Browsing by Author "Tabong, P.T."
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Item Capacity building through comprehensive implementation research training and mentorship: an approach for translating knowledge into practice(Springer Nature, 2023) Asampong, E.; Kamau, E.M; Tabong, P.T.; et al.Abstract Background Implementation research (IR) is increasingly gaining popularity as the act of carrying an intention into effect. It is thus an important approach to addressing individual practices, policies, programmes and other technologies to solving public health problems. Low- and middle-income countries (LMICs) continue to experience public health problems which could be addressed using implementation research. These countries however fall behind prioritizing implementation research due to the disorganized approach used to providing knowledge about the value and scope of implementation research. This paper seeks to explain steps taken to resolve this by capacity strengthening activities through a comprehensive implementation research training and mentorship programme which was informed by needs assessment. Methods The roll-out of the comprehensive implementation research training and mentorship was done in phases, including engaging the implementation research community through TDR Global, competency building for programme officers and ethical review board/committee members, and practical guidance to develop an implementation research proposal. The Bloom taxonomy guided the training whilst the Kirkpatrick Model was used for the evaluation of the effectiveness of the capacity building. Results The findings identified critical areas of mentors and how mentorship should be structured and the most effective ways of delivering mentorship. These findings were used to develop a mentorship guide in IR. The mentorship guidance is to be used as a check-tool for mentoring participants during trainings as part of the package of resources in implementation research. It is also to be used in equipping review board members with knowledge on ethical issues in implementation research. Conclusion The approach for providing comprehensive implementation research training and mentorship for programme personnel has provided an opportunity for both potential mentors and mentees to make inputsItem Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders(PLOS, 2021) Aikins, M.; Tabong, P.T.; Salari, P.; Tediosi, F.; Asenso-Boadi, F.M.; Akweongo, P.The National Health Insurance Scheme (NHIS) was introduced in 2003 to reduce “out-of-pocket” payments for health care in Ghana. Over a decade of its implementation, issues about the financial sustainability of this pro-poor policy remains a crippling fact despite its critical role to go towards Universal Health Coverage. We therefore conducted this study to elicit stakeholders’ views on ways to improve the financial sustainability of the operations of NHIS. Twenty (20) stakeholders were identified from Ministry of Health, Ghana Health Services, health workers groups, private medical practitioners, civil society organizations and developmental partners. They were interviewed using an interview guide developed from a NHIS policy review and analysis. All interviews were recorded and transcribed verbatim. The data were analysed thematically with the aid of NVivo 12 softwares Stakeholders admitted that the NHIS is currently unable to meet its financial obligations. The stakeholders suggested first the adoption of capitation as a provider payment mechanism to minimize the risk of providers’ fraud and protection from political interference. Sec ondly, they indicated that rapid releases of specific statutory deductions and taxes for NHIS providers could reduce delays in claims’ reimbursement which is one of the main challenges faced by healthcare providers. Aligning the NHIS with the Community-based Health Planning and Services and including preventive and promotive health is necessary to position the Scheme for Universal Health Coverage.Conclusion The Scheme will potentially achieve UHC if protected from political interference to improve the governance and transparency that affects the finances of the scheme and the expansion of services to include preventive and promotive services and cancers.Item Reasons for the utilization of the services of traditional birth attendants during childbirth: A qualitative study in Northern Ghana(SAGE, 2021) Tabong, P.T.; Kyilleh, J.M.; Amoah, W.W.Background: Skilled delivery reduces maternal and neonatal mortality. Ghana has put in place measures to reduce geographical and financial access to skilled delivery. Despite this, about 30% of deliveries still occur either at home or are conducted by traditional birth attendants. We, therefore, conducted this study to explore the reasons for the utilization of the services of traditional birth attendants despite the availability of health facilities. Method: Using a phenomenology study design, we selected 31 women who delivered at facilities of four traditional birth attendants in the Northern region of Ghana. Purposive sampling was used to recruit only women who were resident at a place with a health facility for an in-depth interview. The interviews were recorded and transcribed into Microsoft word document. The transcripts were imported into NVivo 12 for thematic analyses. Results: The study found that quality of care was the main driver for traditional birth attendant delivery services. Poor attitude of midwives, maltreatment, and fear of caesarean