Health promotion as the nexus of public health and clinical care: the case of a district hospital in southern Ghana.

This study explored the extent to which health promotion techniques and activities are incorporated into public health and clinical care at a District Hospital in the Greater Accra Region of Ghana, as well as the challenges that this process faces. Information was obtained at the hospital facility through direct observation, interviews and open-ended questionnaires. Findings showed that the process of incorporating health promotion activities into public health and clinical care at the hospital was underdeveloped. The challenges this process faces based on the research findings include structural challenges, inadequate logistics, increased workload, insufficient human resource capacity, lack of motivation for staff, lack of cooperation, teamwork and consultation, inadequate management and enforcement support, prolonged hospital hours for healthcare workers and patients, and inadequate knowledge of health promotion and training. To address these challenges, suggested measures include promoting teamwork and collaboration among healthcare professionals, training and continuous education, government involvement and enforcement of health promotion integration at the hospital, hospital management involvement, media sensitization and advocacy, provision of financial, material and human resources, motivation and encouragement of the process of health promotion integration, and patient involvement. Further research is also recommended to broaden the scope of this study by involving other health practitioner categories and health promotion stakeholders.

Educational status and beliefs regarding non-communicable diseases among children in Ghana.

BACKGROUND: Increasing prevalence of non-communicable diseases (NCDs) has been observed in Ghana as in other developing countries. Past research focused on NCDs among adults. Recent researches, however, provide evidence on NCDs among children in many countries, including Ghana. Beliefs about the cause of NCDs among children may be determined by the socioeconomic status of parents and care givers. This paper examines the relationship between educational status of parents and/or care givers of children with NCDs on admission and their beliefs regarding NCDs among children. METHODS: A total of 225 parents and/or care givers of children with NCDS hospitalized in seven hospitals in three regions (Greater Accra, Ashanti and Volta) were selected for the study. Statistical techniques, including the chi-square and multinomial logistic regression, were used for the data analysis. RESULTS: Educational status is a predictor of care giver's belief about whether enemies can cause NCDs among children or not. This is the only belief with which all the educational categories have significant relationship. Also, post-secondary/polytechnic (p-value =0.029) and university (p-value = 0.009) levels of education are both predictors of care givers being undecided about the belief that NCDs among children can be caused by enemies, when background characteristics are controlled for. Significant relationship is found between only some educational categories regarding the other types of beliefs and NCDs among children. For example, those with Middle/Juniour Secondary School (JSS)/Juniour High School (JHS) education are significantly undecided about the belief that the sin of parents can cause NCDs among children. CONCLUSIONS: Education is more of a predictor of the belief that enemies can cause NCDs among children than the other types of beliefs. Some categories of ethnicity, residential status and age have significant relationship with the beliefs when background characteristics of the parents and/or care givers were controlled for.

Non-communicable diseases among children in Ghana: health and social concerns of parent/caregivers.

BACKGROUND: Globally, there is a progressive rise in the burden of non-communicable diseases (NCDs). This paper examined the health and social concerns of parents/caregivers on in-patient care for children with NCDs in Ghana. METHODS: This was a cross-sectional study in three large health facilities in Ghana (the largest in the South, the largest in the North and the largest in the Eastern part of Ghana. Data was collected with a structured questionnaire among 225 caregivers (≥18 years) of 149 children with NCDs in health facilities in the three regions. Data was analyzed with simple descriptive statistics. RESULTS: Most caregivers 169(75.0%) were women, relatively young (median age 35years), mostly married and resided in urban areas. Sickle cell disease was the commonest NCD among the children. All 169(75.0%) caregivers believed children suffer NCDs because of sins of parents/ancestors, 29(12.9%) believed herbalists/spiritualists have insights into treating NCDs and 73(32.6%) have previously used herbs/traditional medicine for child's illness. NCD in children was a burden and caused financial difficulties for families. Most caregivers (>96.0%) indicated NCDs in children should be included in national health insurance benefits package and a comprehensive national NCD policy is needed. CONCLUSION: Absence of national NCD policy for children is a major challenge. The burden of care rests mainly on the parents/caregivers. A national strategic intervention on the importance of awareness generation on the causes, risk factors, prevention and treatment of NCDs for families and communities is essential. Government support through national health and social policy initiatives are essential.

Investigating parents/caregivers financial burden of care for children with non-communicable diseases in Ghana.

BACKGROUND: The introduction of the Ghana national health insurance scheme (NHIS) has led to progressive and significant increase in utilization of health services. However, the financial burden of caring for children with non-communicable diseases (NCDs) under the dispensation of the NHIS, especially during hospitalization, is less researched. This paper therefore sought to assess the financial burden parents/caregivers face in caring for children hospitalized with NCDs in Ghana, in the era of the Ghana NHIS. METHODS: We conducted a cross-sectional survey of 225 parents or caregivers of children with NCDS hospitalized in three hospitals. Convenience sampling was used to select those whose children were discharged from hospital after hospitalization. Descriptive statistics such as frequencies and chi-square and logistic regression were used in data analysis. The main outcome variable was financial burden of care, proxied by cost of hospitalization. The independent variable included socio-economic and other indicators such as age, sex, income levels and financial difficulties faced by parents/caregivers. RESULTS: The study found that over 30 % of parents/caregivers spend more than Gh¢50 (25$) as cost of treatment of children hospitalized with NCDs; and over 40 % of parents/caregivers also face financial difficulties in providing health care to their wards. It was also found that even though many children hospitalized with NCDs have been covered by the NHIS, and that the NHIS indeed, provides significant financial relief to parents in the care of children with NCDs, children who are insured still pay out-of-pocket for health care, in spite of their insurance status. It was also found that there is less support from relatives and friends in the care of children hospitalized with NCDs, thus exacerbating parents/caregivers financial burden of caring for the children. CONCLUSIONS: Even though health insurance has proven to be of significant relief to the financial burden of caring for children with NCDs, parents/caregivers still face significant financial burden in the care of their wards. Stakeholders in health care delivery should therefore ensure that all children with NCDs including those excluded from the NHIS should be covered by NHIS. A special effort focusing on identifying children with NCDs within the lower income groups, especially from rural areas, in order to exempt them from any form of payment for their health care is recommended.

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 Ghana's 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.

Barriers to implementing health sector administrative decentralisation in Ghana: a study of the Nkwanta district health management team.

PURPOSE: This paper aims to examine empirically the ways in which workforce knowledge and organisational factors of an implementing agency affected the implementation of health sector administration decentralisation in Ghana with insights from the Nkwanta district health administration. DESIGN/METHODOLOGY/APPROACH: This is a qualitative study using data from individual and group interviews through purposive selection of health officials, who were directly involved in the work of actual implementation of the programme. Specifically, participants included senior management, middle management and junior workers, who had worked at least for the past three months in the district. FINDINGS: The study found that most of the interviewees involved in the implementation process are knowledgeable of the objectives of the decentralisation process. Also, major factors that are militating against effective decentralisation in the district include inadequate funds, lack of qualified personnel, inadequate logistics and equipment, poor interpersonal relationships, lack of transparency and a good operational system, lack of incentives to motivate the staff, political interference, poor infrastructure and high rate of illiteracy. ORIGINALITY/VALUE: The findings of this study will help improve the implementation of decentralisation within the health sector in Ghana. The paper provides recommendations, which, if considered for implementation, will help improve the decentralisation process.