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Item Access to and Use of Information Centres among Scientists at Council for Scientific and Industrial Research – Crops Research Institute, Kumasi, Ghana(2012) Acheampong, L.D.; Dzandu, M.D.The study investigated the access to and use of information centres among scientists at Council for Scientific and Industrial Research, Crops Research Institute (CSIR-CRI), Kumasi, Ghana. The study aimed at ascertaining the level of access to and use of information centres among scientists. The research design for the study was a study case. Questionnaire and interview schedule were used to collect data from 73 scientists and 3 library staff respectively. The study revealed that scientists used information centres but at a minimal rate, accessibility was unlimited. They would however use it more if the centre is well resourced with competent personnel, equipment and current and relevant materials. In addition, scientists use the centre for research purposes and prefer to use journals to other type of materials. The study recommended that scientific information centres should subscribe to current electronic journals, procure modern equipment and also train the staff of the information centres to encourage high patronages of the centres by the scientists. In addition, networking of information centres should be encouraged since no library or information centre can solely cater for the information needs of scientists.Item Access to Healthcare Services Among Children with Cerebral Palsy in the Greater Accra Region(University of Ghana, 2020-10) Andah, N.L.Item Access to reeds and mat making in the lower Volta basin of Ghana(Singapore Journal of Tropical Geography, 2014) Ayivor, J.S.This paper explores the origins of pressures on reeds and sedges used for mat making in the lower Volta basin of Ghana, and their impact on the socially embedded system which dictates access to reed fields. Data for the study were collected through field work employing participatory rural appraisal methods in 18 communities, involving 152 mat weavers. The findings showed that the mat-weaving industry has contributed immensely in providing poor women a means of livelihood but reed marshes in the basin have reduced in recent years due to hydrological changes in the area caused by the damming of the Volta upstream. The decline in the availability of reed is exerting immense pressure on this once freely available resource, thus inducing landlords to impose a price on the rights of entry into marshlands by reed collectors. The imposition of these charges affected the very people that the mat-weaving industry is targeted to help. The study recommends the local and central government to play a more active role and civil society groups to broaden the livelihood base of women living in this region. © 2014 The Author. Singapore Journal of Tropical Geography © 2014 Department of Geography, National University of Singapore and Wiley Publishing Asia Pty Ltd.Item Analysis of factors influencing caterers of the Ghana school feeding programme to purchase rice from local farmers in the Tamale metropolis, tolon-kumbungu and karaga districts(Agris On-line Papers in Economics and Informatics, 2014-06) Shaibu, A.F.; Al-Hassan, R.M.The Ghana School Feeding Programme is the local version of the Home Grown School Feeding. Launched in 2005, the programme has three basic objectives; Poverty Reduction and Food Security, Reducing Hunger and Malnutrition and Boosting Domestic Food production in Ghana. Studies have shown that the programme have had tremendous impact on school enrolment, retention and malnutrition but the same cannot be said about its agricultural portfolio. Indications are that the programme has not succeeded in boosting domestic food production. Over the years no clear procurement procedures relating to the purchase of foodstuff have been followed. Linkage between the Ghana School Feeding Programme and local farmers is a subject matter that is under-researched. This study therefore seeks to assess the factors that influence Ghana School Feeding Programme caterers to buy rice from local farmers in the Tamale metropolis, Tolon-Kumbungu and Karaga districts of the northern of Ghana. The findings will be useful to policy makers and rice farmers in generally especially with regard to agricultural marketing opportunities created by the School Feeding Programme. Analysis of the Ghana School Feeding Programme’s procurement of rice from local farmers was conducted using a probit regression model. The willingness of caterers to buy rice from the local farmer which is a binary choice is the dependent variable and the factors which are hypothesized to influence the decision of the caterer are the independent variables. The results show that majority of caterers buy rice from local millers and the market and very little from local farmers. The factors which had significant influence on the caterers to buy from the local rice farmer include, availability of storage facility, other jobs done by caterers, price of milled rice, easy location of rice farmers and delays in the payment of feeding bursaries. The Ghana School Feeding Programme Secretariat should employ caterers who are unemployed and do not have any other jobs doing. Also the provision of adequate storage facilities in schools