Browsing by Author "Dodoo, J.N.O."
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Item A Stakeholder Analysis Of The Capitation Pilot Under Ghana’s National Health Insurance Scheme In The Ashanti Region(University of Ghana, 2013-07) Dodoo, J.N.O.; Nonvignon, J.; University of Ghana, College of Health Sciences, School of Public HealthGhana established the National Health Insurance Scheme (NHIS) through the enactment of Act 650 in 2003 which was to secure the provision of basic healthcare services to persons resident in the country. Since the implementation of NHIS in 2004, the Fee-For- Service (FFS) has been used for the payment of drugs and some other services until 2008 when the Ghana Diagnostic-Related Groups (G-DRGs) was introduced to pay providers on the basis of claims made by them to the District Mutual Health Insurance Scheme (DMHIS). In January 2012, the NHIA initiated the pilot implementation of the capitation policy in the Ashanti Region. The aim of the study was to undertake a stakeholder analysis of the capitation pilot under Ghana’s National Health Insurance Scheme pilot in Ashanti Region to investigate the stakeholders’ position, power and interest during the piloting of the policy. This is a single case study design using qualitative data collection and analysis methods Data were collected using an interview guide for regional level actors and a Focus Group Discussion guide for clients. The study area was Kumasi Metropolitan Assembly, Ejisu Juabeng Municipal Assembly and Atwima Nwabiagya District Assembly all in the Ashanti Region. Twenty (20) stakeholders were purposively selected and interviewed. Two Focus Group Discussions were held. Data analysis was done manually using thematic analysis. Stakeholder tools like tables, matrices and force field analysis were used to present findings. One of the key findings of this study was that though stakeholders were generally aware of the capitation policy and its pilot implementation there were lots of misinterpretations of some parts of the policy especially at the pre-implementation phase which led to opposition from some primary stakeholders like the clients and staff of the District Mutual Health Insurance Scheme. However, as these stakeholders begun to get a better understanding of the policy, their position changed. The general position of stakeholders (both primary and secondary) is that capitation payment system is a good idea. However, a critical attention must be given to the contentious aspects of the policy in order to facilitate effective scaling-up implementation. Measures such as reviewing the capitation rate and implementing an alternative provider payment method for smaller facilities such as Health centres, CHPS compounds and maternity homes should be considered.Item The "universal" in UHC and Ghana's National Health Insurance Scheme: Policy and implementation challenges and dilemmas of a lower middle income country(BioMed Central Ltd., 2016) Agyepong, I.A.; Abankwah, D.N.Y.; Abroso, A.; Chun, C.; Dodoo, J.N.O.; Lee, S.; Mensah, S.A.; Musah, M.; Twum, A.; Oh, J.; Park, J.; Yang, D.; Yoon, K.; Otoo, N.; Asenso-Boadi, F.Background: Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns which mean it is highly stigmatized and this poses a threat to both providers and researchers. This study sought to explore challenges to providing safe abortion services from the perspective of health providers in Ghana. Methods: A descriptive qualitative study using in-depth interviews was conducted. The study was conducted in three (3) hospitals and five (5) health centres in the capital city in Ghana. Participants (n = 36) consisted of obstetrician/gynaecologists, nurse-midwives and pharmacists. Results: Stigma affects provision of safe-abortion services in Ghana in a number of ways. The ambiguities in Ghanaian abortion law and lack of overt institutional support for practitioners increased reluctance to openly provide for fear of stigmatisation and legal threat. Negative provider attitudes that stigmatised women seeking abortion care were frequently driven by socio-cultural and religious norms that highly stigmatise abortion practice. Exposure to higher levels of education, including training overseas, seemed to result in more positive, less stigmatising views towards the need for safe abortion services. Nevertheless, physicians open to practicing abortion were still very concerned about stigma by association. Conclusions: Stigma constitutes an overarching impediment for abortion service provision. It affects health providers providing such services and even researchers who study the subject. Exposure to wider debate and education seem to influence attitudes and values clarification training may prove useful. Proper dissemination of existing guidelines and overt institutional support for provision of safe services also needs to be rolled out.