Research Articles
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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community
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Item Does health insurance mitigate the economic impact of negative health outcomes? Evidence from Ghana’s National Health Insurance Scheme(Journal of Social and Economic Development, 2023) Novignon, J.; Nonvignon, J.; Arthur, E.; et al.In many developing countries, financial risk protection for health is under-developed and negative health outcomes can be impoverishing. In this study, we sought to investigate the impact of negative health outcomes on household welfare and the role of public health insurance to mitigate this impact. We used data from the seventh round of the Ghana Living Standards Survey (GLSS). To address the potentially non-random nature of the health insurance scheme, the Lewbel instrumental variable estimation technique was used. The results suggest that more days of illness lead to fewer hours of labour supply and this result was statistically significant across all specifications. We found evidence of a heterogeneous impact of negative health outcomes through health insurance coverage on hours of labour supply for the full sample. We also find that for rural dwellers and informal sector workers, days of illness reduced labour supply, while the impact was relatively less with health insurance coverage. The findings call for policies that focus on reforming the NHIS to ensure effectiveness and achieve its primary objectives of removing financial barriers to health care in Ghana.Item Making Development Assistance Work For Africa: From Aid-Dependent Disease Control To The New Public Health Order(Health Policy and Planning, 2023) Nonvignon, J.; Soucat, A.; Ofori-Adu, P.; Adeyi, O.The Coronavirus disease (COVID-19) pandemic has revealed the fragility of pre-crisis African health systems, in which too little was invested over the past decades. Yet, development assistance for health (DAH) more than doubled between 2000 and 2020, raising questions about the role of and effectiveness of DAH in triggering and sustaining health system investments. This paper analyses the inter-regional variations and trends of DAH in Africa in relation to some key indicators of health system financing and service delivery performance, examining (1) the trends of DAH in the five regional economic communities of Africa since 2000; (2) the relationship between DAH spending and health system performance indicators, and (3) the quantitative and qualitative dimensions of aid substitution for domestic financing, policy-making, and accountability. Africa is diverse, and the health financing picture has evolved differently in its subregions. DAH represents 10% of total spending in Africa in 2020, but DAH has benefited Southern Africa significantly more than other regions over the past two decades. Results in terms of progress towards universal Health coverage (UHC) is slightly associated with DAH. Overall, DAH may also have substituted for public domestic funding and undermined the formation of sustainable UHC financing models. As the COVID-19 crisis hit, DAH did not increase at the country level. We conclude that the The current architecture of official development assistance (ODA) is no longer fit for purpose. It requires urgent transformation to place countries at the centre of its use. Domestic financing of public health institutions should be at the core of African social contracts. We call for a deliberate reassessment of ODA modalities, repurposing DAH on what it could sustainably finance. Finally, we call for a new, transparent framework to monitor DAH to capture its contribution to building institutions and systems.Item Economic evaluations of non-communicable diseases conducted in Sub-Saharan Africa: a critical review of data sources(Cost Effectiveness and Resource Allocation, 2023) Hollingworth, S.A.; Leaupepe, G-A.; Nonvignon, J.; et al.Background Policymakers in sub-Saharan Africa (SSA) face challenging decisions regarding the allocation of health resources. Economic evaluations can help decision makers to determine which health interventions should be funded and or included in their benefits package. A major problem is whether the evaluations incorporated data from sources that are reliable and relevant to the country of interest. We aimed to review the quality of the data sources used in all published economic evaluations for cardiovascular disease and diabetes in SSA. Methods We systematically searched selected databases for all published economic evaluations for CVD and diabetes in SSA. We modified a hierarchy of data sources and used a reference case to measure the adherence to reporting and methodological characteristics, and descriptively analysed author statements. Results From 7,297 articles retrieved from the search, we selected 35 for study inclusion. Most were modelled evaluations and almost all focused on pharmacological interventions. The studies adhered to the reporting standards but were less adherent to the methodological standards. The quality of data sources varied. The quality level of evidence in the data domains of resource use and costs were generally considered of high quality, with studies often sourcing information from reliable databases within the same jurisdiction. The authors of most studies referred to data sources in the discussion section of the publications highlighting the challenges of obtaining good quality and locally relevant data. Conclusions