Browsing by Author "Bawah, A.A."

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Academic promotion policies and equity in global health collaborations
(The Lancet, 2018-11) Hedt-Gauthier, B.; Airhihenbuwa, C.O.; Bawah, A.A.; Burke, K.S.; Cherian, T.; Connelly, M.T.; Hibberd, P.L.; Ivers, L.C.; Jerome, J.G.; Kateera, F.et.al.
When global health researchers in low-income and middle-income countries (LMICs) collaborate with academics in high-income countries (HICs), these partnerships often result in disproportionate benefits for the HIC researchers who gain more opportunities for authorship, more prominent authorship positions, more opportunities to present at conferences, and more funding for administrative and student support for LMIC colleagues. This inequity gap persists despite existing guidelines for good collaborative practice and repeated calls to improve global health research partnerships.1 Models for equitable collaborations differ from country to country and team to team, depending on the experience and empowerment of the LMIC researchers and training institutes, research infrastructure, the length of collaborations, and the amount of funding available for research and training. However, the absence of an optimal model should not be an excuse for poor collaborative dynamics.
Accelerating reproductive and child health programme impact with community-based services: The Navrongo experiment in Ghana
(Bulletin of the World Health Organization, 2006-12) Phillips, J.F.; Bawah, A.A.; Binka, F.N.
Objective: To determine the demographic and health impact of deploying health service nurses and volunteers to village locations with a view to scaling up results. Methods: A four-celled plausibility trial was used for testing the impact of aligning community health services with the traditional social institutions that organize village life. Data from the Navrongo Demographic Surveillance System that tracks fertility and mortality events over time were used to estimate impact on fertility and mortality. Results: Assigning nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated the time taken for attainment of the child survival Millennium Development Goal (MDG) in the study areas to 8 years. Fertility was also reduced by 15%, representing a decline of one birth in the total fertility rate. Programme costs added US$ 1.92 per capita to the US$ 6.80 per capita primary health care budget. Conclusion: Assigning nurses to community locations where they provide basic curative and preventive care substantially reduces childhood mortality and accelerates progress towards attainment of the child survival MDG. Approaches using community volunteers, however, have no impact on mortality. The results also demonstrate that increasing access to contraceptive supplies alone fails to address the social costs of fertility regulation. Effective deployment of volunteers and community mobilization strategies offsets the social constraints on the adoption of contraception. The research in Navrongo thus demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs.
Being ready, willing and able: understanding the dynamics of family planning decision-making through community-based group discussions in the Northern Region, Ghana
(Genus, 2021) Biney, A.A.E.; Wright, K.J.; Kushitor, M.K.; Jackson, E.F.; Phillips, J.F.; Awoonor-Williams, J.K.; Bawah, A.A.
Regional contraceptive use differentials are pronounced in Ghana, with the lowest levels occurring in the Northern Region. Community-based health services, intended to promote maternal and child health and family planning use, may have failed to address this problem. This paper presents an analysis of qualitative data on community perspectives on family planning “readiness,” “willingness,” and “ability” compiled in the course of 20 focus group discussions with residents (mothers and fathers of children under five, young boys and girls, and community elders) of two communities each in two Northern Region districts that were either equipped with or lacking direct access to community health services. The study districts are localities where contraceptive use is uncommon and fertility is exceptionally high. Results suggest that direct access to community services has had no impact on contraceptive attitudes or practice. Widespread method knowledge is often offset by side-effect misperceptions. Social constraints are prominent owing to opposition from men. Findings attest to the need to improve the provision of contraceptive information and expand method choice options. Because societal acceptance and access in this patriarchal setting is critical to use, frontline worker deployment should prioritize strategies for outreach to men and community groups with prominent attention to social mobilization themes and strategies that support family planning.
Catalyzing the scale-up of community-based primary healthcare in a rural impoverished region of northern Ghana.
(2015) Awoonor-Williams, J.K.; Phillips, J.F.; Bawah, A.A.