and the early disbursement of feeding bursaries to caterers are essential in solving the problem of buying foodstuffs directly from farmers.Item ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: A mixed method study(BioMed Central Ltd., 2016) Ankomah, A.; Ganle, J.K.; Lartey, M.Y.; Kwara, A.; Nortey, P.A.; Okyerefo, M.P.K.; Laar, A.K.Background: Timely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access-related barriers that HIV+ persons linked to care in southern Ghana face. Methods: A mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons. Results: All (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors' advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence to receive ART (5.3%), and long distance to treatment centres (4.9%). Conclusions: The results in this study suggest that efforts to provide and scale-up ART to all HIV+ persons must be accompanied by interventions that address structural and individual level access barriers.Item ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study.(The Open Access Publisher, 2016) Ankomah, A.; Kuumuori Ganle, J.; Lartey, M.A.; Kwara, A.; Nortey, P.A.; Okyerefo, M.P.K.; Laar, A.K.Background Timely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access–related barriers that HIV+ persons linked to care in southern Ghana face. Methods A mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons. Results All (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors’ advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence to receive ART (5.3%), and long distance to treatment centres (4.9%). Conclusions The results in this study suggest that efforts to provide and scale-up ART to all HIV+ persons must be accompanied by interventions that address structural and individual level access barriers.Item Assessing the functionality of an emergency obstetric referral system and continuum of care among public healthcare facilities in a low resource setting: an application of process mapping approach(BMC Health Services Research, 2021) Ofosu, B.; Ofori, D.; Asah-Opoku, K.; Boafor, T.Background: Weak referral systems remain a major concern influencing timely access to the appropriate level of care during obstetric emergencies, particularly for Low-and Middle-Income Countries, including Ghana. It is a serious factor threatening the achievement of the maternal health Sustainable Development Goal. The objective of this study is to establish process details of emergency obstetric referral systems across different levels of public healthcare facilities to deepen understanding of systemic barriers and preliminary solutions in an urban district, using Ablekuma in Accra, Ghana as a case study. Methods: The study is an analytical cross-sectional study. Nine [1] targeted interviews were carried out for a three week period in June and July 2019 after informed written consent with two [2] Obstetrics & Gynaecology consultants, two [2] Residents, one family physician, and four [3] Midwives managing emergency obstetric referral across different levels of facilities. Purposeful sampling technique was used to collect data that included a narration of the referral process, and challenges experienced with each step. Qualitative data was transcribed, coded by topics and thematically analysed. Transcribed narratives were used to draft a process map and analyze the defects within the emergency obstetric referral system. Results: Out of the 34 main activities in the referral process within the facilities, the study identified that 24 (70%) had a range of barriers in relation to communication, transport system, resources (space, equipment and physical structures), staffing (numbers and attitude), Healthcare providers (HCP) knowledge and compliance to referral policy and guideline, and financing for referral. These findings have implication on delay in accessing care. HCP suggested that strengthening communication and coordination, reviewing referral policy, training of all stakeholders and provision of essential resources would be beneficial. Conclusion: Our findings clearly establish that the emergency obstetric referral system between a typical teaching hospital in an urban district of Accra-Ghana and peripheral referral facilities, is functioning far below optimum levels. This suggests that the formulation and implementation of policies should be focused around structural and process improvement interventions, strengthening collaborations, communication and transport along the referral pathway. These suggestions are likely to ensure that women receive timely and quality care.Item Assessing the functionality of an emergency obstetric referral system and continuum of care among public healthcare facilities in a low resource setting: an application of process mapping approach(BMC Health Services Research, 2021) Ofosu, B.; Ofori, D.; Ntumy, M.; Asah-Opoku, K.; Boafor, T.Background: Weak referral systems remain a major concern influencing timely access to the appropriate level of care during obstetric emergencies, particularly for Low-and Middle-Income Countries, including Ghana. It is a serious factor threatening the achievement of the maternal health Sustainable Development Goal. The objective of this study is to establish process details of emergency obstetric referral systems across different levels of public healthcare facilities to