Kilian Nasung Atuoye

Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana

BackgroundThe Ghana Community based Health Planning and Services (CHPS) strategy targets to bring health services to the doorsteps of clients in a manner that improves maternal and child health outcomes. In this strategy, referral is an important component but it is threatened in a rural context where transportation service is a problem. Few studies have examined perceptions of rural dwellers on transportation challenges in accessing maternal health care services within CHPS.MethodsUsing the political ecology of health framework, this paper investigates transportation barriers in health access in a rural context based on perceived cause, coping mechanisms and strategies for a sustainable transportation system. Eight (8) focus group discussions involving males (n = 40) and females (n = 45) in rural communities in a CHPS zone in the Upper West Region of Ghana were conducted between September and December 2013.ResultsLack of vehicular transport is suppressing the potential positive impact of CHPS on maternal and child health. Consistent neglect of road infrastructural development and endemic poverty in the study area makes provision of alternative transport services for health care difficult. As a result, pregnant women use risky methods such as bicycle/tricycle/motorbikes to access obstetric health care services, and some turn to traditional medicines and traditional birth attendants for maternal health care services.ConclusionThese findings underscore the need for policy to address rural transport problems in order to improve maternal health. Community based transport strategy with CHPS is proposed to improve adherence to referral and access to emergency obstetric services.

Persistent misconceptions about HIV transmission among males and females in Malawi

BackgroundThe prevalence of HIV in Malawi is one of the highest in sub-Saharan Africa, and misconceptions about its mode of transmission are considered a major contributor to the continued spread of the virus.MethodsUsing the 2010 Malawi Demographic and Health Survey, the current study explored factors associated with misconceptions about HIV transmission among males and females.ResultsWe found that higher levels of ABC prevention knowledge were associated with lower likelihood of endorsing misconceptions among females and males (OR = 0.85, p < 0.001; OR = 0.85, p < 0.001, respectively). Compared to those in the Northern region, both females and males in the Central (OR = 0.54, p < 0.001; OR = 0.53, p < 0.001, respectively) and Southern regions (OR = 0.49, p < 0.001; OR = 0.43, p < 0.001, respectively) were less likely to endorse misconceptions about HIV transmission. Moreover, marital status and ethnicity were significant predictors of HIV transmission misconceptions among females but not among males. Also, household wealth quintiles, education, religion, and urban–rural residence were significantly associated with endorsing misconceptions about HIV transmission.ConclusionBased on our findings, we recommend that education on HIV transmission in Malawi should integrate cultural and ethnic considerations of HIV/AIDS.

Financial sustainability versus access and quality in a challenged health system: an examination of the capitation policy debate in Ghana

Policy makers in low and middle-income countries are frequently confronted with challenges of increasing health access for poor populations in a sustainable manner. After several years of trying out different health financing mechanisms, health insurance has recently emerged as a pro-poor health financing policy. Capitation, a fixed fee periodically paid to health service providers for anticipated services, is one of the payment policies in health insurance. This article examines claims and counter-claims made by coalitions and individual stakeholders in a capitation payment policy debate within Ghanas National Health Insurance Scheme. Using content analysis of public and parliamentary proceedings, we situate the debate within policy making and health insurance literature. We found that the ongoing capitation payment debate stems from challenges in implementation of earlier health insurance claims payment systems, which reflect broader systemic challenges facing the health insurance scheme in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims about the contested capitation payment system. In addition, we found that the health of poor communities, women and children are being used as surrogates for political and individual arguments in the policy debate. The article recommends a more holistic and participatory approach through persuasion and negotiation to join interests and core evidence together in the capitation policy making in Ghana and elsewhere with similar contexts.

Debated agronomy: public discourse and the future of biotechnology policy in Ghana

ABSTRACT This paper examines the highly contested and ongoing biotechnology (Bt) policy-making process in Ghana. We analyse media content on how Bt is viewed in the context of Ghana’s parliamentary debate on the Plant Breeders Bill and within the broader public policy-making literature. This paper does not seek to take a position on Bt or the Bill, but to understand how policy actors influence the debate with political and scientific rhetoric in Ghana. The study reveals that in the midst of scientific uncertainties of Bt’s potential for sustainable agriculture production and food security, policy decisions that encourage its future adoption are heavily influenced by health, scientific, economic, environmental and political factors dictated by different ideologies, values and norms. While locally pioneered plant breeding is visible and common in the Ghanaian food chain, plant breeding/GMOs/Bt from international corporations is strongly resisted by anti-GMO coalitions. Understanding the complex and messy nature of Bt policy-making is critical for future development of agricultural technology in Ghana and elsewhere.

