Ama Pokuaa Fenny

Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?

BackgroundMalaria is Ghanas most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to promote access to health services to mitigate the negative impact of the user fee regime. Ten years on, national coverage is less than 40% of the total population and patients continue to make direct payments for health services. This paper analyses the care-seeking behaviour of households for treatment of malaria in Ghana under the NHI policy.MethodUsing a cross-sectional survey of household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah, a multinomial logit model is estimated. The sample consists of 365 adults and children reporting being ill with malaria in the last four weeks prior to the study.ResultsOut of the total, 58% were insured and 71% of them sought care from a formal health facility. Among the insured, 15% chose informal care compared to 48% among the uninsured. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. The results show that the insured are 6 times more likely to choose regional/district hospitals: 5 times more likely to choose health centres/clinics and 7 times more likely to choose private hospitals/clinics over informal care when compared with the uninsured. Individual characteristics such as age, education and wealth status were significant determinants of health care provider choice for specific categories of health facilities.ConclusionOverall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria.

Patient Satisfaction with Primary Health Care - A Comparison between the Insured and Non-Insured under the National Health Insurance Policy in Ghana

Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care. This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients’ satisfaction and examines their links to their health insurance status. The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients’ perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies.

Treatment-Seeking Behaviour and Social Health Insurance in Africa: The Case of Ghana Under the National Health Insurance Scheme

Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah. Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries.

Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients

IntroductionThe National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients.MethodA structured questionnaire was used to collect data from 523 respondents diagnosed with malaria and prescribed malaria drugs from public and private health facilities in 3 districts across Ghana’s three ecological zones. Collected information included initial examinations performed on patients (temperature, weight, age, blood pressure and pulse); observations of malaria symptoms by trained staff, laboratory tests conducted and type of drugs prescribed. Insurance status of patients, age, gender, education level and occupation were asked in the interviews.ResultsOf the 523 patients interviewed, only 40 (8%) were uninsured. Routine recording of the patients’ age, weight, and temperature was high in all the facilities. In general, assessments needed to identify suspected malaria were low in all the facilities with hot body/fever and headache ranking the highest and convulsion ranking the lowest. Parasitological assessments in all the facilities were also very low. All patients interviewed were prescribed ACTs which is in adherence to the drug of choice for malaria treatment in Ghana. However, there were no significant differences in the quality of malaria treatment given to the uninsured and insured patients.ConclusionAdherence to the standard protocol of malaria treatment is low. This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in the country. The results show that about 16 percent of total sample were parasitologically tested. Effective management of the disease demands proper diagnosis and treatment and therefore facilities need to be adequately supplied with RDTs or be equipped with well functioning laboratories to provide adequate testing.

Live to 70 Years and Older or Suffer in Silence: Understanding Health Insurance Status Among the Elderly Under the NHIS in Ghana

ABSTRACT Ghana has introduced a National Health Insurance Scheme (NHIS). Embedded in the NHIS is a policy to exempt poor and vulnerable groups from premiums and user fees. There has been some debate as to why the start-off age for exemption among the elderly is 70 years. Ghana has a shorter life expectancy than middle- and high-income countries and its current age of retirement is 60 years. This study explores the financial and social implications of continuing to charge premiums to people aged 60 to 69 years. Based on the analysis of data from a representative household survey, it is recommended that the exemption policy should be expanded to include all vulnerable elderly persons, regardless of age.

Determinants of enrollment in the NHIS for women in Ghana

Background The National Health Insurance Scheme (NHIS) was introduced in 2005 to provide equitable access to healthcare. Furthermore, concessions were made for pregnant women, yet inequities in access continue to exist. This study explores whether dimensions of social exclusion explain why some groups of women are not benefitting from the scheme. Methods Data was collected from 4050 representative households in five districts. Logistic regression is used to examine the factors that determine enrolment of women under the NHIS. Results The study sample consists of a sub-sample of 3,173 women out of whom 58% were insured. The majority (64.9%) of the women were in the reproductive age (15-45 years). The results show that wealth status, age, health status, locality, perception about the quality of care at health facilities and perception of the NHIS, are the key factors that determine enrolment into the scheme. Conclusion With women dominating the informal sector of Ghana’s economy which is often characterised by relatively low incomes, these inequities in access need to be addressed.

The health-related impacts and costs of violence against women and girls on survivors, households and communities in Ghana

Past research on violence in Ghana primarily discusses domestic violence and some types of sexual violence, but lacks a comprehensive analysis of violence against women and girls (VAWG) and its wider costs and impacts. Our study on the social costs of VAWG is a unique contribution, which aims to fill that gap. Through indepth interviews (IDIs) and focus group discussions (FGDs) with adult women and men, we explored the health impact of VAWG and the resulting social and economic consequences on survivors, their families and their communities. The research, which took place in the Eastern, Central, and Greater Accra regions of Ghana, points to several physical and mental health outcomes among survivors including physical injuries and disability, as well as impacts on mental health such as anxiety and suicidal ideation. Many VAWG survivors also experience stigma and social isolation. Our findings also reveal that survivors’ families can bear various social and economic costs. Lack of public and private service provision and shelters for survivors heighten these impacts. Without institutional support for survivors, families and communities absorb these costs of VAWG.

The health MDGs in Ghana: lessons and implications for the implementation of the sustainable development goals

PurposeThe Millennium Development Goals (MDGs), an initiative by the United Nations, consisted of eight broad goals, which were envisaged to improve the living conditions of the world’s populations. In spite of the momentum and investments made to achieve the MDGs, significant challenges still exist at the global and national levels. In Ghana, the attainment of some MDGs was uneven across the goals and within the country. This paper critically reviews the implementation of the health MDGs in Ghana: specifically, MDG 4, MDG 5 and MDG 6. The study focuses on drawing key lessons from the national implementation strategies and institutional reforms adopted by Ghana towards achieving these health MDG targets.MethodsThe study uses content analysis of policy documents in selected programmatic interventions which have been deemed influential in reaching the health MDGs in Ghana.ResultsIn brief, the results indicate that 73% of the 37 MDG indicators for Ghana were either achieved or could show significant progress. Ghana did not achieve MDG 4 and MDG 5 due to the slow progress it made in improving child and maternal health. The study indicates that key investments need to be made in the health sector, especially in the areas of access to good quality care, to narrow gaps in access and financing.ConclusionsReducing maternal and child mortality in Ghana will require transforming the sectors that drive development, such as energy, agriculture and transportation. It is expected that the lessons learnt will enhance evidence-based policy-making towards achieving the SDGs in Ghana.