deepen understanding of systemic barriers and preliminary solutions in an urban district, using Ablekuma in Accra, Ghana as a case study. Methods: The study is an analytical cross-sectional study. Nine [1] targeted interviews were carried out for a threeweek period in June and July 2019 after informed written consent with two [2] Obstetrics & Gynaecology consultants, two [2] Residents, one family physician, and four [3] Midwives managing emergency obstetric referral across different levels of facilities. Purposeful sampling technique was used to collect data that included a narration of the referral process, and challenges experienced with each step. Qualitative data was transcribed, coded by topics and thematically analysed. Transcribed narratives were used to draft a process map and analyze the defects within the emergency obstetric referral system.Results: Out of the 34 main activities in the referral process within the facilities, the study identified that 24 (70%) had a range of barriers in relation to communication, transport system, resources (space, equipment and physical structures), staffing (numbers and attitude), Healthcare providers (HCP) knowledge and compliance to referral policy and guideline, and financing for referral. These findings have implication on delay in accessing care. HCP suggested that strengthening communication and coordination, reviewing referral policy, training of all stakeholders and provision of essential resources would be beneficial. Conclusion: Our findings clearly establish that the emergency obstetric referral system between a typical teaching hospital in an urban district of Accra-Ghana and peripheral referral facilities, is functioning far below optimum levels. This suggests that the formulation and implementation of policies should be focused around structural and process improvement interventions, strengthening collaborations, communication and transport along the referral pathway. These suggestions are likely to ensure that women receive timely and quality care.Item Assuring health commodity security in resource-poor settings(Elsevier, 2022) Tetteh, E.K.Health planners charged with the task of building or at least maintaining the health of populations within low- and middle-income countries (LMICs) have to find ways of providing steady, predictable supplies of health commodities for unpredictable demands for healthcare and health. To address this issue, this paper emphasizes a focus on aggregate commodity security defined as the continuous interrupted supply of health commodities belonging to all therapeutic categories and not just a selected subset. Given this focus, the paper identifies logistics systems comprising of a set of logistics activities as the machinery for assuring aggregate commodity security. Steady reliable supplies of health commodities, whenever and wherever they are needed, however, means looking beyond logistics systems. Health planners must ask whether there is a healthy supplier base for the commodities needed. The paper notes that a secure supply of health commodities in any LMIC, will remain an illusion without functional logistics systems supported by a healthy supplier base.Item Challenges experienced by clients undergoing assisted reproductive technology in Ghana: An exploratory descriptive study(International Federation of Gynecology and Obstetrics, 2020-04-17) Kyei, J.M.; Manu, A.; Kotoh, A.M.; Meherali, S.; Ankomah, A.Objective: To explore the experiences of clients accessing assisted reproductive technology (ART) services in selected health facilities in Greater Accra, Ghana. Methods: An exploratory, descriptive, qualitative design using a purposive sampling technique was employed. Overall, 12 women and six men participated in the study. In-depth interviews were conducted using a semi-structured interview guide. The Braun and Clarke (2006) procedure for data analysis was followed. Data collection spanned 9 months (January to October 2017). Results: Five major challenges were identified that were commonly experienced by our participants at every phase of the ART treatment, including the high cost of ART treatment, the long distance to treatment centers, drug treatment challenges, disturbances in daily routine and work, and anxiety about pregnancy outcome. Conclusion: Given the emotional and psychological challenges reported by the participants in the present study, an integration of counseling units in the ART centers is recommended, manned by qualified personnel such as clinical psychologists and counselors to support clients at every stage of the treatment. Also, given the high cost of ART services, as reflected in the participants’ views, it is recommended that private health insurance companies fund some aspect of ART services, such as laboratory investigations and medications.Item Characteristics of Women Receiving Emergency Caesarean Section: A Cross‑Sectional Analysis from Ghana and Dominican Republic(Springer, 2021) Adu‑Bonsafoh, K.; Tunçalp, Ӧ.; Castro, A.Background:Significant inequalities still exist between low- and high-income countries regarding access to optimum emergency obstetric care including life-saving emergency caesarean section. These relationships are considerably stronger between population-based caesarean section rates and socio-economic characteristics with poorest