section were barriers to skilled delivery. Community norms dictate that womanhood is linked to vaginal delivery and women who deliver through caesarean section do not receive the same level of respect. Traditional birth attendants were believed to be more experienced and understand the psychosocial needs of women during childbirth, unlike younger midwives. Furthermore, the inability of women to procure all items required for delivery at biomedical facilities emerged as push factors for traditional birth attendant delivery services. Preference for squatting position during childbirth and social support provided to mothers by traditional birth attendants are also an essential consideration for the use of their services. Conclusion: The study concludes that health managers should go beyond reducing financial and geographical access to improving quality of care and the birth experience of women. These are necessary to complement the efforts at increasing the availability of health facilities and free delivery services.Item Socio-Cultural and Health System Factors Affecting Tuberculosis Case Detection and Treatment in the Upper West Region of Ghana(University of Ghana, 2017-07) Tabong, P.T.Background: Since the year 2005, Ghana has been implementing the new Stop TB strategy in all health facilities nationwide. This new strategy aims at increasing case detection rate (CDR) to 70% by 2010 and beyond. However, the Upper West Region (UWR) of Ghana could only increase case detection to 37% in 2010 and to 42.1% in 2014. This study therefore assesses the socio-cultural and health systems factors responsible for low case detection and prompt treatment. Methodology: This descriptive study employed a mixed method (quantitative and qualitative). The quantitative study adopted multi-stage sampling technique to select six hundred (606) respondents, ≥ 18 years from four randomly selected sub-districts across four districts in the region for a community survey. With regards to the qualitative study, purposive sampling technique was used to sample 15 people with tuberculosis, seven treatment supporters (for TB patients who had treatment supporters), 24 stakeholders; health workers at district hospitals, district health directorates, sub-district level, and traditional healers for in-depth interviews. In addition, eight focus group discussions (N=72) were conducted, stratified by gender and type of residence. The quantitative data was analyzed using STATA 13. Univariable, bivariable and multivariable logistic analysis were conducted with p-value of <0.05 considered as significant. The qualitative data were recorded digitally, transcribed verbatim and analyzed using thematic content analysis with the aid of NVivo 11 software. Data triangulation strategy was used to present both the quantitative and qualitative findings of the study. Results: The study revealed that TB locally referred to as korongkpong and kusibine can be caused by cough during sex, a curse or bewitchment. These beliefs had a profound influence on the health seeking behaviour for TB. The cultural connotations for the causes of TB made people with the condition to first seek health care from spiritualists and traditional healers. This affected case detection and prompt treatment. The study further found that females were 3.9 times more likely (aOR=3.93, 95% CI=1.1745, 3.1789) to use biomedical health facility than males for productive cough. People belonging to the least poor households were 3.7 (aOR=3.79, 95% CI=0.3392, 0.8127) times more likely to use biomedical health facilities with productive cough though people in the poorest socio-economic status are more vulnerable to TB. The study reported that there was low level of knowledge about TB in the study area. This low knowledge was further worsened by the various misconceptions about the disease in the community and low TB related promotion activities. The study further found that health workers were not routinely screening for TB among patients that report with cough. Of the 132 respondents who had reported to a health facility with cough for more than two weeks, only 31 (23.5%) of them were screened for TB with 13 (41.9%) of those screened having the disease. This lack of screening was further undermined by laboratory workers unwillingness to conduct sputum microscopy for TB diagnosis because of inadequate motivation. This resulted in delays in getting test results, a situation that affected patients’ confidence in the health system and encouraged the use of non-orthodox health care outlets and self-medication. Furthermore, the study found low coordination between district health directorate, hospitals and sub-district health facilities with regards to TB related work. This low coordination affected the screening of patients for TB and perception about motivation of staff involved in the clinical care aspect of TB control. Conclusions: Tuberculosis has been given a superstitious label by community members and therefore the treatment they seek is often inappropriate which undermined case detection and treatment. Health workers were not screening people who report at health facilities with productive cough for more than two weeks as required by the DOTS policy. Delays in getting test results and lack of coordination between district health directorates and district hospitals affected early case detection and favoured the use of non-orthodox health care outlets.Item Stakeholders perspective of, and experience with contact tracing for COVID-19 in Ghana: A qualitative study among contact tracers, supervisors, and contacts.