Browsing by Author "Sanborn, C."
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Item Facilities and resources for diabetes care at regional health facilities in southern Ghana(Diabetes Research and Clinical Practice, 1998-11) Amoah, A.G.; Owusu, S.K.; Saunders, J.T.; Fang, W.L.; Asare, H.A.; Pastors, J.G.; Sanborn, C.; Barrett, E.J.; Woode, M.K.A.; Osei, K.In the fall of 1995, each of the five provincial hospitals in southern Ghana was visited and facilities and resources for diabetes care assessed. In addition, health facilities and standards of care questionnaires were completed. Only Korle Bu Teaching Hospital run a diabetes clinic and had diabetologists. Only two facilities had an eye specialist or trained dietician. None of the five facilities had a trained diabetes educator or chiropodist. Except for sphygmomanometers, basic equipment for clinical care were lacking. Basic biochemistry tests were available at all facilities. Creatinine clearance and 24-h urine protein, glycated haemoglobin, fasting triglyceride, total cholesterol and HDL cholesterol were available at only one centre. None of the facilities measured C-peptide, islet cell antibody and urine microalbumin. None of the facilities had chronic haemodialysis service. Insulin supply was erratic at two institutions. Three regions had active diabetes associations. The facilities and system of diabetes care in southern Ghana revealed in this study are far from satisfactory. Training of health care personnel in diabetes management and education may enhance diabetes care despite the existing constraints. Furthermore, the development of international and regional gradelines for facilities and resources may facilitate implementation of international resolutions and clinical practice guidelines.Item A national diabetes care and education programme: the Ghana model(Diabetes Research and Clinical Practice, 2000-08) Amoah, A.G.; Owusu, S.K.; Acheampong, J.W.; Agyenim-Boateng, K.; Asare, H.R.; Owusu, A.A.; Mensah-Poku, M.F.; Adamu, F.C.; Amegashie, R.A.; Saunders, J.T.; Fang, W.L.; Pastors, J.G.; Sanborn, C.; Barrett, E.J.; Woode, M.K.An account is given of how a national diabetes care and education programme was developed in Ghana, a developing country, through international collaboration of medical schools, industry and government health care institutions. The approach is by way of trained diabetes teams consisting of physicians, dietitians and nurse educators at two tertiary institutional levels (teaching hospitals) who in turn trained teams consisting of physicians, dietitians or diettherapy nurses, nurse educators and pharmacists at regional and district/sub-regional levels to offer care and education to patients and the community. In three years all regional and about 63% of sub- regional/district health facilities had trained diabetes health care teams, run diabetes services and had diabetes registers at these institutions. Additionally a set of guidelines for diabetes care and education was produced. All programme objectives with the exception of one (deployment of diabetes kits) were met. Distances to be travelled by persons with diabetes to receive diabetes care had been reduced considerably. The success of the project has given an impetus to the collaborators to extend the programme to the primary health care level. The continuing prohibitive prices of diabetes medications and supplies however, could be addressed by removing taxes on such supplies. The Ghana diabetes care model, a 'top-down' approach, initially involving two diabetes centres is recommended to other developing countries, which intend to incorporate diabetes care and education into their health care system.Item Political settlements and the governance of extractive industry: A comparative analysis of the longue durée in Africa and Latin America(2017) Bebbington, A.; Abdulai, A.G.; Hinfelaar, M.; Humphreys Bebbington, D.; Sanborn, C.This paper synthesises findings from research in Bolivia, Ghana, Peru and Zambia to address the following three questions: 1) How does the nature of political settlements affect the governance of the mining and hydrocarbon sectors and the relationships between those sectors and patterns of social inclusion and exclusion? 2) How do the circulation of ideas and the materiality of the resources in question affect this relationship? 3) What is the role of transnational ideational, institutional and political economic factors in these relationships? These questions are approached by considering the relationships between political settlements and extractive industry since the late 19th century, with special emphasis on the last three decades. The paper concludes that the nature of settlements has had important implications for the relationships between resource-dependent economies and the nature and degree of social inclusion, but far less effect on productive structure, with no political settlement having particular success in fostering economic diversification or reducing the weight of resource rents within the national economy. The paper also concludes that the very nature of the extractive economy influences the dynamics of national political settlements for the following reasons. First, the potential rents that resource extraction makes possible, and the high cost of engaging in mining or hydrocarbon industries, create incentives for particular forms of political exclusion. Second, colonial and post-colonial histories of resource extraction give political valence to ideas that have helped mobilise actors in ways that change relations of power and institutional arrangements. Third, the materiality of subsoil resources has direct implications for subnational forms of holding power that can influence resource access and control. Finally, the global nature of mineral and hydrocarbon economies, combined with the materiality of resources, bring both transnational and local political actors into the constitution of national political settlements. This makes for a particularly complex politics of scale surrounding settlements in resource-dependent economies.