John Kuumuori Ganle

‘What men don’t know can hurt women’s health’: a qualitative study of the barriers to and opportunities for men’s involvement in maternal healthcare in Ghana

BackgroundThe importance of mens involvement in facilitating women’s access to skilled maternal healthcare in patriarchal societies such as Ghana is increasingly being recognised. However, few studies have been conducted to examine men’s involvement in issues of maternal healthcare, the barriers to men’s involvement, and how best to actively involve men. The purpose of this paper is to explore the barriers to and opportunities for men’s involvement in maternal healthcare in the Upper West Region of Ghana.MethodsQualitative focus group discussions, in-depth interviews and key informant interviews were conducted with adult men and women aged 20–50 in a total of seven communities in two geographic districts and across urban and rural areas in the Upper West Region of Ghana. Attride-Stirling’s thematic network analysis framework was used to analyse and present the qualitative data.ResultsFindings suggest that although many men recognise the importance of skilled care during pregnancy and childbirth, and the benefits of their involvement, most did not actively involve themselves in issues of maternal healthcare unless complications set in during pregnancy or labour. Less than a quarter of male participants had ever accompanied their wives for antenatal care or postnatal care in a health facility. Four main barriers to men’s involvement were identified: perceptions that pregnancy care is a female role while men are family providers; negative cultural beliefs such as the belief that men who accompany their wives to receive ANC services are being dominated by their wives; health services factors such as unfavourable opening hours of services, poor attitudes of healthcare providers such as maltreatment of women and their spouses and lack of space to accommodate male partners in health facilities; and the high cost associated with accompanying women to seek maternity care. Suggestions for addressing these barriers include community mobilisation programmes to promote greater male involvement, health education, effective leadership, and respectful and patient-centred care training for healthcare providers.ConclusionsThe findings in this paper highlight the need to address the barriers to men’s involvement, engage men and women on issues of maternal health, and improve the healthcare systems – both in terms of facilities and attitudes of health staff - so that couples who wish to be together when accessing care can truly do so.

Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study

Background While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled womens access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. Methods and Findings A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Conclusions Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare providers as well as the provision of disability-friendly transport and healthcare facilities and services are needed.

‘If I go with him, I can't talk with other women’: Understanding women's resistance to, and acceptance of, men's involvement in maternal and child healthcare in northern Ghana

Mens involvement in maternal and child healthcare especially in patriarchal societies such as Ghana is increasingly being advocated. While a number of studies have been conducted to explore mens views on their involvement, few studies have examined the perspectives of childbearing women. Based on qualitative focus group discussions that were conducted between January and August 2014 with a total of 125 adult women in seven communities in the Upper West Region of Ghana, this paper examines womens perspectives on mens involvement in maternal and child healthcare. Findings suggest that although many women recognised the benefits of mens involvement, few actually supported greater male involvement. The majority of women expressed negative attitudes and opinions on the involvement of men. These negative attitudes and opinions were framed by three broad factors: perceptions that pregnancy and child care should be a female role while men should be bread winners; womens desire to avoid negative stereotyping; and fears that mens involvement may turn hitherto secure social spaces for women into insecure ones. These narrative accounts largely challenge current programmatic efforts that seek to promote mens involvement in maternal and child healthcare, and suggest that such male involvement programmes are less likely to succeed if the views and concerns of childbearing women are not taken into account.

The good in evil: a discourse analysis of the galamsey industry in Ghana

Abstract Galamsey, a low-tech, labour-intensive, small-scale mining activity in Ghana, has recently come under intense criticism and state policing despite being an important livelihood source. Based on empirical research, this paper uses discourse analysis to re-examine galamsey politics in Ghana, focusing on why people are engaged in galamsey despite attempts to curtail it. Findings suggest that for most individuals and communities, poverty, displacement from agricultural lands and unemployment explain their initial entry into the industry. However, the legal, regulatory and policing regimes, together with complex, ambivalent relationships between government, large-scale mining companies, traditional authorities and galamsey operators, all help to perpetuate galamsey. These findings provide a counter-narrative to the dominant discourse of opportunism and demonisation which often characterises public discussions on Ghana’s galamsey industry. Rather than the combative approach taken by the state towards the galamsey phenomenon, urgent legislative and policy reforms are needed in order to streamline the licensing regime and address the drivers of galamsey.

