Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of primary health care? Perspectives of key stakeholders in northern Ghana

In 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana's health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC.; Using qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers. A stakeholders' workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from respondents for the achievement of the goals of UHC and PHC.; The key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS; inadequate coordination among stakeholders in PHC delivery; and inadequate funding for PHC, particularly on preventive and promotive services. Other areas are: the bypassing of PHC facilities due to lack of basic services at the PHC level such as laboratory services, as well as proximity to the district hospitals; and finally the lack of clear understanding of the national policy on PHC.; This study suggests that despite the progress that has been made since the establishment of the NHIS in Ghana, there are still huge gaps that need urgent attention to ensure that the goals of UHC and PHC are met. The key areas of misalignment identified in this study, particularly on the delays in reimbursements need to be taken seriously. It is also important for more dialogue between the NHIA and service providers to address key concerns in the implementation of the NHIS which is key to achieving UHC

Spatio-temporal malaria transmission patterns in Navrongo demographic surveillance site, northern Ghana

The relationship between entomological measures of malaria transmission intensity and mortality remains uncertain. This is partly because transmission is heterogeneous even within small geographical areas. Studying this relationship requires high resolution, spatially structured, longitudinal entomological data. Geostatistical models that have been used to analyse the spatio-temporal heterogeneity have not considered the uncertainty in both sporozoite rate (SR) and mosquito density data. This study analysed data from Kassena-Nankana districts in northern Ghana to obtain small area estimates of malaria transmission rates allowing for this uncertainty.; Independent Bayesian geostatistical models for sporozoite rate and mosquito density were fitted to produce explicit entomological inoculation rate (EIR) estimates for small areas and short time periods, controlling for environmental factors.; Mosquitoes were trapped from 2,803 unique locations for three years using mainly CDC light traps. Anopheles gambiae constituted 52%, the rest were Anopheles funestus. Mean biting rates for An. funestus and An. gambiae were 32 and 33 respectively. Most bites occurred in September, the wettest month. The sporozoite rates were higher in the dry periods of the last two years compared with the wet period. The annual EIR varied from 1,132 to 157 infective bites. Monthly EIR varied between zero and 388 infective bites. Spatial correlation for SR was lower than that of mosquito densities.; This study confirms the presence of spatio-temporal heterogeneity in malaria transmission within a small geographical area. Spatial variance was stronger than temporal especially in the SR. The estimated EIR will be used in mortality analysis for the area

Rules of engagement: perspectives on stakeholder engagement for genomic biobanking research in South Africa

Background: Genomic biobanking research is undergoing exponential growth in Africa raising a host of legal, ethical and social issues. Given the scientific complexity associated with genomics, there is a growing recognition globally of the importance of science translation and community engagement (CE) for this type of research, as it creates the potential to build relationships, increase trust, improve consent processes and empower local communities. Despite this level of recognition, there is a lack of empirical evidence of the practise and processes for effective CE in genomic biobanking in Africa. Methods: To begin to address this vacuum, 17 in-depth face to face interviews were conducted with South African experts in genomic biobanking research and CE to provide insight into the process, benefits and challenges of CE in South Africa. Emerging themes were analysed using a contextualised thematic approach. Results: Several themes emerged concerning the conduct of CE in genomic biobanking research in Africa. Although the literature tends to focus on the local community in CE, respondents in this study described three different layers of stakeholder engagement: community level, peer level and high level. Community level engagement includes potential participants, community advisory boards (CAB) and field workers; peer level engagement includes researchers, biobankers and scientists, while high level engagement includes government officials, funders and policy makers. Although education of each stakeholder layer is important, education of the community layer can be most challenging, due to the complexity of the research and educational levels of stakeholders in this layer. Conclusion: CE is time-consuming and often requires an interdisciplinary research team approach. However careful planning of the engagement strategy, including an understanding of the differing layers of stakeholder engagement, and the specific educational needs at each layer, can help in the development of a relationship based on trust between the research team and various stakeholder groups. Since the community layer often comprises vulnerable populations in low and middle income countries (LMICs), co-development of innovative educational tools on genomic biobanking is essential. CE is clearly a component of a broader process best described as stakeholder engagement

Evolving perspectives on broad consent for genomics research and biobanking in Africa. Report of the Second H3Africa Ethics Consultation Meeting, 11 May 2015.

A report on the Second H3Africa Ethics Consultation Meeting, which was held in Livingstone, Zambia on 11 May 2015. The meeting demonstrated considerable evolution by African Research Ethics Committees on thinking about broad consent as a consent option for genomics research and biobanking. The meeting concluded with a call for broader engagement with policy makers across the continent in order to help these recognise the need for guidance and regulation where these do not exist and to explore harmonisation where appropriate and possible

Developing the science and methods of community engagement for genomic research and biobanking in Africa.

