Browsing by Author "Sheff, M.C."
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Item A comparative qualitative study of misconceptions associated with contraceptive use in southern and northern Ghana(Frontiers in Public Health, 2014-09) Adongo, P.B.; Tabong, P.T.-N.; Azongo, T.B.; Phillips, J.F.; Sheff, M.C.; Stone, A.E.; Tapsoba, P.Evidence from Ghana consistently shows that unmet need for contraception is pervasive with many possible causes, yet howthese may differ by cultural zone remains poorly understood. This qualitative study was designed to elicit information on the nature and form of misconceptions associated with contraceptive use among northern and southern Ghanaians. Twenty-two focus group discussions (FGDs) with married community members were carried out. Community health officers, community health volunteers, and health care managers were also interviewed using a semi-structured interview guide. FGDs and in-depth interviews were recorded digitally, transcribed verbatim, and analyzed using QSR Nvivo 10 to compare contraceptive misconceptions in northern and southern Ghana. Results indicate that misconceptions associated with the use of contraceptives were widespread but similar in both settings. Contraceptives were perceived to predispose women to both primary and secondary infertility, uterine fibroids, and cancers. As regular menstrual flow was believed to prevent uterine fibroids, contraceptive use-related amenorrhea was thought to render acceptors vulnerable to uterine fibroids as well as cervical and breast cancers. Contraceptive acceptors were stigmatized and ridiculed as promiscuous. Among northern respondents, condom usewas generally perceived to inhibit erection and therefore capable of inducing male impotence, while in southern Ghana, condom use was believed to reduce sensation and sexual gratification.The study indicates that misconceptions associated with contraceptive use are widespread in both regions. Moreover, despite profound social and contextual differences that distinguish northern and southern Ghanaians, prevailing fears and misconceptions are shared by respondents from both settings. Findings attest to the need for improved communication to provide accurate information for dispelling these misconceptions. © 2014 Adongo, Tabong , Azongo, Phillips, Sheff, Stone and Tapsoba.Item Does the provision of community health services offset the effects of poverty and low maternal educational attainment on childhood mortality? An analysis of the equity effect of the Navrongo experiment in Northern Ghana(SSM - Population Health, 2019-04) Bawah, A.A.; Phillips, J.F.; Asuming, P.O.; Jackson, E.F.; Walega, P.; Kanmiki, E.W.; Sheff, M.C.; Oduro, A.The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. CHPS was derived from a plausibility trial of the Navrongo Health Research Centre testing four contrasting primary health care strategies: i) Training unpaid volunteers to promote health in communities, ii) placing nurses in communities with training and supplies for treating childhood illnesses, iii) combining the nurse and volunteer approaches, and iv) sustaining a comparison condition whereby clinic services were provided without community resident workers. This paper presents an age-conditional proportional hazard analysis of the long term impact of community health worker exposure among 94,599 children who were ever under age five over the January 1, 1995 to December 2010 period, adjusting for age conditional effects of shifts in exposure type as CHPS was scaled up in Navrongo project area over the 1995–2000 period. Results show that children whose parents are uneducated and relatively poor experience significantly higher mortality risks than children of the educated and less poor. Conditional hazard regression models assess the impact of CHPS on health equity by estimating the interaction of equity indicators with household exposure to CHPS service operations, adjusting for age conditional exposure to original Community Health and Family Planning Project (CHFP) service strategies as scale-up progressed. The association of mortality risk among children with uneducated and relatively impoverished mothers is offset by exposure to community health nursing services. If exposure is limited to volunteer-provided services alone, survival benefits arise only among children of relatively advantaged households. Findings lend support to policies that promote the CHPS nurse approach to community-based services as a core health component of poverty reduction programs.Item Evaluating health service coverage in Ghana’s Volta Region using a modified Tanahashi model(Global Health Action, 2020-03-16) Bawah, A.A.; Sheff, M.C.; Asuming, P.O.; Kyei, P.; Kushitor, M.; Phillips, J.F.; Kachur, S.P.Background: The