Browsing by Author "Novignon, J."
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Item Determinants of modern family planning use among women of reproductive age in the Nkwanta district of Ghana: A case-control study(Reproductive Health, 2014-08) Eliason, S.; Awoonor-Williams, J.K.; Eliason, C.; Novignon, J.; Nonvignon, J.; Aikins, M.Background: Average contraceptive prevalence rate in the Nkwanta district of Ghana was estimated to be 6.2% relative to the national average at the time, of 19%. While several efforts had been made to improve family planning in the country, the district still had very low use of modern family planning methods. This study sought to determine the factors that influenced modern family planning use in general and specifically, the factors that determined the consistently low use of modern family planning methods in the district. Methods: A case-control study was conducted in the Nkwanta district of Ghana to determine socio-economic, socio-cultural and service delivery factors influencing family planning usage. One hundred and thirty cases and 260 controls made up of women aged 15-49 years were interviewed using structured questionnaires. A logistic regression was fitted. Results: Awareness and knowledge of modern family planning methods were high among cases and controls (over 90%). Lack of formal education among women, socio-cultural beliefs and spousal communication were found to influence modern family planning use. Furthermore, favourable opening hours of the facilities and distance to health facilities influenced the use of modern contraceptives. Conclusion: While modern family planning seemed to be common knowledge among these women, actual use of such contraceptives was limited. There is need to improve use of modern family planning methods in the district. In addition to providing health facilities and consolidating close-to-client service initiatives in the district, policies directed towards improving modern family planning method use need to consider the influence of formal education. Promoting basic education, especially among females, will be a crucial step as the district is faced with high levels of school dropout and illiteracy rates. © 2014 Eliason et al.Item Determinants of modern family planning use among women of reproductive age in the Nkwanta district of Ghana: a case¿control study(2014-08-13) Eliason, S.; Awoonor-Williams, J.K.; Eliason, C.; Novignon, J.; Nonvignon, J.; Aikins, M.Abstract Background Average contraceptive prevalence rate in the Nkwanta district of Ghana was estimated to be 6.2% relative to the national average at the time, of 19%. While several efforts had been made to improve family planning in the country, the district still had very low use of modern family planning methods. This study sought to determine the factors that influenced modern family planning use in general and specifically, the factors that determined the consistently low use of modern family planning methods in the district. Methods A case–control study was conducted in the Nkwanta district of Ghana to determine socio-economic, socio-cultural and service delivery factors influencing family planning usage. One hundred and thirty cases and 260 controls made up of women aged 15–49 years were interviewed using structured questionnaires. A logistic regression was fitted. Results Awareness and knowledge of modern family planning methods were high among cases and controls (over 90%). Lack of formal education among women, socio-cultural beliefs and spousal communication were found to influence modern family planning use. Furthermore, favourable opening hours of the facilities and distance to health facilities influenced the use of modern contraceptives. Conclusion While modern family planning seemed to be common knowledge among these women, actual use of such contraceptives was limited. There is need to improve use of modern family planning methods in the district. In addition to providing health facilities and consolidating close-to-client service initiatives in the district, policies directed towards improving modern family planning method use need to consider the influence of formal education. Promoting basic education, especially among females, will be a crucial step as the district is faced with high levels of school dropout and illiteracy rates.Item The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence from panel data analysis.(Health Economics Review, 2012-02-22) Novignon, J.; Olakojo, S.A.; Nonvignon, J.Background: Health care expenditure has been low over the years in developing regions of the world. A majority of countries in these regions, especially sub-Saharan Africa (SSA), rely on donor grants and loans to finance health care. Such expenditures are not only unsustainable but also inadequate considering the enormous health care burden in the region. The objectives of this study are to determine the effect of health care expenditure on population health status and to examine the effect by public and private expenditure sources. Methods: The study used panel data from 1995 to 2010 covering 44 countries in SSA. Fixed and random effects panel data regression models were fitted to determine the effects of health care expenditure on health outcomes. Results: The results show that health care expenditure significantly influences health status through improving life expectancy at birth, reducing death and infant mortality rates. Both public and private health care spending showed strong positive association with health status even though public health care spending had relatively higher impact. Conclusion: The findings imply that health care expenditure remains a crucial component of health status improvement in sub-Saharan African countries. Increasing health care expenditure will be a significant step in achieving the Millennium Development Goals. Further, policy makers need to establish effective public-private partnership in allocating health care expenditures.Item Fiscal Space for Health in Sub-Saharan African Countries: An Efficiency Approach(African Journal of Health Economics, 2011) Novignon, J.; Novignon, J.The study argues that potential savings from