Roger A. Atinga

Motivation and retention of health workers in Ghana's district hospitals: addressing the critical issues.

PURPOSE This study seeks to undertake a systematic review to consolidate existing empirical evidence on the impact of financial and non-financial incentives on motivation and retention of health workers in Ghanas district hospitals. DESIGN/METHODOLOGY/APPROACH The study employed a purely quantitative design with a sample of 285 health workers from ten district hospitals in four regions of Ghana. A stepwise regression model was used in the analysis. FINDINGS The study found that financial incentives significantly influence motivation and intention to remain in the district hospital. Further, of the four factor model of the non-financial incentives, only three (leadership skill and supervision, opportunities for continuing professional development and availability of infrastructure and resources) were predictors of motivation and retention. RESEARCH LIMITATIONS/IMPLICATIONS A major limitation of the study is that the sample of health workers was biased towards nurses (n = 160; 56.1 percent). This is explained by their large presence in remote districts in Ghana. A qualitative approach could enrich the findings by bringing out the many complex views of health workers regarding issues of motivation and retention, since quantitative studies are better applied to establish causal relationships. ORIGINALITY/VALUE The findings suggest that appropriate legislations backing salary supplements, commitment-based bonus payments with a set of internal regulations and leadership with sound managerial qualities are required to pursue workforce retention in district hospitals.

Healthcare quality under the National Health Insurance Scheme in Ghana: Perspectives from premium holders

Purpose – The purpose of this study is to examine how premium holders of Ghanas Health Insurance Scheme (NHIS) perceive the state of quality healthcare delivery in public hospitals in the country.Design/methodology/approach – Questionnaires were administered to a sample of 250 insured patients receiving care in some selected public hospitals accredited by the National Health Insurance Authority in Ghana. Results are presented using descriptive statistics and Chi‐square analysis.Findings – The results demonstrate that the human dimensions of service quality (interaction with service provider and attitude of healthcare providers) were perceived by the insured patients to be good, and they constitute significant determinants of perceived service quality. Although waiting time was generally perceived to be long, it is not in any way associated with patient perception of quality of care.Originality/value – The findings of the study provide an important step towards strengthening service quality in public hosp...

Determinants of antenatal care quality in Ghana

Purpose – To achieve Goal 5 of the MDGs, the Government of Ghana introduced the free maternal health service system to break financial barriers of access to maternal care services. In spite of this, facility-based deliveries continue to be low due partly to poor quality of antenatal care that prevents pregnant women from giving birth in hospitals. The aim of this study is to examine factors shaping quality of antenatal care in selected public hospitals in the country. Design/methodology/approach – 363 expectant mothers were randomly selected for interview. Women who have previously received antenatal care in the health facilities for at least two occasions were interviewed. Multivariate logistic regression model were computed to examine correlates of antenatal care quality. Findings – The odds of reporting quality of antenatal care as good was higher among women aged between 30 and 34 years. Similarly women with junior/senior high education were more likely to report antenatal care quality as good. Distance to the health facilities generally influence women perception of antenatal care quality but the relative odds of reporting quality of care as good attenuated with proximity to the health facility. Five factors (pleasant interaction with providers, privacy during consultation, attentiveness of providers, adequate facilities and availability of drugs) emerged as statistically significant in explaining antenatal care quality after controlling for selected demographic variables. Originality/value – Results of the study generally demonstrate the need to improve maternal services in public facilities to stimulate utilisation and facility-based deliveries.

Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management

BackgroundIn 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals.MethodsA qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana’s ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically.ResultsThe results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care.ConclusionStudy’s findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation.

Factors influencing the decision to drop out of health insurance enrolment among urban slum dwellers in Ghana

To identify the factors influencing dropout from Ghanas health insurance scheme among populations living in slum communities.

Managerial problems of hospitals under Ghana's National Health Insurance Scheme

Purpose – Hospital and health system managers are facing several problems following the introduction of Ghanas national health insurance policy. This study aims to investigate the opinions of health managers about the problems emanating from the national health insurance policy for hospital managers in regard to reimbursement, claims management, service delivery and waiting time.Design/methodology/approach – The study involved key informants from 12 National Health Insurance Scheme (NHIS) accredited district hospitals, which were purposively selected from five regions in Ghana. Data were collected using in‐depth personal interviews with managers of pharmacy, supply/procurement, accounts and insurance scheme units of the hospitals. Data analysis was guided by the major themes that emerged during the interviews. A framework approach to analysis was used, grouping and incorporating themes and sub‐themes that emerged from the interview data.Findings – The major findings identified by interviewees with regard...