The data sources in some domains are considered high quality but there remains a need to make substantial improvements in the methodological adherence and overall quality of data sources to provide evidence that is sufficiently robust to support decision making in SSA within the context of UHC and health benefits plans. Many SSA governments will need to strengthen and build their capacity to conduct economic evaluations of interventions and health technology assessment for improved priority setting. This capacity building includes enhancing local infrastructures for routine data production and management. If many of the policy makers are using economic evaluations to guide resource allocation, it is imperative that the evidence used is of the feasibly highest quality.Item The Role of the Private Sector in the COVID-19 Pandemic: Experiences From Four Health Systems(Frontiers in Public Health, 2022) Wallace, L.J.; AgyepongI., I.; Nonvignon, J.; et al.As societies urbanize, their populations have become increasingly dependent on the private sector for essential services. The way the private sector responds to health emergencies such as the COVID-19 pandemic can determine the health and economic wellbeing of urban populations, an effect amplified for poorer communities. Here we present a qualitative document analysis of media reports and policy documents in four low resource settings-Bangladesh, Ghana, Nepal, Nigeria-between January and September 2020. The review focuses on two questions: (i) Who are the private sector actors who have engaged in the COVID-19 first wave response and what was their role?; and (ii) How have national and sub-national governments engaged in, and with, the private sector response and what have been the effects of these engagements? Three main roles of the private sector were identified in the review. (1) Providing resources to support the public health response. (2) Mitigating the financial impact of the pandemic on individuals and businesses. (3) Adjustment of services delivered by the private sector, within and beyond the health sector, to respond to pandemic-related business challenges and opportunities. The findings suggest that a combination of public-private partnerships, contracting, and regulation have been used by governments to influence private sector involvement. Government strategies to engage the private sector developed quickly, reflecting the importance of private services to populations. However, implementation of regulatory responses, especially in the health sector, has often been weak reflecting the difficulty governments have in ensuring affordable, quality private services. Lessons for future pandemics and other health emergencies include the need to ensure that essential non-pandemic health services in the government and non-government sector can continue despite elevated risks, surge capacity to minimize shortages of vital public health supplies is available, and plans are in place to ensure private workplaces remain safe and livelihoods protected.Item COVID-19 Vaccination in Lower-Middle Income Countries: National Stakeholder Views on Challenges, Barriers, and Potential Solutions(Frontiers in Public Health, 2021) Tagoe, E.T.; Sheikh, N.; Nonvignon, J.; et al.The development of COVID-19 vaccines does not imply the end of the global pandemic as now countries have to purchase enough COVID-19 vaccine doses and work towards their successful rollout. Vaccination across the world has progressed slowly in all, but a few high-income countries (HICs) as governments learn how to vaccinate their entire populations amidst a pandemic. Most low- and middle-income countries (LMICs) have been relying on the COVID-19 Vaccines Global Access (COVAX) Facility to obtain vaccines. COVAX aims to provide these countries with enough doses to vaccinate 20% of their populations. LMICs will likely encounter additional barriers and challenges rolling out vaccines compared HICs despite their significant experience from the Expanded Programme on Immunisation (EPI). This study explores potential barriers that will arise during the COVID-19 vaccine rollout in lower-middle-income countries and how to overcome them. We conducted sixteen semi-structured interviews with national-level stakeholders from Ghana and Bangladesh (eight in each country). Stakeholders included policymakers and immunisation programme experts. Data were analysed using a Framework Analysis technique. Stakeholders believed their country could use existing EPI structures for the COVID-19 vaccine rollout despite existing challenges with the EPI and despite its focus on childhood immunisation rather than vaccinating the entire population over a short period of time. Stakeholders suggested increasing confidence in the vaccine through community influencers and by utilising local government accredited institutions such as the Drug Authorities for vaccine approval. Additional strategies they discussed included training more health providers and recruiting volunteers to increase vaccination speed, expanding government budgets for COVID-19 vaccine purchase and delivery, and exploring other financing opportunities to address in-country vaccine shortages. Stakeholders also believed that LMICs may encounter challenges complying with priority lists. Our findings suggest that COVID-19 vaccination is different from previous vaccination programs, and therefore, policymakers have to expand the EPI structure and also take a systematic and collaborative approach to plan and effectively rollout