Community health workers in Ghana: the need for greater policy attention

From the 1970s to the 1990s, the WHO, United Nations and other agencies mooted the idea of formally training and recognising community health workers (CHWs) to complement efforts to improve primary healthcare delivery in low and middle income countries. Recently, CHWs have been recognised as important players in the achievement of the health-related Millennium Development Goals (MDGs). Despite this recognition, little understanding exists in Ghana about the activities of CHWs: who they are; how they are recruited; what they do; level of health policy support; contribution to healthcare delivery and the challenges they face. Based on a rapid scoping review of the existing literature, and our experience working in Ghana, this paper reflects on the role of CHWs in healthcare delivery in Ghana. We argue that CHWs have played critical roles in improving health service delivery and outcomes, including guinea worm eradication, expanded immunisation coverage, maternal and child health, and HIV/AIDS treatment and management. However, these achievements notwithstanding, CHWs face challenges which prevent them from being optimally productive, including capacity problems, neglect by the healthcare system, high attrition rates and inadequate supervision. Policymakers in Ghana therefore need to give increased attention to CHWs, provide remuneration for their activities, create career opportunities and other means of motivations to boost their productivity and sustain gains associated with their activities.

‘The floods came and we lost everything’: weather extremes and households’ asset vulnerability and adaptation in rural Ghana

Extreme weather events such as flooding have been observed to deplete households’ assets and render households vulnerable to shocks and poverty. Few empirical studies have however examined households’ asset vulnerability and adaptation to such extreme events in Ghana. Based on qualitative research with two ecologically fragile communities in Ghana, this paper explores the asset vulnerability and adaptation strategies of households against periodic flooding. Findings suggested that households’ assets most vulnerable to flooding were farmlands, human health, housing and financial savings. However, flooding did not affect households’ assets equally; the effects were gendered and differentiated, often occasioned by inequalities in exposure, vulnerability, access to resources, capabilities and opportunities. Nonetheless, many households are actively adapting their assets by acquiring new knowledge about early warning systems, employing different farming practices and diversifying their assets. Understanding the differences in households’ asset vulnerability as well as in the priorities that men and women, as well as the young and old, place on different asset adaptation strategies could therefore be important in the effectiveness of climate change adaptation as well as the sustainability of communities.

Inclusion of men in maternal and safe motherhood services in inner-city communities in Ghana: evidence from a descriptive cross-sectional survey

BackgroundThere has been a growing realisation of the need to enhance men’s inclusion in maternal and safe motherhood services, especially in low-income settings. However, empirical studies on the extent to which men are involved in maternal and safe motherhood services especially in poor inner-city communities are lacking. The purpose of this study was to describe the level of men’s inclusion in maternal and safe-motherhood services in inner-city communities in Ghana, and to assess the barriers of men’s involvement.MethodsA descriptive cross-sectional quantitative survey was conducted among a total of 256 randomly selected adult men in Chorkor, an inner-city fishing community in Accra, the capital city of Ghana. A multistage sampling strategy was used to select houses, households and respondents. Descriptive statistical techniques were used to analyse the data. Data analysis was done with the aid of SPSS version 20.ResultsAlthough almost all (96.6%) respondents knew the meaning of family planning, as high as 236(92.2%) have never accompanied their wives/partners to clinics to seek family planning services. Also 242(94.5%) and 251(98%) of men, respectively, knew the importance of antenatal services and supervised delivery. However, only 114(44.5%) of men ever accompanied their wives/partners to seek skilled delivery services. Men’s involvement was hindered by barriers such as attitude of health workers, long waiting time and socio-cultural beliefs.ConclusionThe study revealed a gap between men’s awareness of the importance of maternal and safe motherhood services and their actual involvement in accessing these services with their female partners. There is a need to create a supportive environment that encourages men to be involved in maternal health services to help reduce maternal/neonatal morbidity and mortality.

ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study.

BackgroundTimely 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.MethodsA 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.ResultsAll (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%).ConclusionsThe 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.