households experiencing significant unmet needs persistently. Objective: To explore the characteristics of women receiving emergency C-section using a new, validated definition in Ghana and the Dominican Republic. Materials and Methods: This was a cross-sectional study conducted in Ghana and the Dominican Republic. Multivariable logistic regression analysis was used to determine women’s characteristics associated with emergency C-section. Results: This analysis included 2166 women who had recently delivered via C-section comprising 653 and 1513 participants from Accra and Santo Domingo, DR, respectively. Multivariable analyses showed that women, both in Ghana and the DR, were more likely to have an emergency C-section if they did not have a previous C-Section (adjusted Odds Ratio (aOR): 2.45, 95% CI [1.57–3.81]; and aOR: 15.5, 95% CI [10.5–22.90], respectively) and if they were having their frst childbirth, compared to women with previous childbirth (aOR: 1.77, 95%CI [1.13–2.79]; and aOR: 1.46, 95%CI [1.04–2.04], respectively). Also, preterm birth was associated with significantly decreased likelihood of emergency C-section compared with childbirth occurring at term in both Ghana and the DR (aOR: 0.31, 95%CI [0.20–0.48]; and aOR: 0.43, 95%CI [0.32–0.58], respectively). Among the Ghanaian participants, having an emergency C-section was positively associated with being referred and negatively associated with being older than 35 years of age. Characteristics such as education, religion, marital status, and residence did not differ between women’s emergency versus non-emergency C-section status. Conclusion Emergency C-section was found to be significantly higher in women with no prior C-section or those having their first births but lower in those with preterm birth in both Ghana and the DR. Data from additional countries are needed to confirm the relationship between emergency C-section status and socio-economic and obstetric characteristics, given that the types of interventions required to assure equitable access to potentially life-saving C-section will be determined by how and when access to care is being denied or not available.Item Equity in Access to Immunization Services Among Children in Urban Ga South Municipality(University of Ghana, 2019-07) Amponsem, A.F.Item Four ways geographic information systems can help to enhance health service planning and delivery for infectious diseases in low-income countries(Journal of Health Care for the Poor and Underserved, 2012-11) Brijnath, B.; Ansariadi; de Souza, D.K.Focusing specifically on infectious diseases in low-income countries, this paper discusses four ways Geographic Information Systems (GIS) can facilitate health service planning and delivery: (1) deeper insight into where health care services should be located; (2) improved health surveillance and real-time planning for disease control and population health; (3) stronger accountability and evidence-informed dialogue between funders and the service providers and; (4) greater opportunities to translate complex data into more accessible formats which policymakers can quickly interpret and act on. Taking its use beyond just a research instrument, GIS is a way to undertake multidisciplinary work and improve health service planning and delivery. © Meharry Medical College.Item Gender Differences In Access To, And Use Of, Farmlands: A Case Study Of Abokobi In The Ga East Municipality(University of Ghana, 2015-07) Appiah, J.AAgriculture is the main pillar of Ghana’s development and the majority of food producers are women. However, women and men do not always have equal access to farmlands. Disparities in access and control over agricultural productive resources contribute to a high incidence of poverty especially for women. This study therefore used Abokobi in the Ga-East Municipality as a case to examine the gender difference in access to and use of farmland. The objectives of the study were to examine the gender differences, if any, in farm production characteristics; investigate the constraints women face in accessing farmlands; and to examine the gender differences in the economic wellbeing at the household level. The study employed a snow ball technique to select 150 farmers from Abokobi. Descriptive statistical tools, proportion test, t-test and a logit model were used to present the findings of the study. Contrary to what one might expect, the study found no statistically significant difference in farm production characteristics between men and women. With regards to their economic wellbeing, though men appeared to have higher per capita income and expenditure than females, the differences were not statistically significant. However, men had higher asset index than women. Based on the study, it appears efforts aimed at advocating for women’s right may be yielding some benefits. However, given that women are less empowered economically in terms of asset accumulation, more work needs to be done to remove the economic constraint and thereby further boost equity between men and women.Item Geospatial Distribution of Tuberculosis Cases and Access to Healthcare in Birim South District(University of Ghana, 2021-03) Owusu, K.Item Improving maternal healthcare utilisation in sub‐Saharan Africa through micro‐finance(Emerald Group Publishing Limited, 2011) Abekah-Nkrumah, G.; Abor, P.; Adjasi, C.; Abor, J.Purpose – This paper aims to examine links between women's access to micro‐finance and how they use maternal healthcare services in sub‐Saharan Africa (SSA). Design/methodology/approach – The authors use theoretical and empirical literature to propose a framework to sustain and improve women's access to maternal healthcare services through micro‐financing. Findings – It is found that improved access to micro‐finance by women, combined with education may enhance maternal health service uptake. Research limitations/implications – The paper does not consider empirical data in the analysis. The authors advocate empirically testing the framework proposed in other SSA countries. Social implications – It is important to empower women by facilitating their access to education and micro‐finance. This has implications for improving maternal healthcare utilization in SSA. Originality/value – The paper moves beyond poor access to maternal health services in SSA and proposes a framework for providing sustainable solutions.Item Inequalities in access to education and healthcare(European Journal of Dental Education, 2008-02) Nunn, J.; Freeman, R.; Anderson, E.; Carneiro, L.C.; Carneiro, M.S.A.; Formicola, A.; Frezel, R.et.al.The burden of disease is borne by those who suffer as patients but also by society at large, including health service providers. That burden is felt most severely in parts of the world where there is no infrastructure, or foreseeable prospects of any, to change the status quo without external support. Poverty, disease and inequality pervade all the activities of daily living in low-income regions and are inextricably linked. External interventions may not be the most appropriate way to impact on this positively in all circumstances, but targeted programmes to build social capital, within and by countries, are more likely to be sustainable. By these means, basic oral healthcare, underpinned by the primary healthcare approach, can be delivered to more equitably address needs and demands. Education is fundamental to building knowledge-based economies but is often lacking in such regions even at primary and secondary level. Provision of private education at tertiary level may also introduce its own inequities. Access to distance learning and community-based practice opens opportunities and is more likely to encourage graduates to work in similar areas. Recruitment of faculty from minority groups provides role models for students from similar backgrounds but all faculty staff must be involved in supporting and mentoring students from marginalized groups to ensure their retention. The developed world has to act responsibly in two crucial areas: first, not to exacerbate the shortage of skilled educators and healthcare workers in emerging economies by recruiting their staff; second, they must offer educational opportunities at an economic rate. Governments need to lead on developing initiatives to attract, support and retain a competent workforce. © 2008 Blackwell Munksgaard and The American Dental Education Association.Item Insured clients out-of-pocket payments for health care under the national health insurance scheme in Ghana(BMC Health Services Research, 2021) Akweongo, P.; Aikins, M.; Wyss, K.; Salari, P.; Tediosi, F.Background: In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) designed to promote universal health coverage and equitable access to health care. The scheme has largely been successful, yet it is confronted with many challenges threatening its sustainability. Out-of-pocket payments (OOP) by insured clients is one of such challenges of the scheme. This study sought to examine the types of services OOP charges are made for by insured clients and how much insured clients pay out-of-pocket. Methods: This was a descriptive cross-sectional health facility survey. A total of 2066 respondents were interviewed using structured questionnaires at the point of health care exit in the Ashanti, Northern and Central regions of Ghana. Health facilities of different levels were selected from 3 districts in each of the three regions. Data were collected between April and June 2018. Using Epidata and STATA Version 13.1 data analyses were done using multiple logistic regression and simple descriptive statistics and the results presented as proportions and means. Results: Of all the survey respondents 49.7% reported paying out-of-pocket for out-patient care while 46.9% of the insured clients paid out-of-pocket. Forty-two percent of the insured poorest quintile also paid out-of-pocket. Insured clients paid for consultation (75%) and drugs (63.2%) while 34.9% purchased drugs outside the health facility they visited. The unavailability of drugs (67.9%) and drugs not covered by the NHIS (20.8%) at the health facility led to outof- pocket payments. On average, patients paid GHS33.00 (USD6.6) out-of-pocket. Compared to the Ashanti region, patients living in the Northern region were 74% less at odds to pay out-of-pocket for health care. Conclusion and recommendation: Insured clients of Ghana’s NHIS seeking health care in accredited health facilities make out-of-pocket payments for consultation and drugs that are covered by the scheme. The out-of-pocket payments are largely attributed to unavailability of drugs at the facilities while the consultation fees are