the vaccinesItem Economic Analysis of Health Inequality Among the Elderly in Ghana(Journal of Population Ageing, 2020) Fonta, C.L.; Nonvignon, J.; Aikins, M.; Nonvignon, J.; Aryeetey, G.C.In Ghana, the ageing population is growing at a fast pace amidst challenging socioeconomic environment. As such, the health of elderly persons in Ghana is of emerging concern and of high priority to the Government. In this study, we seek to measure health inequality among elderly persons in Ghana to determine its existence and explore the factors driving it. Data for the study were drawn from the World Health Organization (WHO)‘s Study on Global Ageing and Adult Health (SAGE Wave 1) and analyzed using STATA and a Distributive Analysis Stata Package (DASP) installed in STATA. Health inequality was measured using concentration curves and concentration index (CI). Furthermore, a regression-based approach was used to determine factors associated with health inequality and their estimated contributions to health inequality. The CI for poor SRH was −0.059 indicating greatest poor health among the poor. The highest contributors to health inequality were presence of at least a chronic condition (63.4%), followed by the age group 70 years and above (26.6%), being single (13.9%), poor (3.9%) and uneducated (0.3%). The probability of reporting poor health was higher with increasing age (Coeff = 0.27, p < 0.05), having at least a chronic condition (Coeff = 0.34, p < 0.05), being single (Coeff = 0.14, p < 0.05) and being poor (Coeff = 0.17, p < 0.05). The results show that health inequality exists among the elderly in Ghana and that poor health was greatest among the poor. Socioeconomic, demographic and health related factors are associated with health inequality.Item Strengths, disconnects and lessons in local and central governance of the response to the first wave of COVID-19 in Ghana(Ghana Medical Journal, 2022) Wallac, L.J.; Afun, N.E.E.; Nonvignon, J.; et al.Objectives: To explore governance, coordination and implementation actors, structures and processes, facilitators, and barriers within local government and between central and local government in Ghana’s COVID-19 response dur ing the first wave of the outbreak. Design: Cross-sectional single case study. Data collection involved a desk review of media, policy and administrative documents and key informant in-depth interviews. Setting: Two municipalities in the Greater Accra region of Ghana Participants: Local government decentralised decision makers and officials of decentralised departments. Interventions: None. Main Outcome Measures: None Results: Coordination between the national and local government involved the provision of directives, guidelines, training, and resources. Most of the emergency response structures at the municipal level were functional except for some Public Health Emergency Management Committees. Inadequate resources challenged all aspects of the re sponse. Coordination between local government and district health directorates in risk communication was poor. Dur ing the distribution of relief items, a biased selection process and a lack of a bottom-up approach in planning and implementation were common and undermined the ability to target the most vulnerable beneficiaries. Conclusions: Adequate financing and equipping of frontline health facilities and workers for surveillance, laboratory and case management activities, transparent criteria to ensure effective targeting and monitoring of the distribution of relief items, and a stronger bottom-up approach to the planning and implementation of interventions need to be given high priority in any response to health security threats such as COVID-19.Item Health systems, population and patient challenges for achieving universal health coverage for hypertension in Ghana(Health Policy and Planning, 2021) Koduah, A.; Nonvignon, J.; Colson, A.; et al.Ghana has signed on to the United Nations Sustainable Development Goal to achieve universal health coverage (UHC), ensuring that all individu als receive the health care they require without financial hardship. Achieving that goal is a difficult task in any setting. The challenges are further exacerbated by a changing disease landscape, as the burden of non-communicable diseases (NCDs) is increasing and creating a dual burden along with infectious diseases. This study explores the existing health system for delivering hypertension care and the challenges of delivering UHC for hypertension in Ghana. Document analysis of national health reports, policies and legislations along with a review of research articles was conducted to explore the challenges of delivering UHC for NCDs in Ghana, and hypertension in particular. The main themes and indicators related to the challenges of delivering UHC for hypertension were mapped and analysed. The main challenges to delivering UHC for hypertension can be grouped into population and patient, on the one hand, and health system factors, on the other. Population and patient factors include (1) unhealthy lifestyles overburdening the health system, (2) poor health-seeking behaviour and (3) poor adherence to medication, which has led to uncontrolled cases and poor clinical outcomes even among treated patients with hypertension. Health system factors include (1) inadequate health system capacity for early diagnosis due to an increasing number of patients, (2) inequitable distribution of health care facilities affecting access, (3) finan cial sustainability of the National Health Insurance Scheme