United Nations 2030 Sustainable Development Goals have reaffirmed the international community’s commitment to maternal, newborn, and child health, with further investments in achieving quality essential service coverage and financial protection for all. Objective: Using a modified version of the 1978 Tanahashi model as an analytical framework for measuring and assessing health service coverage, this paper aims to examine the system of care at the community level in Ghana’s Volta Region to highlight the continued reforms needed to achieve Universal Health Coverage. Methods: The Tanahashi model evaluates health system coverage through five key measures that reflect different stages along the service provision continuum: availability of services; accessibility; initial contact with the health system; continued utilization; and quality coverage. Data from cross-sectional household and health facility surveys were used in this study. Immunization and antenatal care services were selected as tracer interventions to serve as proxies to assess systems bottlenecks. Results: Financial access and quality coverage were identified as the biggest bottlenecks for both tracer indicators. Financial accessibility, measured by enrollment in Ghana’s National Health Insurance Scheme was poor with 16.94% presenting valid membership cards. Childhood immunization was high but dropped modestly from 93.8% at initial contact to 76.7% quality coverage. For antenatal care, estimates ranged from 65.9% at initial visit to 25.1% quality coverage. Conclusion: Results highlight the difficulty in achieving high levels of quality service coverage and the large variations that exist within services provided at the primary care level. While vertical investments have been prioritized to benefit specific health services, a comprehensive systems approach to primary health care needs to be further strengthened to reach Ghana’s Universal Health Coverage objectives.Item Measuring Health Systems Strength and Its Impact: Experiences from the African Health Initiative(BMC Health Services Research, 2017-12) Sherr, K.; Fernandes, Q.; Kanté, A.M.; Bawah, A.; Condo, J.; Mutale, W.; Hingora, A.; Mboya, D.; Exavery, A.; Tani, K.; Manzi, F.; Pemba, S.; Phillips, J.; Kante, A.M.; Ramsey, K.; Baynes, C.; Awoonor-Williams, J.K.; Nimako, B.A.; Kanlisi, N.; Jackson, E.F.; Sheff, M.C.; Kyei, P.; Asuming, P.O.; Biney, A.,; Chilengi, R.; Ayles, H.; Mwanza, M.; Chirwa, C.; Stringer, J.; Mulenga, M.; Musatwe, D.; Chisala, M.; Lemba, M.; Drobac, P.; Rwabukwisi, F.C.; Hirschhorn, L.R.; Binagwaho, A.; Gupta, N.; Nkikabahizi, F.; Manzi, A.; Farmer, D.B.; Hedt-Gauthier, B.; Cuembelo, F.; Michel, C.; Gimbel, S.; Wagenaar, B.; Henley, C.; Kariaganis, M.; Manuel, J.L.; Napua, M.; Pio, A.Background: Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Methods: Using the World Health Organization's health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership's leadership team were asked to list - in rank order - the importance of the six building blocks in relation to their intervention. Results: Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and health financing, were the building blocks reported to be of lower focus. Conclusion: The African Health Initiative experience furthers the science of evaluation for health systems strengthening, highlighting areas for further methodological development - including the development of valid, feasible measures sensitive to interventions in multiple contexts (particularly in leadership and governance) and describing interactions across building blocks; in developing summary statistics to facilitate testing intervention effects on health systems and associations with health status; and designing appropriate analytic models for complex, multi-level open health systems.Item Research Capacity Building Integrated into PHIT Projects: Leveraging Research and Research Funding to Build National Capacity(BMC Health Services Research, 2017-12) Hedt-Gauthier, B.L.; Chilengi, R.; Jackson, E.; Michel, C.; Napua, M.; Odhiambo, J.; Bawah, A.; Hingora, A.; Mboya, D.; Exavery, A.; Tani, K.; Manzi, F.; Pemba, S.; Phillips, J.; Kante, A.M.; Ramsey, K.; Baynes, C.; Awoonor-Williams, J.K.; Nimako, B.A.; Kanlisi, N.; Jackson, E.F.; Sheff, M.C.; Kyei, P.; Asuming, P.O.; Biney, A.; Ayles, H.; Mwanza, M.; Chirwa, C.; Stringer, J.; Mulenga, M.; Musatwe, D.; Chisala, M.; Lemba, M.; Mutale, W.; Drobac, P.; Cyamatare Rwabukwisi, F.; Hirschhorn, L.R.; Binagwaho, A.; Gupta, N.; Nkikabahizi, F.; Manzi, A.; Condo, J.; Farmer, D.B.; Sherr, K.; Cuembelo, F.; Michel, C.; Gimbel, S.; Wagenaar, B.; Henley, C.; Kariaganis, M.; Manuel, J.L.; Pio, A.ackground: Inadequate research capacity impedes the development of evidence-based health programming in sub-Saharan Africa. However, funding