Historically, community engagement (CE) in research has been implemented in the fields of public health, education and agricultural development. In recent years, international discussions on the ethical and practical goals of CE have been extended to human genomic research and biobanking, particularly in the African context. While there is some consensus on the goals and value of CE generally, questions remain about the effectiveness of CE practices and how to evaluate this. Under the auspices of the Human Heredity and Health in Africa Initiative (H3Africa), the H3Africa CE working group organized a workshop in Stellenbosch, South Africa in March 2016 to explore the extent to which communities should be involved in genomic research and biobanking and to examine various methods of evaluating the effectiveness of CE. In this paper, we present the key themes that emerged from the workshop and make a case for the development of a rigorous application, evaluation and learning around approaches for CE that promote a more systematic process of engaging relevant communities. We highlight the key ways in which CE should be embedded into genomic research and biobanking projects

Digitalization and the Future of Work and Policy in Sub-Saharan Africa

Digitalization in Africa holds immense potential to drive socioeconomic progress; however, it also presents notable challenges that must be navigated with care. Despite this, the African perspective is significantly underrepresented in the global discourse regarding the consequences of technological advancement. This dissertation presents an empirical investigation into the effects of digitalization on the future of work and social policy in Sub-Saharan Africa (SSA), with a focus on Ghana. It addresses critical research gaps by examining the consequences of digitalization across four interrelated dimensions: structural economic change, public attitudes towards digitalization, digital inequalities, and preferred policy responses to technological risks. It employs a mixed-methods approach, combining quantitative analyses of macro-level data and field survey data with qualitative content analysis of open-ended survey responses. Key findings reveal that digitalization is closely associated with a structural shift from agriculture to service-oriented employment and enhanced productivity across sectors in SSA. The shift comes with a general optimism among Ghanaians about digitalization’s potential to create jobs, improve efficiency, productivity and in navigating structural challenges historically marred by market and government failures. However, there are also significant digital inequalities that can worsen pre-existing socioeconomic disparities and introduce new ones. To mitigate these, this research identifies a strong public preference for policies that support job creation, income redistribution, and digital skill development. The findings suggest that while digitalization offers avenues for economic growth and development, it also necessitates a recalibration of social policies to ensure inclusive benefits. Overall, this dissertation contributes to the literature on digitalization and social policy in developing countries, offering valuable insights for policymakers, scholars, and practitioners interested in leveraging digitalization for inclusive development in SSA.Die Digitalisierung in Afrika birgt ein immenses Potenzial, um den sozioökonomischen Fortschritt voranzutreiben; sie birgt jedoch auch beträchtliche Herausforderungen, die Vorsicht ratsam erscheinen lassen. Trotz der Herausforderungen ist die afrikanische Perspektive im globalen Diskurs über die Folgen des technologischen Fortschritts deutlich unterrepräsentiert. Diese Dissertation stellt eine empirische Untersuchung der Auswirkungen der Digitalisierung auf die Zukunft der Arbeit und der Sozialpolitik in Subsahara-Afrika (SSA) vor, wobei der Schwerpunkt auf Ghana liegt. Sie schließt wichtige Forschungslücken, indem sie die Folgen der Digitalisierung in vier miteinander verknüpften Dimensionen untersucht: strukturellem wirtschaftlichem Wandel, öffentlichen Einstellungen zur Digitalisierung, digitalen Ungleichheiten und politischen Reaktionen auf technologische Risiken. Die Studie verwendet einen gemischten Methodenansatz, der u.a. quantitative Analysen von Makrodaten und Feldumfragedaten mit qualitativen Inhaltsanalysen von offenen Umfrageantworten kombiniert. Die wichtigsten Ergebnisse zeigen, dass die Digitalisierung eng mit einem Strukturwandel von der Landwirtschaft hin zu dienstleistungsorientierter Beschäftigung und einer höheren Produktivität in allen Sektoren in SSA verbunden ist. Dieser Wandel geht einher mit einem allgemeinen Optimismus der Ghanaer hinsichtlich des Potenzials der Digitalisierung, Arbeitsplätze zu schaffen, die Effizienz und Produktivität zu verbessern und strukturelle Herausforderungen zu bewältigen, die in der Vergangenheit durch Markt- und Regierungsversagen geprägt waren. Es gibt jedoch auch erhebliche digitale Ungleichheiten, die bereits bestehende sozioökonomische Ungleichheiten verschärfen und neue Ungleichheiten schaffen können. Um diese Ungleichheiten abzumildern, zeigt diese Studie eine starke öffentliche Präferenz für politische Maßnahmen, die die Schaffung von Arbeitsplätzen, die Umverteilung von Einkommen und die Entwicklung digitaler Fähigkeiten unterstützen. Die Ergebnisse deuten darauf hin, dass die Digitalisierung zwar Möglichkeiten für wirtschaftliches Wachstum und Entwicklung bietet, aber auch eine Neukalibrierung der Sozialpolitik erforderlich macht, um integrative Vorteile zu gewährleisten. Insgesamt leistet diese Dissertation einen Beitrag zur Literatur über Digitalisierung und Sozialpolitik in Entwicklungsländern und bietet wertvolle Erkenntnisse für politische Entscheidungsträger, Wissenschaftler und Praktiker, die daran interessiert sind, die Digitalisierung für eine inklusive Entwicklung in SSA zu nutzen