Ghana's Community-based Health Planning and Services (CHPS) initiative develops accessible healthcare with participatory community support, using strategies developed and tested by a project of the Navrongo Health Research Centre. In 1996, the project was expanded to a district-wide four-celled trial. In response to evidence that strategies could reduce fertility and childhood mortality, a replication project was launched to develop methods for scale-up. Based on experience gained, CHPS scale-up was launched in 2000. Although CHPS now reaches all of Ghana's districts, the pace of scale-up within districts has been slow. In response, the Ministry of Health conducted a review of factors that constrain CHPS scale-up and problems that detract from its original evidence-based design. To resolve problems that were identified, a project was launched in 2010 to test means of accelerating CHPS scale-up and expand its range of care. Known as the Ghana Essential Health Interventions Program (GEHIP), the project provided catalytic revenue to four treatment district managers for 3 years, in conjunction with implementation of strategies for comprehensive leadership development and community partnership. Monitoring systems were developed to gauge CHPS coverage time trends in all nine study districts. GEHIP successfully accelerated CHPS implementation, producing 100% of its targeted community coverage within 5 years of implementation. Coverage in comparison districts also improved. However, the rate of coverage and per cent of the population reached by CHPS in comparison districts was only half that of GEHIP districts. GEHIP success in completing CHPS coverage represents the initial stage of a national program for strengthening community health systems in Ghana.
The child survival impact of the Ghana Essential Health Interventions Program: A health systems strengthening plausibility trial in Northern Ghana
(PLoS ONE, 2019-05-23) Bawah, A.A.; Awoonor-Williams, J.K.; Asuming, P.O.; Jackson, E.F.; Boyer, C.B.; Kanmiki, E.W.; Achana, S.F.; Akazil, J.; Phillips, J.F.
Background The Ghana Health Service in collaboration with partner institutions implemented a five-year primary health systems strengthening program known as the Ghana Essential Health Intervention Program (GEHIP). GEHIP was a plausibility trial implemented in an impoverished region of northern Ghana around the World Health Organizations (WHO) six pillars combined with community engagement, leadership development and grassroots political support, the program organized a program of training and action focused on strategies for saving newborn lives and community-engaged emergency referral services. This paper analyzes the effect of the GEHIP program on child survival. Methods Birth history data assembled from baseline and endline surveys are used to assess the hazard of child mortality in GEHIP treatment and comparison areas prior to and after the start of treatment. Difference-in-differences (DiD) methods are used to compare mortality change over time among children exposed to GEHIP relative to children in the comparison area over the same time period. Models test the hypothesis that a package of systems strengthening activities improved childhood survival. Models adjusted for the potentially confounding effects of baseline differentials, secular mortality trends, household characteristics such as relative wealth and parental educational attainment, and geographic accessibility of clinical care. Results The GEHIP combination of health systems strengthening activities reduced neonatal mortality by approximately one half (HR = 0.52, 95% CI = 0.28,0.98, p = 0.045). There was a nullincremental effect of GEHIP on mortality of post-neonate infants (from 1 to 12 months old) (HR = 0.72; 95% CI = 0.30,1.79; p = 0.480) and post-infants (from 1 year to 5 years old) -(HR = 1.02; 95% CI = 0.55–1.90; p = 0.940). Age-specific analyses show that impact was concentrated among neonates. However, effect ratios for post-infancy were inefficiently assessed owing to extensive survival history censoring for the later months of childhood. Children were observed only rarely for periods over 40 months of age. Conclusion GEHIP results show that a comprehensive approach to newborn care is feasible, if care is augmented by community-based nurses. It supports the assertion that if appropriate mechanisms are put in place to enable the various pillars of the health system as espoused by WHO in rural impoverished settings where childhood mortality is high, it could lead to accelerated reductions in mortality thereby increasing survival of children. Policy implications of the pronounced neonatal effect of GEHIP merit national review for possible scale-up.
Child Wanted and When? Fertility Intentions, Wantedness, and Child Survival in Rural Northern Ghana
(2016) Bawah, A.A.; Asuming, P.; Debpuur, C.; James, F.P.
Panel survey data collected in rural northern Ghana asked women about the “wantedness” status of their children. Parous women were asked whether they wanted more children, while those who had never had a child were asked whether they wanted to have children in the future; those who said that they did not want to have any more children in the future were asked whether they wanted to become pregnant when they last became pregnant and, if so, whether they wanted to become pregnant at the time, or would have preferred to be pregnant earlier or later. This article analyzes longitudinal responses to these questions over a 10-year period. Birth and survival histories of subsequently born children linked to preference data permit investigation of the question: are “wanted” children more likely to survive than “unwanted” children? Hazard models are estimated to determine whether children born to women who indicated that they did not want to have a child at the time they did, or did not want any more children in the future, have a higher risk of mortality relative to children who were reported wanted at the time of pregnancy. Results show no significant differences in adjusted mortality risks between children who were reported to be wanted and those reported to be unwanted.
Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana
(Global Health Action, 2020-02-03) Biney, A.; Wright, K.J.; Kushitor, M.; Awoonor-Williams, J.K.; Bawah, A.A.; Phillips, J.F.
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.
Community-Based Health Planning and Services Plus programme in Ghana: A qualitative study with stakeholders in two Systems Learning Districts on improving the implementation of primary health care
(2020-01-08) Bawah, A.A.; Kweku, M.; Amu, H.; Awolu, A.; Adjuik, M.; Ayanore, M.A.; Manu, E.; Tarkang, E.E.; Komesuor, J.; Asalu, G.A.; Aku, F.Y.; Kugbey, N.; Anumu, F.; Boateng, L.A.; Alornyo, J.S.; Glover, R.; Letsa, T.; Kanlisi, N.S.; Awoonor-Williams, J.K.; Phillips, J.F.; Gyapong, J.O.
In 1999, Ghana introduced the Community-Based Health Planning and Services (CHPS) as the key primary health care strategy. In this study, we explored the challenges, capacity development priorities, and stakeholder perspectives on improving the CHPS concept as it has been fraught with a myriad of challenges since its inception. Our study is the outcome of the national programme for strengthening the implementation of CHPS Initiative in Ghana (CHPS+) introduced in 2017. Methods This exploratory research was a qualitative study conducted in two Systems Learning Districts (SLDs) of CHPS+ in the Volta Region of Ghana from March to May, 2018. Four focus group discussions and two general discussions were conducted among 60 CHPS+ stakeholders made up of health workers and community members. Data analyses were conducted using conceptual content analysis. Statements of the participants were presented as quotes to substantiate the views expressed. Results Negative attitude, high attrition, inadequacy and unavailability of health professionals at post when needed were challenges associated with the health professionals. Late referrals lack of proper community entry and engagement, non-availability of essential logistics, distance of CHPS compounds from communities, and inadequate funding were challenges associated with the health system. Lack of community ownership of the CHPS programme, lack of security at CHPS compounds, and late reporting of cases by the community members were also realised as challenges emanating from the community members. Priority areas for capacity development of health workers identified included logistics management, community entry and engagement, emergency delivery, managing referrals at the CHPS level, and resuscitation of newborns. Conclusion Health-worker, community, and health systems-based challenges inhibit the implementation of CHPS in Ghana. Capacity development of health professionals and continuous community engagement are avenues that can improve implementation of the programme
Contraceptive use and method mix dynamics in Sub-saharan Africa: time trends and the infuence of the HIV pandemic
(Contraception and Reproductive Medicine, 2024) Bawah, A.A.; Kyei, P.S.; Agyei‑Asabere, C.
Background Contraceptive use dynamics continue to be of priority in sub-Saharan Africa because of persistently high levels of fertility. This paper focuses on the use of barrier versus non-barrier contraceptive use in sub-Sahara Africa hypothesizing that the HIV pandemic in the region would be responsible for increases in the use of barrier methods over time. Methods This paper uses Demographic and Heath Survey (DHS) data from 32 countries to conduct extensive analysis of trends in contraceptive use and method mix that refers to the distribution of contraceptive methods use among the sexually active population. The paper examines how contraceptive method mix dynamics have changed over time and whether the trends differ by marital status and gender using cross-tabulations. It furthers examines the determinants of method choice using logistic regressions. Results The findings indicate that the use of barrier methods, most markedly for unmarried women and men, rose substantially between the late 1980s and late 2000s in the region in tandem with trends in HIV prevalence. The results further show marked differences in method mix by gender with men being more likely to report barrier method use than women. Conclusions The findings indicate shifting preferences in contraceptive choice. The time trend analyses highlight the importance of expanding the focus of contraceptive use studies beyond women in this context as the study finds differing trends for men.
Contraceptive use intentions and unmet need for family planning among reproductive-aged women in the Upper East Region of Ghana
(Reproductive Health, 2019-03) Bawah, A.A.; Asuming, P.; Achana, S.F.; Kanmiki, E.W.; Awoonor-Williams, J.K.; Phillips, J.F.
