Browsing by Author "Janssens, W."
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Item Comparison of perceived and technical healthcare quality in primary health facilities: Implications for a sustainable National Health Insurance Scheme in Ghana(Public Library of Science, 2015) Alhassan, R.K.; Duku, S.O.; Janssens, W.; Nketiah-Amponsah, E.; Spieker, N.; Van Ostenberg, P.; Arhinful, D.K.; Pradhan, M.; Rinke De Wit, T.F.Background: Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurancesustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. Purpose: To examine the differences in perceptions of clients and health staff on quality healthcareand determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. Methods: This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. AWilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used toascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Results: Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to qualityimprovement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone willnot necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. Conclusion: There is the need to intensify client education and balanced commitment to technical andperceived quality improvement efforts. This will help enhance client confidence in Ghana's healthcare system, stimulate active participation in the national health insurance, increasehealthcare utilization and ultimately improve public health outcomes.Item The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment(Health Economics, 2022) Duku, S.K.O.; Nketiah-Amponsah, E.; Fenenga, C.J.; Janssens, W.; Pradhan, M.Abstract Health insurance enrollment in many Sub-Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study assesses the impact of a community engagement intervention designed to improve the quality of healthcare and health insurance services on households living nearby the facilities. Although the intervention improved the medical-technical quality of health services, our results show that households' subjective perceptions of the quality of healthcare and insurance services did not increase. Nevertheless, the likelihood of illness and concomitant healthcare utilization reduced, and especially households who were not insured at baseline were more likely to enroll in health insurance. The results show that solely increasing the technical quality of care is not sufficient to increase households' subjective assessments of healthcare quality. Still, improving technical quality can directly contribute to health outcomes and further increase health insurance coverage, especially among the previously uninsured.Item Genetic analysis of HIV type 2 from Ghana and Guinea-Bissau, West Africa(AIDS Research and Human Retroviruses, 2001-12) Ishikawa, K.; Janssens, W.; Banor, J.S.; Shinno, T.; Piedade, J.; Sata, T.; Ampofo, W.K.; Brandful, J.A.M.; Koyanagi, Y.; Yamamoto, N.; Canas-Ferreira, W.F.; Adu-Sarkodie, Y.; Kurata, T.The phylogenetic variability of part of the long terminal repeat (LTR) region of HIV-2 strains isolated in 1995 from five individuals residing in Bissau, the capital city of Guinea-Bissau, and collected from seven persons from Kumasi, Ghana in 1996-1997, was analyzed. All Guinean samples and all but one Ghanaian sample clustered with HIV-2 subtype A. One Ghanaian sample (14%) was classified as HIV-2 subtype B. This study adds to previous reports on HIV-2 subtype distribution in West Africa indicating local prevalence of HIV-2 subtype B in Ivory Coast and neighboring Ghana. © 2001 Mary Ann Liebert, Inc.Item Perceptions of healthcare quality in Ghana: Does health insurance status matter?(PLoS ONE, 2018-01) Duku, S.K.O.; Nketiah-Amponsah, E.; Janssens, W.; Pradhan, M.This study’s objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare for both the insured and uninsured. © 2018 Duku et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.