Gordon Abekah-Nkrumah

The socio‐economic determinants of maternal health care utilization in Ghana

Purpose – The study aims to examine the socio‐economic determinants of maternal health services utilization in Ghana.Design/methodology/approach – Probit and ordered probit models are employed in this study.Findings – The results generally indicate that most women in Ghana undertake the required visits for antenatal services and also take both doses of the tetanus toxoid vaccine as required by World Health Organization. However, the results show low levels of usage in terms of the other maternal health care services (i.e. prenatal care, delivery at a health facility, and postnatal care). There is clearly an urgent need to develop innovative strategies that will help upscale intervention especially for improvement in the use of these services by women in Ghana. The regression results reveal that utilization of maternal health services and intensity of use of antenatal services are influenced by age of mother, type of birth, education of mother, ethnicity, economic status, geographic location, residence, an...

An examination of hospital governance in Ghana

– The purpose of this paper is to examine the nature of governance structures in Ghanaian hospitals by comparing the governance systems in public and private hospitals., – This study employs a comparative case methodology. It compares the governance structures in private hospitals to that of public hospitals in Ghana to ascertain whether they exhibit different or similar governance systems. The results obtained are analyzed and discussed to ascertain the extent to which the governance structures in these hospitals conform to Taylors principles of good governance., – The results of the study revealed numerous differences in the governance structures in private and public hospitals in Ghana. From the review of Taylors principles of good governance and the comparative case analysis, it was observed that some of the principles are not present in the current hospital governance systems., – The findings of this paper have important implications for proper governance and management of the Ghanaian health institutions.

Predictors of satisfaction with child birth services in public hospitals in Ghana

PURPOSE The purpose of this paper is to examine the association between experiences during childbirth and satisfaction with childbirth services. DESIGN/METHODOLOGY/APPROACH A cross-sectional analytical approach using a structured questionnaire and exit interviews was employed to gather data from 885 women who delivered vaginally in two public hospitals. Data were analysed by generating frequencies and chi-square which was used in running a binary logistic regression using a stepwise backward elimination approach. FINDINGS With a response rate of 78.75 percent the key predictor variables of satisfaction with care were: friendliness of staff (OR = 15.12, p = 0.00); the amount of information provided on the condition and treatment of women (OR = 9.3857, p = 0.007); the feeling of being treated with respect (OR = 3.5581, p = 0.023); and the provision of information about channels of complaint about care (OR = 50.0839, p = 0.000). It is therefore recommended that steps be instituted to improve client-/health worker interpersonal relationships, to improve the amount and quality of information provided to clients, and also to establish formal structures for complaint management in hospitals. RESEARCH LIMITATIONS/IMPLICATIONS The study sampled only women with vaginal deliveries, considering the fact that women with caesarean deliveries have different experiences. Thus views of those with caesarean deliveries are excluded. ORIGINALITY/VALUE Several studies have been conducted in Ghana on issues of health service satisfaction and quality, but this is about the first, critically looking at satisfaction with child birth services in Ghana.

Socioeconomic determinants of use of reproductive health services in Ghana

BackgroundThe study examines trends in the consumption of reproductive health services (use of modern contraceptives, health facility deliveries, assisted deliveries, first trimester antenatal visit and 4+ antenatal visits) and their determinants using four rounds of Ghana Demographic and Health Surveys (1993, 1998, 2003 and 2008) data.MethodsThe study uses cross-sectional and pooled probit and negative bionomial regressions models to estimate the determinants of use of the above listed reproductive health services for the period from 1993 to 2008.ResultsSummary statistics suggest that the above-listed reproductive health services have consistently improved from 1993 to 2008. However, use of traditional methods of contraception increased in urban centers between 2003 and 2008, although the reverse was the case in rural areas. Regression results suggest that place of residence, access to and availability of health services, religion, and birth order are significant correlates of use of reproductive health services. Additionally, the study suggests that the number of living children has the largest effect on use of modern contraception. The effect of a partner’s education on use of modern contraception is higher than that of the woman, and a much stronger correlation exists between household wealth and use of reproductive health inputs than expected.ConclusionThe study associates the increasing use of traditional contraceptives in urban centers and the much stronger effect of household wealth with urban poverty and the increasing indirect cost of health services, and argues for interventions to improve quality of service in public facilities and reduce inequities in the distribution of health facilities. Finally, the study advocates for family planning-related interventions that involve and target partners given the importance of partner education in the use of modern contraception.

