S.; Bawah, A.; Owusu, G.; et al.Background: Identifying urban deprived areas, including slums, can facilitate more targeted planning and development policies in cities to reduce socio-economic and health inequities, but methods to identify them are often ad-hoc, resource intensive, and cannot keep pace with rapidly urbanizing communities. Objectives: We apply a spatial modelling approach to identify census enumeration areas (EAs) in the Greater Accra Metropolitan Area (GAMA) of Ghana with a high probability of being a deprived area using publicly available census and remote sensing data. Methods: We obtained United Nations (UN) supported field mapping data that identified deprived ‘‘slum” areas in Accra’s urban core, data on housing and population conditions from the most recent census, and remotely sensed data on environmental conditions in the GAMA. We first fitted a Bayesian logistic regres sion model on the data in Accra’s urban core (n=2,414 EAs) that estimated the relationship between hous ing, population, and environmental predictors and being a deprived area according to the UN’s deprived area assessment. Using these relationships, we predicted the probability of being a deprived area for each of the 4,615 urban EAs in GAMA. Results: 899 (19%) of the 4,615 urban EAs in GAMA, with an estimated 745,714 residents (22% of its urban population), had a high predicted probability (>80%) of being a deprived area. These deprived EAs were dispersed across GAMA and relatively heterogeneous in their housing and environmental conditions, but shared some common features including a higher population density, lower elevation and vegetation abundance, and less access to indoor piped water and sanitation. Conclusion: Our approach using ubiquitously available administrative and satellite data can be used to identify deprived neighbourhoods where interventions are warranted to improve living conditions, and track progress in achieving the Sustainable Development Goals aiming to reduce the population living in unsafe or vulnerable human settlements.Item Is Ghana's pro-poor health insurance scheme really for the poor? Evidence from Northern Ghana(BioMed Central Ltd., 2014) Akazili, J.; Welaga, P.; Bawah, A.; Achana, F.S.; Oduro, A.; Awoonor-Williams, J.K.; Williams, J.E.; Aikins, M.; Phillips, J.F.Background: Protecting the poor and vulnerable against the cost of unforeseen ill health has become a global concern culminating in the 2005 World Health Assembly resolution urging member states to ensure financial protection to all citizens, especially children and women of reproductive age. Ghana provides financial protection to its citizens through the National Health Insurance Scheme (NHIS). Launched in 2004, its proponents claim that the NHIS is a pro-poor financial commitment that implements the World Health Assembly resolution. Methods: Using 2011 survey data collected in seven districts in northern Ghana from 5469 women aged 15 to 49 the paper explores the extent to which poor child-bearing age mothers are covered by the NHIS in Ghana's poorest and most remote region. Factors associated with enrolment into the NHIS are estimated with logistic regression models employing covariates for household relative socio-economic status (SES), location of residence and maternal educational attainment, marital status, age, religion and financial autonomy. Results: Results from the analysis showed that 33.9 percent of women in the lowest SES quintile compared to 58.3 percent for those in the highest quintile were insured. About 60 percent of respondents were registered. However, only 40 percent had valid insurance cards indicating that over 20 percent of the registered respondents did not have insurance cards. Thus, a fifth of the respondents were women who were registered but unprotected from the burden of health care payments. Results show that the relatively well educated, prosperous, married and Christian respondents were more likely to be insured than other women. Conversely, women living in remote households that were relatively poor or where traditional religion was practised had lower odds of insurance coverage. Conclusion: The results suggest that the NHIS is yet to achieve its goal of addressing the need of the poor for insurance against health related financial risks. To ultimately attain adequate equitable financial protection for its citizens, achieve universal health coverage in health care financing, and fully implement the World Health Assembly resolution, Ghana must reform enrolment policies in ways that guarantee pre-payment for the most poor and vulnerable households.Item Is Ghana¿s pro-poor health insurance scheme really for the poor? Evidence from Northern Ghana(2014-12-14) Akazili, J.; Welaga, P.; Bawah, A.; Achana, F.S.; Oduro, A.; Awoonor-Williams, J.K.; Williams, J.E.; Aikins, M.; Phillips, J.F.Abstract Background Protecting the poor and vulnerable against the cost of unforeseen ill health has become a global concern culminating in the 2005 World Health Assembly resolution urging member states to ensure financial protection to all citizens, especially children and women of reproductive age. Ghana provides financial protection to its citizens through the National Health Insurance Scheme (NHIS). Launched in 2004, its proponents claim that the NHIS is a pro-poor financial commitment that implements the World Health Assembly resolution. Methods Using 2011 survey data collected in seven districts in northern Ghana from 5469 women aged 15 to 49 the paper explores the extent to which poor child-bearing age mothers are covered by the NHIS in Ghana’s poorest and most remote region. Factors associated with enrolment into the NHIS are estimated with logistic regression models employing covariates for household relative socio-economic status (SES), location of residence and maternal educational attainment, marital status, age, religion and financial autonomy. Results Results from the analysis showed that 33.9 percent of women in the lowest SES quintile compared to 58.3 percent for those in the highest quintile were insured. About 60 percent of respondents were registered. However, only 40 percent had valid insurance cards indicating that over 20 percent of the registered respondents did not have insurance cards. Thus, a fifth of the respondents were women who were registered but unprotected from the burden of health care payments. Results show that the relatively well educated, prosperous, married and Christian respondents were more likely to be insured than other women. Conversely, women living in remote households that were relatively poor or where traditional religion was practised had lower odds of insurance coverage. Conclusion The results suggest that the NHIS is yet to achieve its goal of addressing the need of the poor for insurance against health related financial risks. To ultimately attain adequate equitable financial protection for its citizens, achieve universal health coverage in health care financing, and fully implement the World Health Assembly resolution, Ghana must reform enrolment policies in ways that guarantee pre-payment for the most poor and vulnerable households.Item Measuring Health Systems Strength and Its Impact: Experiences from the African Health Initiative(BMC Health Services Research, 2017-12) Sherr, K.; Fernandes, Q.; Kanté, A.M.; Bawah, A.; Condo, J.; Mutale, W.; Hingora, A.; Mboya, D.; Exavery, A.; Tani, K.; Manzi, F.; Pemba, S.; Phillips, J.; Kante, A.M.; Ramsey, K.; Baynes, C.; Awoonor-Williams, J.K.; Nimako, B.A.; Kanlisi, N.; Jackson, E.F.; Sheff, M.C.; Kyei, P.; Asuming, P.O.; Biney, A.,; Chilengi, R.; Ayles, H.; Mwanza, M.; Chirwa, C.; Stringer, J.; Mulenga, M.; Musatwe, D.; Chisala, M.; Lemba, M.; Drobac, P.; Rwabukwisi, F.C.; Hirschhorn, L.R.; Binagwaho, A.; Gupta, N.; Nkikabahizi, F.; Manzi, A.; Farmer, D.B.; Hedt-Gauthier, B.; Cuembelo, F.; Michel, C.; Gimbel, S.; Wagenaar, B.; Henley, C.; Kariaganis, M.; Manuel, J.L.; Napua, M.; Pio, A.Background: Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Methods: Using the World Health Organization's health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership's leadership team were asked to list - in rank order - the importance of the six building blocks in relation to their intervention. Results: Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and health financing, were the building blocks reported to be of lower focus. Conclusion: The African Health Initiative experience furthers the science of evaluation for health systems strengthening, highlighting areas for further methodological development - including the development of valid, feasible measures sensitive to interventions in multiple contexts (particularly in leadership and governance) and describing interactions across building blocks; in developing summary statistics to facilitate testing intervention effects on health systems and associations with health status; and designing appropriate analytic models for complex, multi-level open health systems.Item Research Capacity Building Integrated into PHIT Projects: Leveraging Research and Research Funding to Build National Capacity(BMC Health Services Research, 2017-12) Hedt-Gauthier, B.L.; Chilengi, R.; Jackson, E.; Michel, C.; Napua, M.; Odhiambo, J.; Bawah, A.; Hingora, A.; Mboya, D.; Exavery, A.; Tani, K.; Manzi, F.; Pemba, S.; Phillips, J.; Kante, A.M.; Ramsey, K.; Baynes, C.; Awoonor-Williams, J.K.; Nimako, B.A.; Kanlisi, N.; Jackson, E.F.; Sheff, M.C.; Kyei, P.; Asuming, P.O.; Biney, A.; Ayles, H.; Mwanza, M.; Chirwa, C.; Stringer, J.; Mulenga, M.; Musatwe, D.; Chisala, M.; Lemba, M.; Mutale, W.; Drobac, P.; Cyamatare Rwabukwisi, F.; Hirschhorn, L.R.; Binagwaho, A.; Gupta, N.; Nkikabahizi, F.; Manzi, A.; Condo, J.; Farmer, D.B.; Sherr, K.; Cuembelo, F.; Michel, C.; Gimbel, S.; Wagenaar, B.; Henley, C.; Kariaganis, M.; Manuel, J.L.; Pio, A.ackground: Inadequate research capacity impedes the development of evidence-based health programming in sub-Saharan Africa. However, funding for research capacity building (RCB) is often insufficient and restricted, limiting institutions' ability to address current RCB needs. The Doris Duke Charitable Foundation's African Health Initiative (AHI) funded Population Health Implementation and Training (PHIT) partnership projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania and Zambia) to implement health systems strengthening initiatives inclusive of RCB. Methods: Using Cooke's framework for RCB, RCB activity leaders from each country reported