Background Motivations for use of contraceptives vary across populations. While some women use contraceptives for birth spacing, others adopt contraception for stopping childbearing. As part of efforts to guide the policy framework to promote contraceptive utilization among women in Ghana, this paper examines the intentions for contraceptive use among reproductive-aged women in one of the most impoverished regions of Ghana. Methods This paper utilizes data collected in 2011 from seven districts in the Upper East Region of northern Ghana to examine whether women who reported the use of contraceptives did so for the purposes of stopping or spacing childbirth. A total of 5511 women were interviewed on various health and reproductive health related issues, including fertility and family planning behavior. Women were asked if they would like to have any more children (for those who already had children or those who were pregnant at the time of the survey). Results The prevalence of contraceptive use was low at 13%, while unmet need is highly pervasive and demand for family planning is predominantly for spacing future childbearing rather than for the purpose of stopping. Overall, about 31.7%of women not using contraceptives reported a need for spacing while 17.6% expressed a need for limiting. Thus, the latent demand for family planning is dominated by preferences for space rather than limiting childbearing. Conclusion Results show that there is latent demand for family planning and therefore if family planning programs are appropriately implemented they can yield the desired impact.
Contraceptive use intentions and unmet need for family planning among reproductive-aged women in the Upper East Region of Ghana
(Reproductive Health, 2019-03) Bawah, A.A.; Asuming, P.; Achana, S.F.; Kanmiki, E.W.; Awoonor-Williams, J.K.; Phillips, J.F.
Background:Motivations for use of contraceptives vary across populations. While some women use contraceptivesfor birth spacing, others adopt contraception for stopping childbearing. As part of efforts to guide the policyframework to promote contraceptive utilization among women in Ghana, this paper examines the intentions forcontraceptive use among reproductive-aged women in one of the most impoverished regions of Ghana.Methods:This paper utilizes data collected in 2011 from seven districts in the Upper East Region of northernGhana to examine whether women who reported the use of contraceptives did so for the purposes of stopping orspacing childbirth. A total of 5511 women were interviewed on various health and reproductive health relatedissues, including fertility and family planning behavior. Women were asked if they would like to have any morechildren (for those who already had children or those who were pregnant at the time of the survey).Results:The prevalence of contraceptive use was low at 13%, while unmet need is highly pervasive and demandfor family planning is predominantly for spacing future childbearing rather than for the purpose of stopping.Overall, about 31.7%of women not using contraceptives reported a need for spacing while 17.6% expressed a needfor limiting. Thus, the latent demand for family planning is dominated by preferences for space rather than limitingchildbearing.Conclusion:Results show that there is latent demand for family planning and therefore if family planningprograms are appropriately implemented they can yield the desired impact.
Contraceptive use intentions and unmet need for family planning among reproductive-aged women in the Upper East Region of Ghana 11 Medical and Health Sciences 1117 Public Health and Health Services 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine
(Reproductive Health, 2019-02-21) Bawah, A.A.; Asuming, P.; Achana, S.F.; Kanmiki, E.W.; Awoonor-Williams, J.K.; Phillips, J.F.
Background: Motivations for use of contraceptives vary across populations. While some women use contraceptives for birth spacing, others adopt contraception for stopping childbearing. As part of efforts to guide the policy framework to promote contraceptive utilization among women in Ghana, this paper examines the intentions for contraceptive use among reproductive-aged women in one of the most impoverished regions of Ghana. Methods: This paper utilizes data collected in 2011 from seven districts in the Upper East Region of northern Ghana to examine whether women who reported the use of contraceptives did so for the purposes of stopping or spacing childbirth. A total of 5511 women were interviewed on various health and reproductive health related issues, including fertility and family planning behavior. Women were asked if they would like to have any more children (for those who already had children or those who were pregnant at the time of the survey). Results: The prevalence of contraceptive use was low at 13%, while unmet need is highly pervasive and demand for family planning is predominantly for spacing future childbearing rather than for the purpose of stopping. Overall, about 31.7%of women not using contraceptives reported a need for spacing while 17.6% expressed a need for limiting. Thus, the latent demand for family planning is dominated by preferences for space rather than limiting childbearing. Conclusion: Results show that there is latent demand for family planning and therefore if family planning programs are appropriately implemented they can yield the desired impact.