efficiency could be effective alternative to increasing health system financing in SSA. Health system efficiency estimates were derived from the Data Envelopment Analysis (DEA) and Stochastic Frontier Analysis (SFA) and used to compute potential gains from efficiency. Data was sourced from the World Bank's world development indicators for 45 SSA countries in 2011. The results reveal that average potential saving in health expenditure from improved efficiency was 8.09% and 2.24% of GDP per capita in the DEA and SFA models, respectively. Countries with relatively higher potential gains from efficiency include Sierra Leone, Liberia, Lesotho and Swaziland. On the other hand, Cape Verde, Eritrea, Madagascar and Mauritius recorded low potential gains from efficiency. The results imply that in the face of significant economic challenges and burden on government budget, improving health expenditure efficiency to create some fiscal space will be an important step.Item Health and vulnerability to poverty in Ghana: evidence from the Ghana Living Standards Survey Round 5(2012-05-06) Novignon, J.; ; Mussa, R.; Chiwaula, L.S.Abstract Background An understanding of the complex relationship between health status and welfare is crucial for critical policy interventions. However, the focus of most policies in developing regions has been on current welfare to the neglect of forward-looking welfare analysis. The absence of adequate research in the area of future poverty or vulnerability to poverty has also contributed to the focus on current welfare. The objectives of this study were to estimate vulnerability to poverty among households in Ghana and examine the relationship between health status and vulnerability to poverty. Method The study used cross section data from the Fifth Round of the Ghana Living Standards Survey (GLSS 5) with a nationally representative sample of 8,687 households from all administrative regions in Ghana. A three-step Feasible Generalized Least Squares (FGLS) estimation procedure was employed to estimate vulnerability to poverty and to model the effect of health status on expected future consumption and variations in future consumption. Vulnerability to poverty estimates were also examined against various household characteristics. Results Using an upper poverty line, the estimates of vulnerability show that about 56% of households in Ghana are vulnerable to poverty in the future and this is higher than the currently observed poverty level of about 29%. Households with ill members were vulnerable to poverty. Moreover, households with poor hygiene conditions were also vulnerable to future poverty. The vulnerability to poverty estimates were, however, sensitive to the poverty line used and varied with household characteristics. Conclusion The results imply that policies directed towards poverty reduction need to take into account the vulnerability of households to future poverty. Also, hygienic conditions and health status of households need not be overlooked in poverty reduction strategies.Item Health status and labour force participation in sub-saharan Africa: A dynamic panel data analysis(African Development Review, 2015-03) Novignon, J.; Arthur, E.; Nonvignon, J.Sub‐Saharan African countries face significant health challenges, with several countries still far from reaching the health‐related targets of the Millennium Development Goals (MDGs). The implication of this on economic growth and individual welfare is daunting. An important channel through which population health affects economic performance is labour supply and productivity. The objective of the study was to investigate a macro level relationship between population health status and labour force participation in sub‐Saharan Africa. The study used panel data covering 46 countries from 1990 to 2011. A dynamic panel data model was estimated using the generalized method of moments. The results show that population health status (measured by life expectancy at birth) relates positively with labour force participation. The relationship was significant for total and female labour force participation. The findings call for improved population health status following the importance of labour force participation at the macro levels. Improved labour force contributes to the economic performance of a country at the macro level. Effective policy efforts should be directed towards providing facilities that will improve population health hence providing enough healthy time to participate in the labour force.Item HIV/AIDS-related stigma and HIV test uptake in Ghana: Evidence from the 2008 demographic and health survey(Etude de la Population Africaine, 2014) Novignon, J.; Novignon, N.; Aryeetey, G.; Nonvignon, J.The study examined the association between HIV test uptake and socioeconomic characteristics of individuals, including HIV-related stigma behaviours. The study also investigated the socioeconomic determinants of HIV-related stigma in Ghana. Cross tabulations and logistic regression techniques were applied to data from the 2008 Ghana Demographic and Health Survey. The results showed significantly low HIV test uptake and some level of HIV-related stigma prevalence in Ghana. Higher wealth status, educational attainment and HIV-related stigma were significant determinants of HIV test uptake. Aside wealth status and education, rural place of residence and religious affiliation were positive and significant determinants of HIV-related stigma. The findings call for comprehensive HIV education including treatment, prevention and care. Legislations to discourage stigma and improve HIV-testing will be critical policy steps in the right direction. © 2014, Union for African Population Studies. All rights reserved.Item Improving primary health care facility performance in Ghana: Efficiency analysis and fiscal space implications(BioMed Central Ltd., 2017) Novignon, J.; Nonvignon, J.Background: Health centers in Ghana play an important role in health care delivery especially in deprived communities. They usually serve as the first line of service and meet basic health care needs. Unfortunately, these facilities are faced with inadequate resources. While health