The use of non-prescribed anti-malarial drugs for the treatment of malaria in the Bolgatanga municipality, northern Ghana

BackgroundThe use of non-prescribed anti-malarial drugs can lead to treatment failure and development of drug-resistant parasites. This study investigated the use of non-prescribed anti-malarial drugs for the treatment of malaria in the Bolgatanga Municipality of northern Ghana.MethodsThis was a cross-sectional survey of a random sample of 392 adults and children with episodes of malaria in the last four weeks prior to the study.ResultsMajority of survey respondents 96.9% (380) knew the symptoms of malaria, 75% (294) knew the causes of malaria and 93.1% (365) were aware of mode of transmission of malaria. The use of non-prescribed anti-malarial drugs was 16.8% (95% CI: 13.3-21.0) among the respondents. About 56% (95% CI: 43.3-68.3) of the respondents who took non-prescribed anti-malaria drugs took non-artemisinin-based combination therapy (chloroquine, artemether, amodiaquine and sulphadoxine-pyrimethamine). Respondents above five years of age were more likely to use non-prescribed anti-malarial drugs than those below five years of age [P < 0.001]; respondents who knew the right source of malaria treatment were less likely to use non-prescribed anti-malarial drugs than those who did not [P = 0.002]. Respondents using non-prescribed anti-malarials were influenced by people around them who used non-prescribed anti-malarials. Thus, these respondents were more likely to use non-prescribed anti-malarials than those who were not influenced [P = 0.004].ConclusionsRespondents’ knowledge of malaria treatment and the influence of people using non-prescribed anti-malarials are factors affecting use of non-prescribed anti-malarials. The study concludes that there is high use of non-prescribed anti-malarial drugs in the municipality and most of the non-prescribed anti-malarias were non-artemisinin-based combination therapy. The study recommends education of the general public and chemical sellers to reduce the use of non-prescribe anti-malaria drugs.

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...

Drivers of prenatal care quality and uptake of supervised delivery services in ghana.

Background: In spite of the introduction of free maternal healthcare in Ghana, utilization of supervised delivery services continues to be low due partly to poor quality of antenatal care (ANC). Aim: The study sought to identify the determinants of perceived quality of ANC and uptake of skilled delivery services. Subjects and Methods: A total of 363 expectant mothers were randomly selected in urban health facilities for interview. Logistic regression models were computed to examine the relative odds of reporting quality of antenatal as good and the intention to receive skilled delivery care. Results: The odds of reporting ANC quality as good was high for women aged between 30 and 34 years. Perceived quality of ANC increases with increasing access to education but more likely to be higher for women attaining senior high education. Distance to the health facility influences quality perception, but the odds of reporting quality of care as good attenuated with proximity to the health facility. Finally, uptake of supervised delivery services was high for women aged between 35 and 39 years, women with at least junior high education; living close to the health facility and in their second and third trimester. Conclusion: Study′s findings demonstrate the need to improve the quality of maternal health services in public health facilities to encourage women to deliver under skilled care providers.

Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation

Policy analysis on why women and children in low- and middle-income settings are still disadvantaged by access to appropriate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street-level bureaucracy theory, we explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghanas community-based PHC implementation to the disadvantage of women and children accessing and using health services. This was a qualitative study conducted in 4 communities drawn from rural and urban districts of the Upper West region. Data were collected from 8 focus group discussions with community informants, 73 in-depth interviews with clients, 13 in-depth interviews with district health managers and FLP, and observations. Data were recorded, transcribed and coded deductively and inductively for themes with the aid of Nvivo 11 software. Findings showed that apart from FLP frequent lateness to, and absenteeism from work, that affected care seeking for children, their exercise of discretionary power in determining children who deserve care over others had ripple effects: families experienced financial hardships in seeking alternative care for children, and avoided that by managing symptoms with care provided in non-traditional spaces. FLP adverse behaviours were driven by weak implementation structures embedded in the district health systems. Basic obstetric facilities such as labour room, infusion stand, and beds for deliveries, detention and palpation were lacking prompting FLP to cope by conducting deliveries using a patchwork of improvised delivery methods which worked out to encourage unassisted home deliveries. Perceived poor conditions of service weakened FLP commitment to quality maternal and child care delivery. Findings suggest the need for strategies to induce behaviour change in FLP, strengthen district administrative structures, and improve on the supply chain and logistics system to address gaps in CHPS maternal and child care delivery.