Cost of implementing a community-based primary health care strengthening program: The case of the Ghana Essential Health Interventions Program in northern Ghana
(PLoS ONE, 2019-02) Kanmiki, E.W.; Akazili, J.; Bawah, A.A.; Phillips, J.F.; Awoonor-Williams, J.K.; Asuming, P.O.; Oduro, A.R.; Aikins, M.
BACKGROUND: The absence of implementation cost data constrains deliberations on consigning resources to community-based health programs. This paper analyses the cost of implementing strategies for accelerating the expansion of a community-based primary health care program in northern Ghana. Known as the Ghana Essential Health Intervention Program (GEHIP), the project was an embedded implementation science program implemented to provide practical guidance for accelerating the expansion of community-based primary health care and introducing improvements in the range of services community workers can provide. METHODS: Cost data were systematically collected from intervention and non-intervention districts throughout the implementation period (2012-2014) from a provider perspective. The step-down allocation approach to costing was used while WHO health system blocks were adopted as cost centers. We computed cost without annualizing capital cost to represent financial cost and cost with annualizing capital cost to represent economic cost. RESULTS: The per capita financial cost and economic cost of implementing GEHIP over a three-year period was $1.79, and $1.07 respectively. GEHIP comprised only 3.1% of total primary health care cost. Health service delivery comprised the largest component of cost (37.6%), human resources was 28.6%, medicines was 13.6%, leadership/governance was 12.8%, while health information comprised 7.5% of the economic cost of implementing GEHIP. CONCLUSION: The per capita cost of implementing the GEHIP program was low. GEHIP project investments had a catalytic effect that improved community-based health planning and services (CHPS) coverage and enhanced the efficient use of routine health system resources rather than expanding overall primary health care costs.
Determinants of Risky Sexual Behaviour Among Senior High School Students, in La Dade-Kotopon Municipality
(University of Ghana, 2013-07) Ogbada, A.E.; Bawah, A.A.
This was a cross-sectional study that investigated the determinants of risky sexual behaviour among senior high school students in La Dade-Kotopon Municipality in the Greater Accra region of Ghana. A total of 422 adolescents between the ages of 14-19 years in two senior high schools were selected using a multi stage stratified random sampling technique with probability proportion to school size. An interviewer administered questionnaire was used to obtain data on determinants of risky sexual behaviour of the students. Quantitative data were obtained on their socio-demographic status, family structures, sexual and contraceptive history along with their source of information on sexuality, sexual reproductive health programmes in their schools. The data were processed and analysed using SPSS software version 16. Frequencies, chi square and logistic regression were used in the analyses. The median age at sexual debut was 16.0 (2.3) years. The sexually active were 29.4% of all respondents, of which 83.1% of them were engaged in higher risk sex. The proportions of higher risk sex by gender were 77.9% of the sexually active males, and 91.5% of the females. Logistic regression showed that religiousity was the only predictor of risky sexual behaviour. The main source of information on sexuality was non parental i.e. school teachers (34.7%). Only 9.5% of respondents were aware of youth friendly reproductive health services, although only 20.7% of those who were aware have actually utilised the services. Religiousity is an important predictor of risky sexual behaviour among senior high school adolescents in the area. Appropriate interventions are needed to curb the high proportion of higher risk sexual behaviour among the students.
Does the provision of community health services offset the effects of poverty and low maternal educational attainment on childhood mortality? An analysis of the equity effect of the Navrongo experiment in Northern Ghana
(SSM - Population Health, 2019-04) Bawah, A.A.; Phillips, J.F.; Asuming, P.O.; Jackson, E.F.; Walega, P.; Kanmiki, E.W.; Sheff, M.C.; Oduro, A.
The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. CHPS was derived from a plausibility trial of the Navrongo Health Research Centre testing four contrasting primary health care strategies: i) Training unpaid volunteers to promote health in communities, ii) placing nurses in communities with training and supplies for treating childhood illnesses, iii) combining the nurse and volunteer approaches, and iv) sustaining a comparison condition whereby clinic services were provided without community resident workers. This paper presents an age-conditional proportional hazard analysis of the long term impact of community health worker exposure among 94,599 children who were ever under age five over the January 1, 1995 to December 2010 period, adjusting for age conditional effects of shifts in exposure type as CHPS was scaled up in Navrongo project area over the 1995–2000 period. Results show that children whose parents are uneducated and relatively poor experience significantly higher mortality risks than children of the educated and less poor. Conditional hazard regression models assess the impact of CHPS on health equity by estimating the interaction of equity indicators with household exposure to CHPS service operations, adjusting for age conditional exposure to original Community Health and Family Planning Project (CHFP) service strategies as scale-up progressed. The association of mortality risk among children with uneducated and relatively impoverished mothers is offset by exposure to community health nursing services. If exposure is limited to volunteer-provided services alone, survival benefits arise only among children of relatively advantaged households. Findings lend support to policies that promote the CHPS nurse approach to community-based services as a core health component of poverty reduction programs.