Same problem, conflicting ‘truths’: rethinking the missing links in forest degradation narrativization in Ghana

Abstract This paper uses narrative analysis drawing on secondary data from policy documents, reports, and academic literature to examine contemporary discourses on forest degradation in Ghana. Situating the analysis within science and policy-making, we identify the actors, corresponding storylines, and demonstrate how the knowledge produced shapes forest policy. We find that, external voices dominate forest degradation narrativization in Ghana. Amid conflicting statistics on the extent and rate of forest loss, local farmers are tagged as both villains and victims of degradation to which prescriptive technocratic solutions preoccupied with merely replacing trees are prioritized while neglecting underlying poverty and indigenous knowledge systems

Traditional agriculture in transition: examining the impacts of agricultural modernization on smallholder farming in Ghana under the new Green Revolution

ABSTRACT Following the renewed effort at achieving a new green revolution for Africa, emphasis has been placed on modernizing smallholder agriculture through the deployment of improved inputs especially mechanized technologies. In Ghana, the government has in the last decade emphasized the provision of subsidized mechanized ploughing services to farmers alongside a rapidly growing private sector tractor service market. While mechanized technology adoption rates have increased rapidly, the deployment of these technologies has been without critical analysis of the impacts on production patterns and local agrarian systems. This paper examines the distributional impacts of agriculture mechanization on cropping patterns and farm sizes of smallholder farmers in northern Ghana using Geographic Information Systems (GIS) techniques, and semi-structured interviews with smallholder farmers (n=60). Specifically, comparative analysis of the field sizes and cropping patterns of participant farmers prior to and after the adoption of mechanized technologies was conducted. In-depth interviews were used to contextualize the experiences of smallholder farmers toward understanding how mechanization may be impacting traditional agriculture. Our findings reveal a mechanization paradox in which farm sizes are expanding, while cropping patterns are shifting away from traditional staple crops (pearl millet and sorghum bicolor) to market-oriented crops (maize, rice and groundnuts). This transition we argue, has adverse implications on the cultural dimension of food security, the organization of social life, and climate change adaptation. We recommend a retooling of the current agricultural policy focus to ensure context sensitivity for a more robust battle against food insecurity.

Utilisation of skilled birth attendants over time in Nigeria and Malawi

Nutrition is a direct contributor and target to Sustainable Development Goal 2 (“End hunger achieve food security and improved nutrition and promote sustainable agriculture”) a foundation and pre-requisite to Sustainable Development Goal 3 (“Ensure healthy lives and promote well-being for all at all ages”) and a decisive enabler to the remaining goals of the Sustainable Development Agenda 2030. The World Health Organization (WHO) supports all Member States to achieve “a world free of all forms of malnutrition where all people achieve health and well-being” a vision supported by our work with Member States and their partners to ensure universal access to effective nutrition actions and to healthy and sustainable diets1 in the context of the overall effort to ensure universal health coverage2. To do this WHO uses its convening power to help facilitate and align priority setting to mainstream nutrition in the health and development agenda; develop evidence-informed guidance supported by the highest quality science and ethical frameworks; support the adoption of guidance its implementation and the integration of effective actions into existing or new delivery platforms in the health systems. WHO guidelines are documents developed by WHO containing recommendations for clinical practice or public health policy and programmes. A recommendation tells the intended end-user of the guideline what he or she can or should do in specific situations to achieve the best health and nutrition outcomes possible individually or at the population level. It offers a choice among different interventions or measures having an anticipated positive impact on health and nutrition and implications for the use of resources.3 The WHO Department of Nutrition for Health and Development (NHD) develops guidelines in accordance with the procedures established in the WHO Handbook for Guideline Development.2 The WHO guideline development process ensures that WHO guidelines are of high methodological quality and are developed through an independent transparent evidence-informed consensual decision-making process. Though the process with which WHO develops guidelines is highly structured systematic and transparent the process for priority setting (i.e. prioritizing topics4 for guideline development) has been a dynamic one in order to accommodate new and renewed high-level commitments from the WHO Secretariat as well as emerging issues arising from discussions among Member States in the Governing Body fora such as the World Health Assembly (WHA). The priority issues are determined by their importance (i.e. magnitude prevalence and distribution of disease or nutrition problems) or the existence of preventable or modifiable biological behavioural and contextual determinants (risk factors). Updating guidelines is challenging if evidence has to be retrieved to support an increasing number of recommendations. In this situation it is important to give priority to assuring the principle of “primum non nocere” (first do no harm) to address controversial areas and to set a position on areas in which new evidence has emerged and requires prompt action. Ensuring a well-understood and efficiently communicated prioritization process is therefore crucial as external partners and stakeholders play an important role in the WHO guideline implementation process. Independence and transparency of the prioritization process gives the Organization a means of providing assurance that the process is free of any undue influence that may affect the reputation and objectivity of WHO. Therefore in an effort to maintain transparency in the normative work of WHO and to enhance the understanding of the process used to prioritize topics for guideline development among Member States and stakeholders the Department of Nutrition for Health and Development (NHD) is leading the work on making the prioritization process more accessible and has developed an online tool to further facilitate the participation of Member States and their stakeholders in the guideline prioritization process. This process aims to complement the decisions of the World Health Assembly (WHA) the decision-making body of WHO. (ExcerptsABSTRACT Despite recent modest progress in reducing maternal and infant mortality rates in sub-Saharan Africa, Nigeria and Malawi were still in the top 20 countries with highest rates of mortalities globally in 2015. Utilisation of professional services at delivery – one of the indictors of MDG 5 – has been suggested to reduce maternal mortality by 50%. Yet, contextual, socio-cultural and economic factors have served as barriers to uptake of such critical service. In this paper, we examined the impact of residential wealth index on utilisation of Skilled Birth Attendant in Nigeria (2003, 2008 and 2013), and Malawi (2000, 2004 and 2010) using Demographic and Health Survey data sets. The findings from multivariate logistic regressions show that women in Nigeria were 23% less likely to utilise skilled delivery services in 2013 compared to 2003. In Malawi, women were 75% more likely to utilise skilled delivery services in 2010 than in 2000. Residential wealth index was a significant predictor of utilisation of skilled delivery services over time in both Nigeria and Malawi. These findings illuminate progress made - based on which we make recommendations for achievement of SDG-3: ensure healthy lives and promote well-being for all at all ages in Nigeria and Malawi, and similar context.

