Barriers to health care access and utilization among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP): the perspective of users and service providers in north-western Ghana.

AIM: This article draws on the poverty and access to health care framework to explore the barriers to access and utilization of primary health care among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP) in Ghana. BACKGROUND: Although many developing countries have made progress in extending primary health care to their populations following the Alma-Ata Declaration of 1978, the establishment of the Millennium Development Goals, and the Sustainable Development Goals (SDGs), barriers remain pervasive, particularly among vulnerable population groups. Previous studies have hardly paid in-depth attention to this important indicator for measuring progress toward achieving SDG 3. METHODOLOGY: To this end, we conducted a case study of access to health care services and utilization among aged indigents enrolled on the LEAP programme in the Daffiama Bussie Issa District of the Upper West. We collected and analyzed qualitative data from indigents aged 65 years and above, health care providers, and staff of the LEAP and the National Health Insurance Scheme (NHIS). FINDINGS: Our analysis found geographic inaccessibility of health care, high costs of drugs and related services, exclusion of essential services from NHIS benefits package, and irregular transfer of cash to negatively influence access and utilization of health care among aged LEAP beneficiaries in the district. In addition to the need to strengthen the economy, provide health infrastructure and human resources for health in rural areas, the government needs to review the beneficiaries' bimonthly stipends to reflect the daily minimum wage, eliminate the delay in payments, and review the benefits package of the NHIS to include essential services and medical devices commonly used by aged people. Yet implementing these recommendations has affordability implications that require innovation to mobilize additional resources and create the desired fiscal space and institutions that can sustainably implement universal coverage programmes such as the LEAP.

Health-Seeking Behavior and Quality of Life of People Living With HIV: Novel Evidence From Ghana.

The health and economic burdens of HIV/AIDS in low-and-middle-income countries are enormous despite global and local efforts to prevent and mitigate its effect. This study seeks to assess cadres' (or people living with HIV [PLHIV]) health-seeking behavior and its effects on their quality of life (QoL). We collected cross-sectional data from 218 HIV community cadres and 255 noncadres in 11 out of the 16 political regions in Ghana based on a modified WHOQOL-HIV-Brief and EQ-5D questionnaires. We used descriptive statistics to describe the sample and calculate the QoL scores. We also used regression analysis (ordered logit and ordinary least squares) to analyze the factors associated with the QoL of our respondents. We found that women (77%) are still disproportionally affected by HIV. Similarly, the youth, less educated and informal sector employees continue to be affected most by HIV. Factors related to QoL of PLHIV include being a community cadre, health-seeking behavior, comorbidities, and employment type. We recommend that alternative health providers be educated on the basic science of HIV/AIDS to help them offer appropriate support to PLHIV who visit them for care. Additionally, PLHIV should be supported to engage in less energy demanding employment options.

Spatial epidemiology of bacterial meningitis in the Upper West Region of Ghana: Analysis of disease surveillance data 2018-2020.

Background: The use of a Geographic Information System in identifying meningitis hotspots in the Upper West Region (UWR) remains underutilized, making spatial targeting of meningitis hotspots difficult. We therefore utilized surveillance data enabled with GIS technology to target meningitis outbreaks in the UWR. Methods: Secondary data analysis was conducted in the study. The dynamics of bacterial meningitis in space and time were studied using epidemiological data from 2018 to 2020. Spot map and choropleths were used to depict the distribution of cases in the region. Moran's I statistics were used to assess spatial autocorrelation. Getis-Ord Gi*(d) and Anselin Local Moran's statistics were used to identify hotspots and spatial outliers within the study area. A Geographic Weighted Regression model was also used to examine how socio bio-climatic conditions influence the spread of meningitis. Results: There were 1176 cases of bacterial meningitis, 118 deaths, and 1058 survivors between 2018 and 2020. Nandom municipality had the highest Attack Rate (AR) at 492/100,000 persons, followed by Nadowli-Kaleo district at 314/100,000 persons. Jirapa had the highest case fatality rate (CFR) at 17%. The spatio-temporal analysis showed spatial diffusion of meningitis prevalence from the western half of the UWR to the east with a significant number of hotpots and cluster outliers. Conclusion: Bacterial meningitis does not occur at random. Populations (10.9%) under sub-districts identified as hotspots are exceptionally at higher risk of outbreaks. Targeted interventions should be directed towards clustered hotspots, focusing on zones with low prevalence fenced off by high prevalence zones.