Patience Aseweh Abor

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.

Financing public healthcare institutions in Ghana

PURPOSE The financing of healthcare services has been of a major concern to all governments in the face of increasing healthcare costs. For developing countries, where good health is considered a poverty reduction strategy, it is imperative that the hospitals used in the delivery of healthcare services are well financed to accomplish their tasks. The purpose of this paper is to examine how public hospitals in Ghana are financed, and the challenges facing the financing modes adopted. DESIGN/METHODOLOGY/APPROACH To achieve the objectives of the study, one major public healthcare institution in Ghana became the main focus. FINDINGS The findings of the study revealed that the main sources of financing the public healthcare institution are government subvention, internally-generated funds and donor-pooled funds. Of these sources, the internally generated fund was regarded as the most reliable, and the least reliable was the donor-pooled funds. Several challenges associated with the various financing sources were identified. These include delay in receipt of government subvention, delay in the reimbursement of services provided to subscribers of health insurance schemes, influence of government in setting user fees, and the specifications to which donor funds are put. ORIGINALITY/VALUE The findings of this study have important implications for improving the financing of public healthcare institutions in Ghana. A number of recommendations are provided in this regard.

An examination of pharmaceutical supply chain for artemisinin‐based combination therapies in Ghana

Purpose – The purpose of this paper is to examine the pharmaceutical supply chain for artemisinin‐based combination therapies (ACT) in Ghana.Design/methodology/approach – This study employed an inductive approach in examining the dynamics of the pharmaceutical supply chain. The study also used analytical hierarchical process in identifying factors that are detrimental to the ACT supply chain.Findings – The study revealed that there are basically two main supply channels through which ACT enters the Ghanaian pharmaceutical system – private and public. The ACT network depicts a strong evidence of actor interdependence and long‐term relationships. However, the key supply chain enabler – the use of information technology – was found to be lacking, leading to delays and disruptions in the supply chain system. Disruption was found to be the main detrimental factor to the supply chain although delay was found to be occurring more frequently. Price increases indicated a low effect on the supply network at the pha...

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.

The effects of healthcare governance and ownership structure on the performance of hospitals in Ghana

Purpose – The purpose of this study is to examine the effects of health-care governance and ownership structure on the performance of hospitals in Ghana. Design/methodology/approach – The study uses multiple regression models based on a sample of 132 hospitals in Ghana. Findings – The results of the study indicate that hospitals with a governing board perform better than those without a governing board. The results of this study also suggest that board characteristics and ownership structure are important in explaining the performance of hospitals in Ghana. The results further indicate that mission-based and private hospitals with effective board governance structures exhibit better performance than public hospitals. Originality/value – This study makes a number of new and meaningful contributions to the extant literature and the findings support managerialism, stakeholder and resource dependency theories. The findings also have important implications for the effective governance of hospitals.

How do we explain corporate board structure in sub-Saharan Africa?

This study examines the determinants of corporate board structure in selected sub-Saharan Africa. We specifically investigate which firm-level characteristics exhibit any link whatsoever with board size, board composition and board leadership structure in Ghana, Nigeria, Kenya and South Africa. We also ascertain whether alternative governance mechanisms such as institutional shareholders and debt holders serve as substitutes in addressing the agency conflicts in firms. The findings of the study indicate that institutional ownership is an alternative governance mechanism for board size for a majority of the countries under study. The findings of this study also indicate that firm size is the only variable that significantly and positively explains board size for all the four countries under study and the other firm-level characteristics, though significant in some cases in explaining the board structure, take on different signs from country to country and for different board characteristics.

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.

Performance Assessment of the Juaboso District Office of the National Health Insurance Authority

OBJECTIVES To assess the performance of the National Health Insurance Authority (NHIA) in Ghana. METHODS Using a thorough case study of the Juaboso District Office of the NHIA, this study assessed the community coverage rate, the annual expenditure and income, and the trend of claims payment for the period 2009 to 2012 as well as factors influencing the level of patronage of the National Health Insurance Scheme. A self-administered structured questionnaire was used to gather data from the management of the scheme. Secondary data were also gathered from the schemes audited financial statements. Informal discussions were held with the premium collectors and clients to throw more light on revenue generation challenges. RESULTS The study found an increasing trend in the coverage rate on a yearly basis. Over the study period, the rate moved from 30.6 to 60.1, representing an increase of 96.7%. This shows that in terms of coverage rate, the Juaboso District Office of the NHIA is performing very well. The study also found that revenue has increased but the percentage rate of increase has decreased, compared with the coverage percentage rate. Expenditure has been on the rise, increasing by as much as 20.7% in 2011. Again, the study revealed a consistent year-on-year increase in the claims payment, consistent with the national trend. CONCLUSIONS Constant clinical auditing of claims payments is required to ensure accountability. This would lead to transparency with regard to performance assessment of the claims. The findings have important implications for the effective management of the NHIA.

On the determinants of board structure of hospitals in Ghana: stakeholder and resource dependency perspectives

Hospital boards are expected to play a crucial role on the healthcare delivery system and the effectiveness of the hospital board may depend on its structure. Therefore, an appreciation of the structure of hospital boards is an area worth investigating. This study examined the determinants of hospital board structure in Ghana. The study adopted a multiple regression method. The findings of the study indicate that hospital size, hospital age, ownership structure and location of the hospitals are important in explaining the board structure of hospitals in Ghana. The findings of this study are generally relevant for policy on how to structure an effective hospital board.