Unpacking the impact of COVID-19 on child immunization: evidence from Ghana.

Background: With the onset of the COVID-19 pandemic, governments implemented social distancing regulations to limit the spread of the disease. Some health experts warned that these measures could negatively affect access to essential health services, such as routine childhood immunizations. Others noted that without these regulations, COVID-19 cases would increase, leading to overburdened health systems.

Perils and possibilities of health exception laws: A narrative review.

Forty-seven of the 203 countries with abortion laws detailed by the Center for Reproductive Rights have a health exception (HE) clause, inconsistent in both wording and implementation, even within countries. This narrative review sought to determine the understanding and implementation of the legally permissible HE in different countries, or states, to provide clarification and guidance for strategies that will maximize permitted access to safe abortion within the law and avoid undue delays that harm the lives and health of women and their families. A multimethod approach was used.

Examining the Utilization of Social Capital by Ghanaians When Seeking Care for Chronic Diseases: A Personal Network Survey.

With limited social security and health protection in Ghana, intergenerational support is needed by those living with NCDs, who incur recurrent costs when seeking NCD care. We measured the level of informal support received by NCD patients and identified factors that influence support provision. We surveyed 339 NCD patients from three hospitals in Ghana, who listed their social ties and answered questions about their relationship and support frequency.

Implementation of the Community-based Health Planning and Services (CHPS) in rural and urban Ghana: a history and systematic review of what works, for whom and why.

Background: Despite renewed emphasis on strengthening primary health care globally, the sector remains under-resourced across sub-Saharan Africa. Community-based Health Planning and Services (CHPS) has been the foundation of Ghana's primary care system for over two decades using a combination of community-based health nurses, volunteers and community engagement to deliver universal access to basic curative care, health promotion and prevention. This review aimed to understand the impacts and implementation lessons of the CHPS programme.

Trial-based economic evaluation of the system-integrated activation of community health volunteers in rural Ghana.

Background: Globally, steps to revitalise programmes deploying community health workers (CHWs) on a national scale have been growing, but few economic evaluations have been done on system-integrated CHW programmes. Ghana has dual cadres of CHWs: community health officers (CHOs) and community health volunteers (CHVs). CHO plays a major role in primary health services but has suffered from chronic staff shortages.

'Let me move to another level': career advancement desires and opportunities for community health nurses in Ghana.

Career advancement and continued education are critical components of health worker motivation and retention. Continuous advancement also builds health system capacity by ensuring that leaders are those with experience and strong performance records. To understand more about the satisfaction, desires, and career opportunities available to community health nurses (CHNs) in Ghana, we conducted 29 in-depth interviews and four focus group discussions across five predominantly rural districts.

Supervision of community health nurses in Ghana: a mixed-methods study on experiences and mentorship needs.

Adequate supervision is critical to maintain the performance of health workers who provide essential maternal and child health services in low-resource areas. Supportive supervision emphasizing problem-solving, skill development and mentorship has been shown to improve the motivation and effectiveness of health workers, especially at the community level, but it is not always routinely provided. Previous studies have assessed the uptake of supportive supervision among volunteer health workers and paid health centre staff, but less is known about the supervision experiences of paid community-based staff, such as community health nurses (CHNs) in Ghana.

Towards patient-centred care in Ghana: health system responsiveness, self-rated health and experiential quality in a nationally representative survey.

Introduction: Person-centredness, including patient experience and satisfaction, is a foundational element of quality of care. Evidence indicates that poor experience and satisfaction are drivers of underutilisation of healthcare services, which in turn is a major driver of avoidable mortality. However, there is limited information about patient experience of care at the population level, particularly in low-income and middle-income countries.

Best practices in scaling digital health in low and middle income countries.

Healthcare challenges in low and middle income countries (LMICs) have been the focus of many digital initiatives that have aimed to improve both access to healthcare and the quality of healthcare delivery. Moving beyond the initial phase of piloting and experimentation, these initiatives are now more clearly focused on the need for effective scaling and integration to provide sustainable benefit to healthcare systems.Based on real-life case studies of scaling digital health in LMICs, five key focus areas have been identified as being critical for success.

Implementing safe abortion in Ghana: "We must tell our story and tell it well".

In the first years of the new century, the Ministry of Health/Ghana Health Service determined to reduce abortion-associated morbidity and mortality by increasing access to safe care. This was accomplished by interpreting Ghana's restrictive law so that more women qualified for legal services; by framing this effort in public health terms; by bundling abortion together with contraception and postabortion care in a comprehensive package of services; and by training new cadres of health workers to provide manual vacuum aspiration and medical abortion. The Ministry of Health/Ghana Health Service convened medical and midwifery societies, nongovernmental organizations, and bilateral agencies to implement this plan, while retaining the leadership role.

Public Health Rationale for Investments in Emergency Medicine in Developing Countries - Ghana as a Case Study.

Background: Ghana is a developing country that has strategically invested in expanding emergency care services as a means of improving national health outcomes.

Objectives: Here we present Ghana as a case study for investing in emergency care to achieve public health benefits that fuel for national development.

Discussion: Ghana's health leadership has affirmed emergency care as a necessary adjunct to its preexisting primary health care model.

Benefits and Limitations of a Community-Engaged Emergency Referral System in a Remote, Impoverished Setting of Northern Ghana.

Although Ghana has a well-organized primary health care system, it lacks policies and guidelines for developing or providing emergency referral services. In 2012, an emergency referral pilot-the Sustainable Emergency Referral Care (SERC) initiative-was launched by the Ghana Health Service in collaboration with community stakeholders and health workers in one subdistrict of the Upper East Region where approximately 20,000 people reside. The pilot program was scaled up in 2013 to a 3-district (12-subdistrict) plausibility trial that served a population of approximately 184,000 over 2 years from 2013 to 2015.

Evaluation of the reporting completeness and timeliness of the integrated disease surveillance and response system in northern Ghana.

Objectives: The integrated disease surveillance and response (IDSR) and district health information management system II (DHIMS2) strategies were implemented in 2002 and 2012 respectively to improve surveillance data reporting and quality. The objective of this study was to evaluate the reporting completeness and timeliness of the IDSR system at the sub-national level in northern Ghana.

Methods: This was an observational study in Upper East Region (UER).

Improving health information systems for decision making across five sub-Saharan African countries: Implementation strategies from the African Health Initiative.

Background: Weak health information systems (HIS) are a critical challenge to reaching the health-related Millennium Development Goals because health systems performance cannot be adequately assessed or monitored where HIS data are incomplete, inaccurate, or untimely. The Population Health Implementation and Training (PHIT) Partnerships were established in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze advances in strengthening district health systems. Interventions were tailored to the setting in which activities were planned.

A nationwide quality improvement project to accelerate Ghana's progress toward Millennium Development Goal Four: design and implementation progress.

Quality Problem: The gap between evidence-based guidelines and practice of care is reflected, in low- and middle-income countries, by high rates of maternal and child mortality and limited effectiveness of large-scale programing to decrease those rates.

Choice Of Solution: We designed a phased, rapid, national scale-up quality improvement (QI) intervention to accelerate the achievement of Millennium Development Goal Four in Ghana. Our intervention promoted systems thinking, active participation of managers and frontline providers, generation and testing of local change ideas using iterative learning from transparent district and local data, local ownership and sustainability.

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.

The Ghana community-based health planning and services initiative for scaling up service delivery innovation.

Research projects demonstrating ways to improve health services often fail to have an impact on what national health programmes actually do. An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. After nearly two decades of national debate and investigation into appropriate strategies for service delivery at the periphery, the Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care.