for research capacity building (RCB) is often insufficient and restricted, limiting institutions' ability to address current RCB needs. The Doris Duke Charitable Foundation's African Health Initiative (AHI) funded Population Health Implementation and Training (PHIT) partnership projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania and Zambia) to implement health systems strengthening initiatives inclusive of RCB. Methods: Using Cooke's framework for RCB, RCB activity leaders from each country reported on RCB priorities, activities, program metrics, ongoing challenges and solutions. These were synthesized by the authorship team, identifying common challenges and lessons learned. Results: For most countries, each of the RCB domains from Cooke's framework was a high priority. In about half of the countries, domain specific activities happened prior to PHIT. During PHIT, specific RCB activities varied across countries. However, all five countries used AHI funding to improve research administrative support and infrastructure, implement research trainings and support mentorship activities and research dissemination. While outcomes data were not systematically collected, countries reported holding 54 research trainings, forming 56 mentor-mentee relationships, training 201 individuals and awarding 22 PhD and Masters-level scholarships. Over the 5 years, 116 manuscripts were developed. Of the 59 manuscripts published in peer-reviewed journals, 29 had national first authors and 18 had national senior authors. Trainees participated in 99 conferences and projects held 37 forums with policy makers to facilitate research translation into policy. Conclusion: All five PHIT projects strongly reported an increase in RCB activities and commended the Doris Duke Charitable Foundation for prioritizing RCB, funding RCB at adequate levels and time frames and for allowing flexibility in funding so that each project could implement activities according to their trainees' needs. As a result, many common challenges for RCB, such as adequate resources and local and international institutional support, were not identified as major challenges for these projects. Overall recommendations are for funders to provide adequate and flexible funding for RCB activities and for institutions to offer a spectrum of RCB activities to enable continued growth, provide adequate mentorship for trainees and systematically monitor RCB activities.Item What do you do with success? the science of scaling up a health systems strengthening intervention in Ghana(BioMed Central Ltd., 2018) Phillips, J.F.; Awoonor-Williams, J.K.; Bawah, A.A.; Nimako, B.A.; Kanlisi, N.S.; Sheff, M.C.; Asuming, P.O.; Kyei, P.E.; Biney, A.; Jackson, E.F.Background: The completion of an implementation research project typically signals the end of research. In contrast, the Ghana Health Service has embraced a continuous process of evidence-based programming, wherein each research episode is followed by action and a new program of research that monitors and guides the utilization of lessons learned. This paper reviews the objectives and design of the most recent phase in this process, known as a National Program for Strengthening the Implementation of the Community-based Health Planning and Services (CHPS) Initiative in Ghana (CHPS+). Methods: A mixed method evaluation strategy has been launched involving: i) baseline and endline randomized sample surveys with 247 clusters dispersed in 14 districts of the Northern and Volta Regions to assess the difference in difference effect of stepped wedge differential cluster exposure to CHPS+ activities on childhood survival, ii) a monitoring system to assess the association of changes in service system readiness with CHPS+ interventions, and iii) a program of qualitative systems appraisal to gauge stakeholder perceptions of systems problems, reactions to interventions, and perceptions of change. Integrated survey and monitoring data will permit multi-level longitudinal models of impact; longitudinal QSA data will provide data on the implementation process. Discussion: A process of exchanges, team interaction, and catalytic financing has accelerated the expansion of community-based primary health care in Ghana's Upper East Region (UER). Using two Northern and two Volta Region districts, the UER systems learning concept will be transferred to counterpart districts where a program of team-based peer training will be instituted. A mixed method research system will be used to assess the impact of this transfer of innovation in collaboration with national and regional program management. This arrangement will generate embedded science that optimizes prospects that results will contribute to national CHPS reform policies and action. © 2018 The Author(s).