Browsing by Author "Enyimayew, N."
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Item Community Participation in Maternal and Child Health/Family Planning Programmes at the Subdistrict Level(University of Ghana, 1998-09) Henneh, R.K.; Enyimayew, N.; Amuah, E.; University of Ghana, College of Health Sciences, School of Public HealthCommunity Participation has been identified as a key factor in the improvement of health care delivery in Ghana. The Wa District Health Administration set up a number of community health structures with the intention to get communities more involved/participating in health programmes in order to improve coverage and utilization. Despite these community, health structures and other efforts aimed at improving coverage / utilization in health services, there has not be any significant improvement. Nevertheless, the Wa District Health Management Team (DHMT) strongly felt that the unsatisfactory coverage/utilization in health programmes might be due to low or narrow community participation. This study assessed the extent of community participation in health programmes using MCH/FP programmes as a proxy. The study also sought to identify factors which influence community participation. The study was descriptive in design using only qualitative approach. Both primary and secondary data were collected through the use of focus group discussions, in-depth individual/key informant interviews, annual reports, minutes books and log book. Altogether 106 people selected from 38 communities in four subdistricts were involved in the study. The “Pentagram Model” developed by Susan B. Rifkin and associates in 1988 was used to assess the extent of community participation. This model uses five factors or indicators namely Needs Assessment, Resource Mobilization, Organization, Management, and Leadership to assess the extent of Community participation. One of the significant findings was that in all the four subdistricts studied the extent of community participation was found to be either restricted (small) or lying between restricted and mean (fair). The most strained areas were Needs Assessment and Management. Since the extent of community participation was either small (restricted) lied between small and mean it could partly or fully account for the low coverage/utilization of MCH/FP services as well as other health services. However since only subjective and qualitative indicators were used no correlation could be established between small or poor community participation and low coverage/utilization. Another significant finding was that the health professionals had inadequate knowledge on community participation. They had not been trained on the extent to which they should involve the communities in health programmes. The study identified some positive features which could improve community participation. They included the existence of community health structures (e.g. subdistrict health management teams [SDHMTs] village health volunteers, e tc ), and absence of community conflicts in most communities. The study also revealed a few negatively reinforcing factors of community participation. These included: unwillingness of the communities to contribute financially towards health programmes and development, poor quality of leadership especially the SDHMT members in some communities, absence of team work at the community level, and the influence of soothsayers and fetish priests in some of the communities. A standardized framework on the extend and/or level to which the public or communities should participate in health programmes/projects should be developed especially in areas of planning, implementation, monitoring evaluation, and financial mobilization. The Upper West Regional Health Management Team and Wa District Health Management Team should come out with an incentive package for the community structures. The communities should also support the community health structures financially or otherwise especially the traditional birth attendants (TBAs). It is also recommended that health professionals should educate the communities on the need to contribute financially or otherwise to support health programmes. The pentagram model has been found to be very useful. It should be used periodically to assess the extent of community participation in health programmes/projects.Item Essential Obstetric Care- A Comprehensive Coverage Evaluation in Adansi-East District, Ghana(University of Ghana, 1997) Kyei-Faried, S.; Enyimayew, N.; Amuah, E.; University of Ghana,College of Health Sciences,School of Public HealthA comprehensive coverage evaluation of essential obstetric care was carried out at the district referral point and the sub-districts’ first points of contact in the Adansi-East District, Ashanti Region. The evaluation tool consisted of measuring the coverage of essential care availability, access, utilization, adequacy and effectiveness. The essential care variables that were assessed were labour monitoring by partography, performance of obstetric surgery and the treatment of non-surgical obstetric complications. Interviews were conducted among district health managers, service providers, trained traditional birth attendants and women who delivered 12 months prior to the study, to identify factors causing bottlenecks in the coverage. The effectiveness coverage