Evaluating health service coverage in Ghana’s Volta Region using a modified Tanahashi model
(Global Health Action, 2020-03-16) Bawah, A.A.; Sheff, M.C.; Asuming, P.O.; Kyei, P.; Kushitor, M.; Phillips, J.F.; Kachur, S.P.
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.
Family Planning Method Choice Among Married Women in the Gomoa West District
(University of Ghana, 2012-07) Okletey, M.; Bawah, A.A.; University of Ghana, College of Health Sciences, School of Public Health
Introduction: Global population increased to 7.0 billion in 2011 and nearly all of that growth is in the developing countries. Sub-Saharan Africa of which Ghana is not an exception has the highest fertility rate in the world. The GDHS (2008) report indicates that contraceptive prevalence rate has decline in the past five years to 24% in 2008. The Gomoa West District Health Directorate 2010 annual report indicates that family planning acceptor rate has reduced from 40% in 2009 to 33% in 2010 and Depo provera is the choice of method among women. The slow pace of family planning usage in Ghana poses a challenge to the country‟s goal of reducing maternal mortality through the use of family planning. It is therefore necessary to examine the factors associated with family planning method choice among married women in the Gomoa West District to help plan interventions to meet those needs. Methods: A population-based cross sectional survey using both quantitative and qualitative instruments was employed for data collection. Women In fertility Age (WIFA) between the ages of 15-49 years who were married, resident in the Gomoa West District and have ever used or were currently using any method of contraception as at the time of the survey were sampled for the study. Results: Thirty-five percent had ever used family planning method sometime in the past but currently are not using any method whereas 64.5% were currently using. The most ever used modern method is the Injectables (72.9%), the Pill (16.8%) and the Implants accounted for 8.4%. Little over half (50.5%) ever users discontinue due to side effect of the method while 20% was due to desire to have another child. Modern methods are the most preferred methods (97.5%) while 2.5% use traditional method. Injectables accounted for 60%, Implants (17.4%) and the Pill (11.8%) respectively and method use increase. Sixty-eight percent of current users were for spacing births, 22.5% for limiting and 8.5% for preventing unintended pregnancy. There was statistically significance between age, number of children and educational level and the choice of family planning method use. Conclusion: Injectables (Depo provera and Norigynon) is the preferred choice of family planning method among married women in the Gomoa West District. Health service delivery factors such as frequent stock outs of family planning commodities, non-availability of method mix as well as lack of appropriate and quality information on methods might have contributed to the low uptake of Long-Term Methods. Keywords: family planning method, current user, ever user, discontinuation, choice
How different incentives influence reported motivation and perceptions of performance in Ghanaian community-based health planning and services zones
(BMC Research Notes, 2022) Sakeah, E.; Bawah, A.A.; Kuwolamo, I.; Anyorikeya, M.; Asuming, P.O.; Aborigo, R.A.