and delays in reimbursement of claims to facilities that affect the health system’s ability to provide timely management of hypertension and (4) health care facilities and practitioners’ use of non-standardized and uncalibrated blood pres sure measuring equipment. Ghana therefore will need to make important decisions to overcome operational and financial challenges on its path to UHC.Item Characterization of functional disability among older adults in Ghana: A multi-level analysis of the study on global ageing and adult health (SAGE) Wave II(PLOS ONE, 2022) Darkwah, K.A.; Iddi, S.; Nonvignon, J.; Aikins, M.Background Functional disability is a common public health problem that affects the health and quality of life of older adults. This causes them to be highly dependent on other members of their fam ily, receive home care, or to be institutionalized. Although functional disability has been widely studied in developed country settings, very limited studies have focused on age related functional disability in sub-Saharan Africa, and in particular Ghana. The purpose of this study is to assess various factors associated with the difficulties in performing basic and instrumental activities of daily living among older adults in Ghana. Methods This cross-sectional study used data on 1610 older adults aged 50 years and above from the Study on Global Ageing and Adult Health (SAGE) survey Wave II conducted in Ghana. Nine standard functioning difficulty tools of WHODAS II was used for the analysis. The WHODAS II offers continuous summary scores with higher scores showing higher disability, and vice versa. A multi-level regression model was used to identify individual and household level risk factors linked to the functional disability of older adults. Results Female older adults (53.7%) reported having functional disability. The mean functional dis ability among older adults aged 50 years and above was 5.2 (± 5.9). Results indicated that older adults who are females, aged 70 years and above, and had three or more chronic con ditions had a higher functional disability. Also, older adults who have adequate fruit intake and belong to wealthier households were found to have a lower functional disability. Conclusions The study reveals that functional disability among older adults is frequent in Ghana and is associated with having three or more chronic conditions and being overweight/obese. Pre vention of functional disability in old age in Ghana is therefore a matter of great social and economic concern, which calls for coordinate efforts across the board to mitigate this public health challengeItem Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana(PLOS ONE, 2020) Boima, V.; Agyabeng, K.; Nonvignon, J.; et al.Background Kidney transplantation is the preferred treatment for patients with end stage renal disease. However, it is largely unavailable in many sub-Sahara African countries including Ghana. In Ghana, treatment for end stage renal disease including transplantation, is usually financed out-of-pocket. As efforts continue to be made to expand the kidney transplantation pro gramme in Ghana, it remains unclear whether patients with Chronic Kidney Disease (CKD) would be willing to pay for a kidney transplant. Aim The aim of the study was to assess CKD patients’ willingness to pay for kidney transplanta tion as a treatment option for end stage renal disease in Ghana. Methods A facility based cross-sectional study conducted at the Renal Outpatient clinic and Dialysis Unit of Korle-Bu Teaching Hospital among 342 CKD patients 18 years and above including those receiving haemodialysis. A consecutive sampling approach was used to recruit patients. Structured questionnaires were administered to obtain information on demo graphic, socio-economic, knowledge about transplant, perception of transplantation and willingness to pay for transplant. In addition, the INSPIRIT questionnaire was used to assess patients’ level of religiosity and spirituality. Contingent valuation method (CVM) method was used to assess willingness to pay (WTP) for kidney transplantation. Logistic regression model was used to determine the significant predictors of WTP. Results The average age of respondents was 50.2 ± 17.1 years with most (56.7% (194/342) being male. Overall, 90 out of the 342 study participants (26.3%, 95%CI: 21.7–31.3%) were willing to pay for a kidney transplant at the current going price ( $ 17,550) or more. The median amount partici pants were willing to pay below the current price was $986 (IQR: $197 –$1972). Among those willing to accept (67.3%, 230/342), 29.1% (67/230) were willing to pay for kidney transplant at the prevailing price. Wealth quintile, social support in terms of number of family friends one could talk to about personal issues and number of family members one can call on for help were the only factors identified to be significantly predictive of willingness to pay (p-value < 0.05). Conclusion The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. Patients with higher socio-economic status and those with more family members one can call on for help were more likely to pay for kid ney transplantation. The study’s findings give policy makers an understanding of CKD patients circumstances regarding affordability of the medical management of CKD including kidney transplantation. This can help develop pricing models to attain an ideal poise between a cost effective but sustainable kidney transplant programme and improve patient access to this ultimate treatment option.