Why "free maternal healthcare" is not entirely free in Ghana: a qualitative exploration of the role of street-level bureaucratic power.

Background: Ghana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS) in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana's free maternal healthcare policy.

Impact of a community-based primary healthcare programme on childhood diphtheria-tetanus-pertussis (DPT3) immunisation coverage in rural northern Ghana.

Background: Child healthcare services such as diphtheria-tetanus-pertussis (DPT3) vaccination are known to reduce childhood mortality and morbidity. However, inequalities in access to these services in developing countries continue to constrain global efforts aimed at improving child health. This study examines the impact and equity effect of a community-based primary healthcare programme known as the Ghana Essential Health Intervention Programme (GEHIP) on improving the uptake of childhood DPT3 immunisation coverage in a remote rural region of Ghana.

Effect of a community-based primary healthcare programme on adverse pregnancy outcomes in Northern Ghana.

Background: Pregnancy complications and adverse birth outcomes are among the major contributors to poor maternal and child health. Mothers in remote communities are at higher risk of adverse birth outcomes due to constraints in access to healthcare services. In Ghana, a community-based primary healthcare programme called the Ghana Essential Health Interventions Programme (GEHIP) was implemented in a rural region to help strengthen primary healthcare delivery and improve maternal and child healthcare services delivery.

Bio-efficacy, physical integrity, use and attrition of long-lasting insecticidal nets under operational conditions for malaria prevention in Ghana.

Background: Malaria remains a public health challenge in endemic countries of the world. The use of Long-lasting Insecticidal Nets (LLINs) is one of the major ways of malaria vector control. Recent evidence however suggests some LLINs are unable to maintain their effectiveness over their useful life span.

Challenges and facilitators to the provision of sexual, reproductive health and rights services in Ghana.

Expanding access to sexual and reproductive health (SRH) services is one of the key targets of the Sustainable Development Goals. The extent to which sexual and reproductive health and rights (SRHR) targets will be achieved largely depends on how well they are integrated within Universal Health Coverage (UHC) initiatives. This paper examines challenges and facilitators to the effective provision of three SRHR services (maternal health, gender-based violence (GBV) and safe abortion/post-abortion care) in Ghana.

Unawareness of health insurance expiration status among women of reproductive age in Northern Ghana: implications for achieving universal health coverage.

Background: Ghana implemented a national health insurance scheme in 2005 to promote the provision of accessible, affordable, and equitable healthcare by eliminating service user fees. Termed the National Health Insurance Scheme (NHIS), its active enrollment has remained low despite a decade of program implementation. This study assesses factors explaining this problem by examining the correlates of insurance status unawareness among women of reproductive age.

Out-of-pocket payment for primary healthcare in the era of national health insurance: Evidence from northern Ghana.

Background: Ghana introduced a national health insurance program in 2005 with the goal of removing user fees, popularly called "cash and carry", along with their associated catastrophic and impoverishment effects on the population and ensuring access to equitable health care. However, after a decade of implementation, the impact of this program on user fees and out-of-pocket payment (OOP) is not properly documented. This paper contributes to understanding the impact of Ghana's health insurance program on out-of-pocket healthcare payments and the factors associated with the level of out-of-pocket payments for primary healthcare in a predominantly rural region of Ghana.

Cost of implementing a community-based primary health care strengthening program: The case of the Ghana Essential Health Interventions Program in northern Ghana.

Background: The absence of implementation cost data constrains deliberations on consigning resources to community-based health programs. This paper analyses the cost of implementing strategies for accelerating the expansion of a community-based primary health care program in northern Ghana. Known as the Ghana Essential Health Intervention Program (GEHIP), the project was an embedded implementation science program implemented to provide practical guidance for accelerating the expansion of community-based primary health care and introducing improvements in the range of services community workers can provide.

Socio-economic and demographic disparities in ownership and use of insecticide-treated bed nets for preventing malaria among rural reproductive-aged women in northern Ghana.

Background: Malaria continues to be a leading cause of morbidity and mortality in most countries in Sub-Saharan Africa. Insecticide-treated bed nets (ITNs) is one of the cost-effective interventions for preventing malaria in endemic settings. Ghana has made tremendous efforts to ensure widespread ownership and use of ITNs.

An assessment of a performance-based management agreement initiative in Ghana's health service.

Background: As part of its efforts to improve efficiency, accountability and overall performance, the Ghana Health Service (GHS) introduced annual Performance-based Management Agreements (PMAs) in the year 2013. However, no assessment of this initiative has since been made in order to inform policy and practice. This paper provides an assessment of this policy initiative from the perspective of managers at various levels of service implementation.

Socio-demographic determinants of low birth weight: Evidence from the Kassena-Nankana districts of the Upper East Region of Ghana.

Objective: To examine the social, economic and demographic factors that determine low birth weight in the two Kassena Nankana districts of the Upper East region of Ghana.

Methods: Cross-sectional data was collected from January 2009 to December 2011 using the Navrongo Health and Demographic Surveillance System which monitors routine health and demographic outcomes in the study area. Data on foetal characteristics such as birth weight, and sex and maternal age, parity, maternal education, marital status, ethnicity, religious affiliation and socio-economic characteristics were collected and described.

Informal workers' access to health care services: findings from a qualitative study in the Kassena-Nankana districts of Northern Ghana.

Background: Over the past two decades, employment in the informal sector has grown rapidly in all regions including low and middle-income countries. In the developing countries, between 50 and 75% of workers are employed in the informal sector. In Ghana, more than 80% of the total working population is working in the informal sector.

Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana.

Background: There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana's national health insurance scheme.

Socio-economic and demographic determinants of under-five mortality in rural northern Ghana.

Background: In spite of global decline in under-five mortality, the goal of achieving MDG 4 still remains largely unattained in low and middle income countries as the year 2015 closes-in. To accelerate the pace of mortality decline, proven interventions with high impact need to be implemented to help achieve the goal of drastically reducing childhood mortality. This paper explores the association between socio-economic and demographic factors and under-five mortality in an impoverished region in rural northern Ghana.