(PLOS ONE, 2021) Asiimwe, N.; Tabong, P.T.; Iro, S.A.; Noora, C.L.; Opoku-Mensah, K.; Asampong, E.Ghana confirmed the first two cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) infection on 12th March 2020. Following this, the government introduced routine and enhanced contact tracing to identify, quarantine, and test contacts for COVID-19. This study, therefore, intends to document the experiences of contact tracers, their supervisors, during COVID-19 containment in Ghana. Purposive sampling was used to select twenty-seven (27) participants; sixteen contact tracers, six supervisors, and five contacts of COVID-19 cases for an in-depth interview using a topic guide. These interviews were conducted on a phone or face-to-face basis whilst maintaining physical distancing protocol. All these were recorded and transcribed verbatim. Then, QSR NVivo 12 was used to analyse the data thematically. Contact tracers were selected based on their professional background and surveillance experience with other infectious diseases. They were trained before the first confirmed cases of COVID-19 in the country and before deployment. Deployment of contact tracers was in pairs to monitor contacts daily through physical visits or over the phone. Their activities included educating contacts about the condition, filling the symptoms diary, and providing psychological support. Contacts for COVID-19 were identified through case investigation, and their monitoring is done once a day despite the twice-daily requirement. Wherever a case was confirmed, enhanced contact tracing within a 2km radius was done. Furthermore, it was reported that some contacts were not adhering to the self-quarantine. In addition to this, other challenges included; unstable provision of PPEs and remuneration, refusal of some contact to test, delays in receiving test results, and poor coordination of the whole process. The study concludes that contact tracing was generally perceived to be helpful in COVID-19 containment in Ghana. However, adhering to self-quarantine protocol had many challenges for both contact tracers and the contacts. Improving coordination and quick release of test results to contacts is necessary for COVID-19 containment. Lastly, the supply of Personal Protection Equipment and motivation needs to be addressed to help position the country well for effective contact tracing.Item The role of community-based health planning and services strategy in involving males in the provision of family planning services: a qualitative study in Southern Ghana(2013-07-26) Adongo, P.B.; Tapsoba, P.; Phillips, J.F; Tabong, P.T.; Stone, A.; Kuffour, E.; Esantsi, S.F.; Akweongo, P.Abstract Background Reproductive health and Family Planning (FP) services have been of global concern especially in developing countries where fertility rates are high. Traditionally FP services had always targeted females with little or no attention given to males. To ensure equitable distribution of health services, Ministry of Health (MOH), Ghana adopted the Community-Based Health Planning and Services (CHPS) as a nationwide health policy with the aim of reducing obstacles to physical and geographical access to health care delivery including FP services. However, not much is known about the extent to which this policy has contributed to male involvement in FP services. This qualitative descriptive study was therefore designed to explore male involvement in FP services in communities with well functioning CHPS and those with less or no functioning CHPS structures. The study further solicited views of the community on the health status of children. Methods This was a qualitative descriptive study and adapted the design of an ongoing study to assess the impact of male involvement in FP referred to as the Navrongo experiment in Northern Ghana. Twelve focus group discussions were held with both male and female community members, six in communities with functional CHPS and six for communities with less/no-functional CHPS. In addition, fifty- nine (59) in-depth interviews were held with Community Health Officers (CHOs), Community Health Volunteers (CHVs) and Health Managers at both the districts and regional levels. The interviews and discussions were tape recorded digitally, transcribed and entered into QSR Nvivo 10© for analysis. Results The results revealed a general high perception of an improved health status of children in the last ten years in the communities. These improvements were attributed to immunization of children, exclusive breastfeeding, health education given to mothers on childcare, growth monitoring of children and accessible health care. Despite these achievements in the health of children, participants reported that malnutrition was still rife in the community. The results also revealed that spousal approval was still relevant for women in the use of contraceptives; however, the matrilineal system appears to give more autonomy to women in decision-making. The CHPS strategy was perceived as very helpful with full community participation at all levels of the implementation process. Males were more involved in FP services in communities with functioning CHPS than those without functioning CHPS. Conclusion The CHPS strategy has increased access to FP services but spousal consent was very important in the use of FP services. Involving males in reproductive health issues including FP is important to attain reproductive health targets.