Timing and utilisation of antenatal care service in Nigeria and Malawi

ABSTRACT As the world draws curtains on the implementation of Millennium Development Goals (MDGs), there is increasing interest in evaluating the performance of countries on the goals and assessing related challenges and opportunities to inform the upcoming Sustainable Development Goals (SDGs). This study examined changes in the timing and utilisation of maternal health care services in Nigeria and Malawi; using multivariate negative log–log and logistic regression models fitted to demographic and health survey data sets. Predicted probabilities were also computed to observe the net differences in the likelihood of both the first and the required number of antenatal care (ANC) visits for each of the three analysis years. Women in Nigeria were 7% less likely in 2008 compared to 2003, and in Malawi, 32% more likely in 2013 compared to 2000, to utilise ANC in the first trimester of pregnancy. Timing of first ANC visit was strongly influenced by wealth in Nigeria but not in Malawi. The findings in our case studies show how various contextual factors may enable or inhibit policy performance. Maternal and child health, SDGs should incorporate both wealth and degrees of urbanicity into country level implementation strategies.

Factors associated with voluntary testing for HBV in the Upper West Region of Ghana

&NA; This study examined the role of health facilities on testing for Hepatitis B virus in a policy context where screening is only available at a cost. We fitted multivariate multinomial logistic regression models to cross‐sectional data (n = 1374) collected from Upper West Region of Ghana. The analysis showed that approximately 28% of respondents reported ever testing for HBV. Although source of healthcare influenced HBV testing, traders (RRR = 0.29, p ≤ 0.001) and farmers (RRR = 0.34, p ≤ 0.01) were significantly less likely to test voluntarily. Wealth generally predicted voluntary testing, although less so for mandatory testing. The findings highlight the need for free HBV services targeting the very poor, especially those who use community‐level health facilities as their primary source of care. HighlightsType of healthcare facility is important for voluntary hepatitis B testing.Users of primary healthcare facilities are more likely to go for hepatitis B screening voluntarily in Ghana.Socioeconomic disparities serve as barriers to hepatitis B screening in a deprived context.Fee for hepatitis B screening services and vaccination should be removed and services decentralized to primary healthcare facilities.

Married women’s autonomy and post-delivery modern contraceptive use in the Democratic Republic of Congo

BackgroundAlthough use of modern contraception is considered beneficial in lowering maternal and child mortality rates, the prevalence of contraceptive use remains low in the Democratic Republic of Congo. This study examined modern contraceptive use and its linkage to women’s autonomy.MethodsData were drawn from the 2013–2014 Democratic Republic of Congo Demographic and Health Survey. We selected unsterilized and non-pregnant married women who have given birth in the last three years (N = 6680). Logistic regression models were fitted to explore the relationship between women’s autonomy and modern contraceptive use.ResultsThe study found that only 7.1% of married women who had delivered within three years used modern contraceptive methods. After controlling for socioeconomic and demographic factors, the association between women’s autonomy and modern contraceptive use remained positively significant (OR = 1.16; 95% CI = 1.05, 1.29).ConclusionThe findings from this study indicate that it is not enough to provide women with educational and employment opportunities to increase the uptake of modern contraception, but also to enhance women’s assertiveness to make their own decisions regardless of their partners’ preferences within household settings. It is critical for government and other stakeholders to roll out programs aimed at reducing gender inequality and improving women’s autonomy in decision-making about reproductive health.