Obtaining informed consent for genomics research in Africa: analysis of H3Africa consent documents.

BACKGROUND: The rise in genomic and biobanking research worldwide has led to the development of different informed consent models for use in such research. This study analyses consent documents used by investigators in the H3Africa (Human Heredity and Health in Africa) Consortium. METHODS: A qualitative method for text analysis was used to analyse consent documents used in the collection of samples and data in H3Africa projects. Thematic domains included type of consent model, explanations of genetics/genomics, data sharing and feedback of test results. RESULTS: Informed consent documents for 13 of the 19 H3Africa projects were analysed. Seven projects used broad consent, five projects used tiered consent and one used specific consent. Genetics was mostly explained in terms of inherited characteristics, heredity and health, genes and disease causation, or disease susceptibility. Only one project made provisions for the feedback of individual genetic results. CONCLUSION: H3Africa research makes use of three consent models-specific, tiered and broad consent. We outlined different strategies used by H3Africa investigators to explain concepts in genomics to potential research participants. To further ensure that the decision to participate in genomic research is informed and meaningful, we recommend that innovative approaches to the informed consent process be developed, preferably in consultation with research participants, research ethics committees and researchers in Africa

Addressing ethical issues in H3Africa research – the views of research ethics committee members

In June 2014, the H3Africa Working Group on Ethics organised a workshop with members of over 40 research ethics committees from across Africa to discuss the ethical challenges raised in H3Africa research, and to receive input on the proposed H3Africa governance framework. Prominent amongst a myriad of ethical issues raised by meeting participants were concerns over consent for future use of samples and data, the role of community engagement in large international collaborative projects, and particular features of the governance of sample sharing. This report describes these concerns in detail and will be informative to researchers wishing to conduct genomic research on diseases pertinent to the African research context

Rules of engagement: perspectives on stakeholder engagement for genomic biobanking research in South Africa

Background: Genomic biobanking research is undergoing exponential growth in Africa raising a host of legal, ethical and social issues. Given the scientific complexity associated with genomics, there is a growing recognition globally of the importance of science translation and community engagement (CE) for this type of research, as it creates the potential to build relationships, increase trust, improve consent processes and empower local communities. Despite this level of recognition, there is a lack of empirical evidence of the practise and processes for effective CE in genomic biobanking in Africa. Methods: To begin to address this vacuum, 17 in-depth face to face interviews were conducted with South African experts in genomic biobanking research and CE to provide insight into the process, benefits and challenges of CE in South Africa. Emerging themes were analysed using a contextualised thematic approach. Results: Several themes emerged concerning the conduct of CE in genomic biobanking research in Africa. Although the literature tends to focus on the local community in CE, respondents in this study described three different layers of stakeholder engagement: community level, peer level and high level. Community level engagement includes potential participants, community advisory boards (CAB) and field workers; peer level engagement includes researchers, biobankers and scientists, while high level engagement includes government officials, funders and policy makers. Although education of each stakeholder layer is important, education of the community layer can be most challenging, due to the complexity of the research and educational levels of stakeholders in this layer. Conclusion: CE is time-consuming and often requires an interdisciplinary research team approach. However careful planning of the engagement strategy, including an understanding of the differing layers of stakeholder engagement, and the specific educational needs at each layer, can help in the development of a relationship based on trust between the research team and various stakeholder groups. Since the community layer often comprises vulnerable populations in low and middle income countries (LMICs), co-development of innovative educational tools on genomic biobanking is essential. CE is clearly a component of a broader process best described as stakeholder engagement