ICTs and maternal healthcare utilization. Evidence from Ghana

Purpose – Traditionally, the role of technology on health services has been argued from the supply side. The purpose of this paper is to use a demand side perspective to examine the effect of Information and Communication Technologies (ICTs) on the use of maternal health services in Ghana. Design/methodology/approach – Study used data from the 2008 Ghana Demographic and Health Surveys and binary response regression models to examine the effect of womens access to ICTs on maternal healthcare utilization in Ghana. Three variables on maternal healthcare utilization were employed: use of contraception, antenatal care and place of delivery. Findings – Results from the study show that the effect of the use of technology is both positive and significant. In particular, among the other ICTs (i.e. landline phone, listening to radio, watch television, color television in household, computer in household), the coefficients of mobile phone ownership tends to be consistently significant across all four reproductive h...

Exploring the link between organisational justice and job satisfaction and performance in Ghanaian hospitals: Do demographic factors play a mediating role?

Purpose – The purpose of this paper is to examine whether organisational justice (distributive justice, procedural justice and interactional justice) predicts job satisfaction and performance of health professionals and whether the demographic characteristics of hospital employees mediate the relationship between workplace justice and job satisfaction and performance. Design/methodology/approach – Questionnaires were administered to a sample of 300 respondents in seven hospitals using convenient sampling. Hypotheses were tested using multiple and hierarchical regression models. Findings – The paper established that distributive justice, procedural justice and interactional justice predict job satisfaction and performance of health professionals. However, their demographic characteristics are shown to partially mediate the relationship between organisational justice and job satisfaction but not performance. Originality/value – Granted that other studies exist, this is one of the few that focuses on hospita...

Improving maternal healthcare utilisation in sub‐Saharan Africa through micro‐finance

PURPOSE This paper aims to examine links between womens 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 womens 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.

A review of the process of knowledge transfer and use of evidence in reproductive and child health in Ghana

BackgroundThe paper carries out a situational analysis to examine the production, dissemination and utilisation of reproductive and child health-related evidence to inform policy formulation in Ghana’s health sector.MethodsThe study used Wald’s model of knowledge production, transfer and utilisation as a conceptual model to collect relevant data via interviews and administration of questionnaire to a network of persons who either previously or currently hold policy-relevant positions in Ghana’s health sector. Additional data was also gathered through a scoping review of the knowledge transfer and research utilisation literature, existing reproductive and child health policies, protocols and guidelines and information available on the websites of relevant institutions in Ghana’s health sector.ResultsThe findings of the study suggest that the health sector in Ghana has major strengths (strong knowledge production capacity, a positive environment for the promotion of evidence-informed policy) and opportunities (access to major donors who have the resources to fund good quality research and access to both local and international networks for collaborative research). What remains a challenge, however, is the absence of a robust institutional-wide mechanism for collating research needs and communicating these to researchers, communicating research findings in forms that are friendlier to policy-makers and the inability to incorporate funding for research into the budget of the health sector.ConclusionThe study concludes, admonishing the Ministry of Health and its agencies to leverage on the existing strengths and opportunities to address the identified challenges.

Spatial variation in the use of reproductive health services over time: a decomposition analysis

BackgroundThe paper argues that several Sub-Saharan African countries have recorded marked improvements in the use of reproductive health services. However, the literature has hardly highlighted such progress and the factors responsible for them. The current study uses Ghana as a case to examine progress in the consumption of reproductive health services over the last two decades and the factors responsible for such progress.MethodsThe study uses two rounds (1998 and 2014) of Demographic and Health Survey data from Ghana. Standard frequencies, a logit model and decomposition of the coefficients of the logit model (i.e. Oaxaca-type decomposition) was employed to examine changes in the use of reproductive health services (4+ antenatal visits and skilled attendance at birth) at national and sub-national levels (i.e the four ecological zones of Ghana) between 1998 and 2014 as well as factors explaining observed spatial changes between the two periods.ResultsDescriptive results suggest that the highest level of improvement occurred in resource-poor zones (i.e. northern belt followed by the southern belt) compared to the middle belt and Greater Accra, where access to resources and infrastructure is relatively better. Results from Oaxaca-type decomposition also suggest that women and partner’s education, household wealth and availability and accessibility to health facilities are the key factors explaining spatial variation in reproductive health service consumption over the two periods. Most importantly, the marginal efficiency of investment in women and partner’s education and access to health services were highest in the two resource poor zones.ConclusionThere is the need to target resource poor settings with existing or new pro-poor reproductive health interventions. Specifically, the northern and southern zones where the key drivers of education and availability of health facilities are the lowest, will be key to further improvements in the consumption of reproductive health services in Ghana.