of each essential obstetric care variable was found to be very low, below 5%. This was mainly due to bottlenecks at resource availability and service utilization at the district and sub-district levels. There was also a bottleneck at access coverage at the district level for all the variables. The low availability coverage was due to lack of ..:Information and training in the use of essential care resources, absence of resident midwives and lack of rooms to treat cases. The low utilization was as a result of the inability of the facilities to effectively treat obstetric complications. Most women with obstetric complications therefore use facilities outside the district. To improve the effectiveness coverage of essential obstetric care, it is recommended that the District Health Team reallocates midwives, ensures the provision of a minimal package of essential resources in each facility, provides life-saving skills training for essential care providers and strengthens its collaboration with the communities.Item Financing reproductive health services in Africa: The role of aid, insurance, user fees and general taxation(Reproductive Health, Economic Growth and Poverty Reduction in Africa: Frameworks of Analysis, 2010) Enyimayew, N.Financing Reproductive Health Services in Africa: The Role of Aid, Insurance, User fees and General Taxation Nana Enyimayew Without appropriate financial resources, scaling up effective reproductive health interventions in order to achieve the Millennium Development Goal for maternal health (MDG 5)1 will be virtually impossible. Yet little is known about how much is currently being invested in reproductive health services within African countries or whether levels of funding are changing. Estimates place the additional funding requirements to attain universal coverage at a minimum of US$7 billion per year. Other estimates suggest that even greater investments are needed. Irrespective of the precise figure, the conclusion is clear: the financing gap represents a substantial sum in relation to domestic budgets. Adequate, well-managed financing of public health systems in general continues to elude most countries. The difficulty is especially severe in low-income countries, most of which are in Africa, whose health systems struggle with meagre and inequitably distributed resources. Additionally, access to services for the most disadvantaged is usually very poor, further reducing the benefit of already scarce resources for those most in need. Success or otherwise of different health financing strategies is critical in determining the fate of such populations and therefore needs to be documented and presented to inform the development of right policies. Filling the information gaps requires appropriately designed and executed research. At minimum, reproductive health (RH) services may be defined as those activities whose primary purpose is to restore, improve and maintain the health of women and their newborns during pregnancy, childbirth and the seven-day postnatal period. This chapter provides an update of the current knowledge of financing of RH services in Africa and suggests a framework for further research in these areas. It also presents examples of national and regional efforts to adopt and implement financing policies that aim to address national objectives of access, equity, quality and appropriate utilisation of RH services to meet MDG 5 by 2015. Issues of exemptions, subsidies and efficiency are also discussed within the scope of financing RH services. A review of basic services is presented in Table 5.1. Reproductive Health, Economic Growth and Poverty Reduction in Africa 108 Table 5.1: Range of reproductive health services Category of care Interventions Antenatal care Basic antenatal care Management of severe anaemia Treatment of malaria Management of syphilis, gonorrhoea and Chlamydia Normal delivery care Clean and safe delivery Post-partum care Basic newborn care Essential obstetric care Management of eclampsia, sepsis, haemorrhage and abortion complications, plus provision of emergency caesarean section Family planning Family planning information and services Other Prevention and treatment of HIV/AIDS How Much Do Reproductive Health Services Cost? Information from various sources suggests that the per capita cost of providing a package of reproductive health services ranges between US$0.5 and US$6.0 (Weissman et al., 1999; World Bank, 1993). Global costs for reproductive health are estimated at US$7 billion dollars per year till 2015 while analyses done using the methodology of the UN Millennium Project suggest that family planning programmes in Africa alone would increase from US$270 million in 2006 to nearly US$500 million by 2015 (Cleland et al., 2006). A selection of per capita cost estimates is presented in Table 5.2. Table 5.2: Per capita cost estimates for reproductive health services Service Cost (US$) Mother and Baby package (1) 0.5 (current level of service provision) Uganda 1999 1.4–1.8 (standard level of service) WDR Global 1993 (2) 4.0 Making Motherhood Safe (3) 2.0–6.0 Range 0.5–6.0 Sources: (1) Weissman et al. (1999); (2) World Development Report (World Bank, 1993); (3) Ransom and Yinger (2002). Making Motherhood Safer. The wide range of costs reflects the practical difficulty facing service providers, researchers, policy