policy makers seek to increase resources committed to primary healthcare, it is important to understand the nature of inefficiencies that exist in these facilities. Therefore, the objectives of this study are threefold; (i) estimate efficiency among primary health facilities (health centers), (ii) examine the potential fiscal space from improved efficiency and (iii) investigate the efficiency disparities in public and private facilities. Methods: Data was from the 2015 Access Bottlenecks, Cost and Equity (ABCE) project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis (SFA) was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities was estimated using the Nopo matching decomposition procedure. Results: Average efficiency score across all health centers included in the sample was estimated to be 0.51. Also, average efficiency was estimated to be about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, we found that, on average, facilities could save about GH 11,450.70 (US$7633.80) if efficiency was improved. We also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. The matching decomposition showed an efficiency gap of 0.29 between private and public facilities. Conclusion: There is need for primary health facility managers to improve productivity via effective and efficient resource use. Efforts to improve efficiency should focus on training health workers and improving facility environment alongside effective monitoring and evaluation exercises.Item The poverty and inequality nexus in Ghana: A decomposition analysis of household expenditure components(International Journal of Social Economics, 2018-02) Novignon, J.; Nonvignon, J.; Mussa, R.Purpose Understanding the linkages between poverty and inequality is vital to any sustainable development and poverty reduction strategies. In Ghana, while poverty has reduced significantly over the years, inequality has increased. The purpose of this paper is to examine the linkages between inequality in household expenditure components and overall inequality and poverty in Ghana. Design/methodology/approach Using microdata from the sixth round of the Ghana Living Standards Survey (GLSS 6) conducted in 2012/2013, marginal effects and elasticities were computed for both within- and between-component analysis. Findings The results suggest that, in general, reducing within-component inequality significantly reduces overall poverty and inequality in Ghana, compared with between-component inequality. Specifically, inequality in education and health expenditure components were the largest contributors to overall poverty and inequality. The findings imply that policies directed toward reducing within-component inequality will be more effective. Specifically, the findings of the study corroborate recent policies on education and health in Ghana aimed at inequality within these components. Sustaining and scaling up these policies will be a step in the right direction. Originality/value The study contributes to existing studies in several ways: first, this study becomes the first attempt to examine inequality-poverty nexus using household expenditure components in Ghana. Second, the use of expenditure in place of income is an addition to the literature. Income is usually subject to reporting biases and is minimal in expenditure. Finally, the findings highlight the need for poverty reduction strategies to focus on specific household components including education and health. Blanket interventions may not be effective in reducing inequality and poverty.Item Socioeconomic status and the prevalence of fever in children under age five: Evidence from four sub-Saharan African countries(2012-07-27) Novignon, J.; Nonvignon, J.Background The burden of fevers remains enormous in sub-Saharan Africa. While several efforts at reducing the burden of fevers have been made at the macro level, the relationship between socioeconomic status and fever prevalence has been inconclusive at the household and individual levels. The purpose of this study was to examine how individual and household socioeconomic status influences the prevalence of fever among children under age five in four sub-Saharan African countries. Methods The study used data from the 2008 Demographic and Health Survey (DHS) from Ghana, Nigeria, Kenya and Sierra Leone with a total of 38,990 children below age five. A multi-level random effects logistic model was fitted to examine the socioeconomic factors that influence the prevalence of fever in the two weeks preceding the survey. Data from the four countries were also combined to estimate this relationship, after country-specific analysis. Results The results show that children from wealthier households reported lower prevalence of fever in Ghana, Nigeria and Kenya. Result from the combined dataset shows that children from wealthier households were less likely to report fever. In general, vaccination against fever-related diseases and the use of improved toilet facility reduces fever prevalence. The use of bed nets by children and mothers did not show consistent relationship across the countries. Conclusion Poverty does not only influence prevalence of fever at the macro level as shown in other studies but also the individual and household levels. Policies directed towards preventing childhood fevers should take a close account of issues of poverty alleviation. There is also the need to ensure that prevention and treatment mechanisms directed towards fever related diseases (such as malaria, pneumonia, measles, diarrhoea, polio, tuberculosis etc.) are accessible and effectively used.Item Socioeconomic-related inequalities in child malnutrition: evidence from the Ghana multiple indicator cluster survey(Health Econ Rev., 2015-11) Novignon, J.; Aboagye, E.; Agyemang, O.S.; Aryeetey, G.Background Malnutrition is a prevalent public health concern in Ghana. While studies have identified factors that influence child malnutrition and related inequalities in Ghana, very little efforts have been made to decompose these inequalities across various household characteristics. This study examined the influence of socioeconomic factors on inequality in child malnutrition using a