Background: Maternal mortality is still a burden worldwide, and Ghana’s maternal and child mortalities are still high. Incentive schemes have been effective in improving health workers’ performance thereby reducing maternal and child deaths. The efficiency of public health services in most developing countries has been linked to the provision of incentives. Thus, financial packages for Community Health Volunteers (CHVs) serve as enablers for them to be focused and committed to their work. However, the poor performance of CHVs is still a challenge in health service delivery in many developing countries. Although the reasons for these persistent problems are understood, we need to find out how to implement what works in the face of political will and financial constraints. This study assesses how different incentives influence reported motivation and perceptions of performance in Community-based Health Planning and Services Program (CHPS) zones in the Upper East region. Methods: A quasi-experimental study design with post-intervention measurement was used. Performance-based interventions were implemented for 1 year in the Upper East region. The different interventions were rolled out in 55 of 120 CHPS zones. The 55 CHPS zones were randomly assigned to four groups: three groups of 14 CHPS zones with the last group containing 13 CHPS zones. Several alternative types of financial and non-financial incentives as well as their sustainability were explored. The financial incentive was a small monthly performance-based Stipend. The non financial incentives were: Community recognition; paying for National Health Insurance Scheme (NHIS) premiums and fees for CHV, one spouse, and up to two children below 18 years, and; quarterly performance-based Awards for best-performing CHVs. The four groups represent the four different incentive schemes. We conducted 31 In-depth interviews (IDIs) and 31 Focus Group Discussions (FGDs) with health professionals and community members. Results: Community members and the CHVs wanted the stipend as the first incentive but requested that it be increased from the current level. The Community Health Officers (CHOs) prioritized the Awards over the Stipend because they felt it was too small to generate the required motivation in the CHVs. The second incentive was the National Health Insurance Scheme (NHIS) registration. Community recognition was also considered by health professionals as effective in motiving CHVs and work support inputs and CHVs training helped in improving output. The various incentives have helped increase health education and facilitated the work of the volunteers leading to increased outputs: Household visits and Antenatal Care and Postnatal Care coverage improved. The incentives have also influenced the initiative of volunteers. Work support inputs were also regarded as motivators by CHVs, but the challenges with the incentives included the size of the stipend and delays in disbursement. Conclusion: Incentives are effective in motivating CHVs to improve their performance, thereby improving access to and use of health services by community members. The Stipend, NHIS, Community recognition and Awards, and the work support inputs all appeared to be effective in improving CHVs’ performance and outcomes. Therefore, if health professionals implement these financial and non-financial incentives, it could bring a positive impact on health service delivery and use. Also, building the capacities of CHVs and providing them with the necessary inputs could improve output.
How many years of life could be saved if malaria were eliminated from a hyperendemic area of northern Ghana?
(American Journal of Tropical Medicine and Hygiene, 2007-12) Bawah, A.A.; Binka, F.N.
Malaria is endemic in about 90 countries of the world, half of which are in Africa. Little is known about the demographic impact of the disease, however. This article uses demographic methods to examine the impact of mortality from malaria on overall mortality in a hyperendemic rural African setting. Using longitudinal demographic surveillance data from northern Ghana and applying multiple decrement and associated single-decrement life-table methods, we estimate the total number of person-years that would have been saved had malaria been eliminated from the population in 1995, given the age- and cause-specific mortality conditions of the period and gains in life expectancy that are implied. Results suggest that as many as one third of deaths in this population are attributable to malaria, depending on the age group under consideration, and that life expectancy at birth would likely increase by more than six years if malaria were eliminated as a cause of death. Copyright © 2007 by The American Society of Tropical Medicine and Hygiene.
Impact of community health interventions on maternal and child health indicators in the upper east region of Ghana
(BMC Pregnancy and Childbirth, 2023) Sakeah, E.; Bawah, A.A.; Asuming, P.O.; et al.
Background This paper reports on results of a health system strengthening implementation research initiative conducted the Upper East Region of northern Ghana. Transformative interventions to accelerate and strengthen the health delivery were implemented that included empowering community leaders and members to actively participate in health delivery, strengthening the referral systems through the provision of community transport systems, providing basic medical equipment to community clinics, and improving the skills of critical health staff through training. Methods A mixed method design was used to evaluate the impact of the interventions. A quantitative evaluation employed a flexible research design to test the effects of various component activities of the project. To assess impact, a preversus–post randomized cluster survey design was used. Qualitative research was conducted with focus group data and individual in depth interviews to gauge the views of various stakeholders associated with the implementation process. Results After intervention, significant improvements in key maternal and child health indicators such as antenatal and postnatal care coverage were observed and increases in the proportion of deliveries occurring in health facilities and assisted by skilled health personnel relative to pre-intervention conditions. There was also increased uptake of oral rehydration salts (ORS) for treatment of childhood diarrhoea, as well as marked reductions in the incidence of upper respiratory infections (URI). Conclusions A pre-and post-evaluation of impact suggests that the programme had a strong positive impact on the functioning of primary health care. Findings are consistent with the proposition that the coverage and content of the Ghana Community-based Health Planning and Services programme was improved by program interventions and induced discernable changes in key indicators of health system performance.