makers and society in general in meeting the requirements for accurate estimates of reproductive health care costs. These include defining the boundaries of RH, and standardising the content and quality of a given package of care. Questions that continue to engage service providers and policy makers are; How much do reproductive health services at household, community and country level Financing Reproductive Health Services in Africa 109 cost? How much must governments and society spend on RH services to achieve national and global targets. What should be the minimum content of a standard package of care if countries in resource-constrained environments are to meet their targets? Global estimates provide a useful guide to...Item Performance of the Okwawuman Mutual Health Insurance Scheme and Impact on the Utilization and Outcome of Maternal Care Services in Ghana(University of Ghana, 2008-09) Gyakobo, M.K.; Gemegah, A.; Enyimayew, N.; Kunfaa, E.; Adei, S.Background: The Okwawuman Mutual Health Insurance Scheme (OMHIS) had been operating since 2002. However, performance reviews have reported mainly on deficits/surpluses, coverage rates and effects on health services utilization. Objective: The study seeks to assess the performance of the scheme with respect to the performance ratios and its impact on the utilization of differential components of health services and also on maternal care outcomes including caesarean section, vacuum extraction, stillbirth and maternal mortality. Method: A cross-sectional and time series study design was used to collect both primary and secondary data through self administered questionnaires, structured interview guides and checklists. Secondary data were collected from the District Health Directorates and the District Hospitals spanning a period of eight years: Four years before and after the introduction of the OMHIS. The financial and membership records of the OMHIS were also studied. Primary data were gathered through a cross-sectional community survey, hospital exit interviews and key informant interviews. Logistic regression was employed for the test of associations. Results: The overall combined ratio of the OMHIS for the period under review was <1.0 making it a viable scheme. Health services utilization was generally increased against a declining length of stay which was influenced by complications of caesarean section and vacuum extraction (p= 0.000) rather than mode of payment. Drug availability was 95.29% and the prescription of generic (rINN) or proprietary drugs was not influenced by insurance status (P rINN = 0.777; P Proprietary = 0.213). The mean annual caesarean section rate was high, 21-22% and that for vacuum extraction was low, 0.95- 1.35%. There was a mean annual excess caesarean section of 151 cases. Caesarean section and vacuum extraction were not significantly affected by health insurance [OR C/S = 0.337, 95% CI= 0.025-4.493 (Vs. Uninsured); OR V/E = 2.970, 95% CI= 0.223- 39.627 (Vs. Uninsured)]. Insurance impacted significantly on stillbirth (OR= 3.223, 95% CI= 1.527-6.800). Among the medical determinants of stillbirth, low birth weight (<2.5kg) had the strongest impact (OR= 89.979, 95% CI= 12.002-674.564). Stillbirth was more affected by per capita ANC attendance than supervised delivery. Insurance did not impact significantly on maternal mortality [OR= 1.587, 95% CI= 0.325-7.761 (Vs. Insured)] but rather medical determinants; with complications of labour having the strongest impact (OR= 30.320, 95% CI= 9.748-94.309). Supervised delivery played a more pivotal role in influencing maternal mortality than per capita ANC attendance. Conclusion: The Okwawuman Mutual Health Insurance Scheme was viable with government subvention. The scheme caused an increased utilization of the health services but did not influence length of stay in hospital and prescription pattern. The scheme also significantly impacted on stillbirth but was not significantly associated with maternal mortality, caesarean section and vacuum extraction.Item Service Utilization at the Kintampo Health Centre: Implication for Policy Formulation(University of Ghana, 1996) Blay, D.; Enyimayew, N.; Senah, K.; University of Ghana,College of Health Sciences,School of Public HealthService Utilization at the Kintampo Health Centre: Implication for Policy Formulation. From the early 1980s utilization at outpatient services at government health facilities declined considerably, of which the Kintampo Health Centre was a typical example. The main focus of this study was therefore, to find out the factors that influence utilization at the Kintampo Health Centre. The study was descriptive. Questionnaire and available routinely collected data from health institutions were used. Sampling was purposive and adults above 19 years were interviewed. The findings show that, the following factors influence utilization of services: - Proximity - Presence of competent doctor - Availability of drugs - Facilities such as operating theatre - Cost - Attitude of health providers and - Clean environment The result of the study imply that, the demand for health care in rural health centres, such as the one at Kintampo, can be significantly increased if, technically competent and courteous personnel such as medical doctors, with facilities to work with in a very clean environment are available.