on RCB priorities, activities, program metrics, ongoing challenges and solutions. These were synthesized by the authorship team, identifying common challenges and lessons learned. Results: For most countries, each of the RCB domains from Cooke's framework was a high priority. In about half of the countries, domain specific activities happened prior to PHIT. During PHIT, specific RCB activities varied across countries. However, all five countries used AHI funding to improve research administrative support and infrastructure, implement research trainings and support mentorship activities and research dissemination. While outcomes data were not systematically collected, countries reported holding 54 research trainings, forming 56 mentor-mentee relationships, training 201 individuals and awarding 22 PhD and Masters-level scholarships. Over the 5 years, 116 manuscripts were developed. Of the 59 manuscripts published in peer-reviewed journals, 29 had national first authors and 18 had national senior authors. Trainees participated in 99 conferences and projects held 37 forums with policy makers to facilitate research translation into policy. Conclusion: All five PHIT projects strongly reported an increase in RCB activities and commended the Doris Duke Charitable Foundation for prioritizing RCB, funding RCB at adequate levels and time frames and for allowing flexibility in funding so that each project could implement activities according to their trainees' needs. As a result, many common challenges for RCB, such as adequate resources and local and international institutional support, were not identified as major challenges for these projects. Overall recommendations are for funders to provide adequate and flexible funding for RCB activities and for institutions to offer a spectrum of RCB activities to enable continued growth, provide adequate mentorship for trainees and systematically monitor RCB activities.Item Stigma and Discrimination against People Living With Hiv and Aids in The Jaman North District of Brong Ahafo Region(University of Ghana, 2015-07) Abudu, E.A.; Bawah, A.; University of Ghana, College of Health Sciences, School of Public HealthIntroduction: HIV and AIDS related stigmatization and discrimination has severe consequences on HIV and AIDS prevention and interventions, People Living with HIV and AIDS and the spread of the HIV. Objectives: This research aims at determining the level of stigma and discrimination and comprehensive HIV and AIDS Knowledge in the Jaman North District of the Brong Ahafo Region. The study also aims at determining the factors associated with of Stigma and discrimination. Methodology: An analytical cross-sectional study was conducted on three hundred and eighty-four (384) respondents in the Jaman North district of the Brong Ahafo Region. Respondents included males (191) and females (193) above the age of seventeen (17) years in four communities of the district namely Sampa, Goka, Duadaso No.2 and Suma Ahenkro. A multistage and systematic random sampling technique was employed to carry out this research. Due to financial and time constraints four (4) communities in the district were selected. Each of the four communities was divided into four clusters. One cluster was randomly selected and the number of houses listed. Based on the sample size allocated to this community a systematic random approach was used to select houses with not more than two respondents per household. A structured questionnaire based on the USAID tool for measuring stigma and discrimination was modified to obtain information about knowledge on HIV, stigmatizing and discriminatory attitudes. An HIV and AIDS stigma and discriminatory index was then constructed and used to determine the level of stigmatization and discrimination in the district. All ethical issues were strictly adhered to, to ensure confidentiality and anonymity of respondents. Conclusion: The study showed a high level of stigma and discrimination in the Jaman North district (95%) and low knowledge on HIV and AIDS (18%).Females (98.45%) were found to have more stigmatizing and discriminatory attitudes towards PLHIV than males( 92.15%) .This therefore, requires that more efforts be made to educate people in the district about HIV and AIDS and reduce stigma and discrimination.Item 'A War Remembered: Biafra at 50'(2018-03-29) Phillips, J.F.; Bawah, A.By some estimates, the Nigerian Civil War was the greatest catastrophe ever to have occurred in Africa. Over the June, 1967 to January, 1970 period, the conflict may have claimed as many as two million lives. This presentation will be delivered by a former relief officer of the International Committee of the Red Cross who participated in the Biafra relief action over the May to October, 1969 period as an entry-level logistics worker, and from November 1969 to July 1970 as a “UN Forward Observer” assigned to the Third Division of the Nigerian Army. The presentation outlines causes and consequences of the conflict, procedures followed by the relief action, and examples of strategies that failed to have their intended impact. Lessons from Biafra attest to the value of implementation science in crisis situations. Ghana’s humanitarian diplomacy prior to the conflict will be reviewed.