charged to meet the administrative costs of services. These charges occur in disadvantaged regions and in all health facilities. The high reliance on out-of-pocket payments can impede Ghana’s progress towards achieving Universal Health Coverage and the Sustainable Development Goal 3, seeking to end poverty and reduce inequalities. In order to build trust and confidence in the NHIS there is the need to eliminate out-of-pocket payments for consultation and medicines by insured clients.Item Perspectives on access to and control over land, livelihood, and agricultural production outcomes in three districts with land investments in Ghana(Merian Institute for Advanced Studies in Africa (MIASA), 2022-09) Boateng, John KwameThe paper explored perspectives about men and women’s access to and control over land, water, energy, and food resources in the Sene West, Denkyembour, and Kwaebibirem districts of Ghana. Much of the literature suggests that while women may have access, they often do not have control over productive resources and that this lack of control is implicated in gender inequalities. The objectives examined perspectives and attitudes to women’s role in the management of land and questions of access to land and other resources, as well as opinions about who has benefited from large-scale land acquisitions. Mixed methods, constrained by the outbreak of the Covid-19 pandemic were employed. Qualitative and quantitative research approaches were used. The quantitative part involved the use of a paper-based questionnaire given to 30 respondents and the qualitative study focused on six items developed in a study guide for six respondents; this was at the peak of the beginning of the Covid-19 pandemic in Ghana when Accra was under lockdown and most of the country was under severe restrictions. The traditional livelihoods of the people, based mainly on food and cash crop farming, agro-processing, and hunting, have suffered several impacts from the land grabs. These include loss of land, declined access to resources such as fuelwood, damaged ecosystems, deforestation, and lack of alternative ways to maintain food security. However, for those community members who found positions as workers in the large-scale investments especially at Kwae, in the Kwaebibirem municipality, the positive effects of the oil palm out-grower scheme have, in general, benefited not only the scheme out-growers but also the members of the communities surrounding the large-scale oil palm investment.Item Testing the efect of an integrated-intervention to promote access to sexual and reproductive healthcare and rights among women with disabilities in Ghana: a quasi-experimental study protocol(Ganle et al. Reprod Health, 2021) Ganle, J.K.; Ofori, C.; Dery, S..Abstract Background: There is evidence that women with disabilities (WWDs) experience the most difficulty accessing and using sexual and reproductive health and rights (SRHRs) services and information worldwide. However, there are cur rently no workable interventions to reach WWDs with essential SRHR services. This study aims to test the efect of an integrated health facility and individual-level intervention on access to SRHRs information and services among sexu ally active WWDs aged 15–49 years in Ghana. Methods: A quasi-experimental study design with four arms will be implemented in four districts in the Northern region of Ghana to test the efect of three inter-related interventions. The inventions are (1) capacity building in disability-centred SRHRs information and service delivery for healthcare providers, (2) support for WWDs to access disability-unfriendly healthcare infrastructure, and (3) one-on-one regular SRHRs education, information provision, and referral. The frst two interventions are at the health-facility level while the third one is at the individual/family level. The frst arm of the experiment will expose eligible WWDs to all three interventions. In the second arm, WWDs will be exposed to only the two-health facility-level interventions. The third arm will expose WWDs to only the individual level intervention. The forth arm will constitute the control group. A total of 680 (170 in each arm) sexually active women with physical disability and visual impairments will take part in the study over a period of 12 months. To assess the efect of the interventions on key study outcomes (i.e. awareness about, and use of modern contraceptive, ANC attendance, and skilled delivery among parous women), pre- and post-intervention surveys will be conducted. Diference-in-Diference analysis will be used to examine the efect of each intervention in comparison to the control group, while controlling for confounders. Cost-efectiveness analyses will also be conducted on the three-intervention arms vis a vis changes in key outcome measures to identify which of the three interventions is likely to yield greater impact with lower costs. Discussion: Lack of access to SRHRs information and services for WWDs is not only a violation of their right to appro priate and quality SRH care but could also undermine eforts to achieve equitable health under SDG 3. This research is expected to generate evidence to inform local health programmes to increase access to SRHRs among WWDs by strengthening local health system capacity to provide disability-sensitive SRHRs services.