decomposition approach. Go to: Methods The study employed cross section data from the 2011 Multiple Indicator Cluster Survey (MICS). Analysis was done at three levels: First, concentration curves were constructed to explore the nature of inequality in child malnutrition. Secondly, concentration indices were computed to quantify the magnitude of inequality. Thirdly, decomposition analysis was conducted to determine the role of mother’s education and health insurance coverage in inequality of child malnutrition. Go to: Results The concentration curves showed that there exists a pro-poor inequality in child malnutrition measured by stunting and wasting. The concentration indices of these measures indicated that the magnitude of inequality was higher and significant at 1 % for weight-for-age (WAZ) (−0.1641), relative to height-for-age (HAZ) (−0.1613). The decomposition analyses show that whilst mother’s education contributed about 13 and 11 % to inequality in HAZ, it contributed about 18.9 and 11.8 % to inequality in WAZ for primary and secondary or above education attainments, respectively. Finally, health insurance contributed about 1.91 and 1.03 % to inequality in HAZ and WAZ, respectively. Go to: Conclusion The results suggest that there is the need to encourage critical policies directed towards improving female literacy in the country. The existence of a functional health insurance system and increasing universal coverage are recommended to mitigate child malnutrition.Item The use of non-prescription medicine versus self assessed health: evidence from Malaw(International Archives of Medicine, 2011) Novignon, J.; Mussa, R.; Msonda, T.; Nonvignon, J.Background: The use of medicine is an important part of any health care process and the improvement of health status of any population. While some medicines are legitimately prescribed by practitioners, others take drugs not prescribed by practitioners when they suffer from illness or injuries. The effect of such actions on the health of individuals cannot be overlooked. Even though majority of health policies in developing countries have focused on chronic diseases and the functioning of health systems, abuse of drugs or medicines is a serious population health problem that deserves equal attention. The objectives of the current study are to examine the social and economic dimensions of the use of non-prescription medicines and to determine the effect it has on self-assessed health of individuals. Methods: The study employs data from the second Integrated Household Survey of Malawi with a sample of 2506 individuals who reported an incidence of illness or injury over the past two weeks before the survey. Regression analysis is conducted at two levels, first is a probit model to identify socio-economic factors that influence the use of non-prescription medicine. The second step uses an ordered probit to model the effect of the use of non prescription medicines on self-assessed health of individuals. Results: Results from the probit model show that availability of a health facility in the community negatively affects the use of non-prescription medicines. Age of the individual and the total household health expenditure relate to higher use of non-prescription medicine. Results from the ordered probit model shows that individuals who used non-prescription medicines were likely to report lower categories of self-assessed health. Conclusions: While policy makers need to engage in public campaign to educate the population on the health risks posed by the use of non-prescription medicines, attention also has to be paid to the social and economic characteristics of the population. Efforts to provide health facilities in communities where they do not exist and improve existing ones will be a crucial step in reducing the use of non-prescription medicinesItem The use of non-prescription medicine versus self-assessed health: evidence from Malawi(International Archives of Medicine, 2011) Novignon, J.; Mussa, R.; Msonda, T.; Nonvignon, J.Background: The use of medicine is an important part of any health care process and the improvement of health status of any population. While some medicines are legitimately prescribed by practitioners, others take drugs not prescribed by practitioners when they suffer from illness or injuries. The effect of such actions on the health of individuals cannot be overlooked. Even though majority of health policies in developing countries have focused on chronic diseases and the functioning of health systems, abuse of drugs or medicines is a serious population health problem that deserves equal attention. The objectives of the current study are to examine the social and economic dimensions of the use of non-prescription medicines and to determine the effect it has on self-assessed health of individuals. Methods: The study employs data from the second Integrated Household Survey of Malawi with a sample of 2506 individuals who reported an incidence of illness or injury over the past two weeks before the survey. Regression analysis is conducted at two levels, first is a probit model to identify socio-economic factors that influence the use of non-prescription medicine. The second step uses an ordered probit to model the effect of the use of non prescription medicines on self-assessed health of individuals. Results: Results from the probit model show that availability of a health facility in the community negatively affects the use of non-prescription medicines. Age of the individual and the total household health expenditure relate to higher use of non-prescription medicine. Results from the ordered probit model shows that individuals who used non-prescription medicines were likely to report lower categories of self-assessed health. Conclusions: While policy makers need to engage in public campaign to educate the population on the health risks posed by the use of non-prescription medicines, attention also has to be paid to the social and economic characteristics of the population. Efforts to provide health facilities in communities where they do not exist and improve existing ones will be a crucial step in reducing the use of non-prescription medicines.