Financing healthcare in sub-Saharan Africa (SSA) is characterized by high levels of out-of-pocket... more Financing healthcare in sub-Saharan Africa (SSA) is characterized by high levels of out-of-pocket (OOP) payments for healthcare. This renders many individuals vulnerable to poverty and deviates from the Universal Health Coverage (UHC) goal of providing financial protection for healthcare. We examined the relative effects of public and external health spending on OOP healthcare payments in SSA. We used the system generalized method of moments (GMM) estimator and data from the World Bank’s World Development Indicators for 43 SSA countries from 2000 to 2017. The results show that reductions in OOP payments are higher with increases in public spending than external spending. This means increases in public health spending, compared with external health spending, will increase the pace towards achieving the financial protection goal of UHC in SSA. But since government spending is limited by fiscal space and parliamentary approval, public health spending through social health insurance mig...
Background: The Ghana National Health Insurance Scheme was introduced in 2003 to provide financia... more Background: The Ghana National Health Insurance Scheme was introduced in 2003 to provide financial protection to the population. While the Scheme has made strides in improving access to healthcare there have been a few challenges including out of pocket charges to insured patients with weak client power. The study investigated the catastrophic nature of the out-of-pocket charges, the factors affecting the charges and the client power. Methodology: We used primary data collected in 3 administrative regions: Greater Accra, Ashanti and the Northern regions, within the period April and June 2022 to compute catastrophic expenditure of the out-of-pocket healthcare expenditure on household expenditure on food and non-food. In addition, multivariate logistic regressions and a linear regression were run to examine the incidence of the practice and client power. Results: The results showed that on average the insured paid out-of-pocket charges with a probability of 66%. The probability was hi...
The road to universal health coverage depends on resources committed to the health sector. In man... more The road to universal health coverage depends on resources committed to the health sector. In many cases, the political structure and strength of advocacy play an important role in setting budgets for health. However, this has, until recently, not been of interest to health system researchers and policymakers. In this study, we document the political path to the establishment of the Ghana National Health Insurance Scheme (NHIS) as well as continuous political interest in the scheme. To achieve our objectives, we used qualitative data from interviews with key stakeholders. These include stakeholders instrumental in the design and establishment of the NHIS. We also reviewed party manifestoes from the two main political parties in the country. Promises relating to the NHIS were extracted from the various manifestos and analysed. Other documents that account for the design and implementation of the scheme were reviewed. We found that the establishment of the NHIS was down to political c...
In many developing countries, financial risk protection for health is underdeveloped and negative... more In many developing countries, financial risk protection for health is underdeveloped and negative health outcomes can be impoverishing. In this study, we sought to investigate the impact of negative health outcomes on household welfare and the role of public health insurance in mitigating this impact. We used Ghana's public-funded National Health Insurance Scheme as a case study. Data was from the sixth round of the Ghana Living Standards survey (GLSS). To address the potentially non-random nature of the Ghana health insurance scheme, a two-stage least squares (2SLS) estimation technique was used. The results suggest that longer days of illness leads to less hours of labour supply and this result was statistically significant across all specifications. We found no evidence of heterogeneous impact of negative health outcomes through health insurance coverage on hours of labour supply. However, disaggregating the results into the urban and rural, and the gender samples, we find that for rural dwellers and males who experienced longer days of illness, labour supply was less when they had access to health insurance. The findings call for policy that focuses on reforming the NHIS to ensure effectiveness and achieving its primary objectives. One option is to ensure availability of prescription drugs and to enhance the procedure for accessing services at healthcare centres to encourage participation and continuous renewal of subscription by Ghanaians.
This study provides a comparative investigation of the onset of the Demographic Dividend (DD) in ... more This study provides a comparative investigation of the onset of the Demographic Dividend (DD) in Ghana, Sierra Leone and The Gambia. The paper examines the onset of the window of opportunity for harnessing the first DD in the three countries to inform relevant policy actions to reap its benefits. The study uses the National Transfer Accounts Approach, which measures at the aggregate level how individuals at each age acquire and use economic resources by examining the demographic transition alongside economic development in each country. The goal is to determine the commencement of the DD and its implications for policy action. While the window of opportunity of harnessing the labour DD of Ghana started in 1980s and expected to end in 2025, that of The Gambia and Sierra Leone began in 2000 and 2003 respectively, estimated to end by 2050. Sierra Leone and The Gambia have thirty years to make good use of this window of opportunity. Ghana on the other hand according to the data used has...
Background: Early initiation of breastfeeding and exclusive breastfeeding practices have been arg... more Background: Early initiation of breastfeeding and exclusive breastfeeding practices have been argued to be one of the important ways of ensuring child health. Unfortunately, owing to modernization, most nursing mothers fail to adhere to such practices. This is believed to be a factor contributory to poor child health in Ghana. Thus, this study investigated the effect of timely initiation of breastfeeding on child health in Ghana. Methods: Cross sectional data using secondary data based on the positivism approach to research was employed. The Ordinary least squares and the Instrumental variables approach were used in estimating the effect of breastfeeding and other socio demographic indicators on the health of the child. Data for the study was sourced from the 2008 round of the Ghana Demographic and Health Survey. Results: The results indicate that timely initiation of breastfeeding, both immediately and hours after birth are important factors that influence the child's health. Additionally, factors such as the wealth of the household, mother's education, age and size of the child at birth and age of the mother are important factors that also influence the health of the child in Ghana. Conclusion: The findings imply that efforts should be made on encouraging appropriate breastfeeding practices among nursing mothers to ensure proper child development and growth in Ghana.
This article examines the effect of health insurance ownership among expectant mothers on facilit... more This article examines the effect of health insurance ownership among expectant mothers on facility-based delivery, having controlled for a host of socio-economic and demographic characteristics. Home deliveries often endanger the health of women, where complications are often referred to appropriate health facilities only when the condition has already deteriorated. Consequently, this study examines the extent to which expectant mothers’ access to health insurance influence their choice of delivery facilities broadly categorized into public health facilities, private health facilities and home delivery. Methodologically, the multinomial logistic regression is employed in the empirical estimation. Using the 2008 Ghana Demographic and Health Survey, we found at both the bivariate and multivariate level that women with access to health insurance are more likely to deliver in modern health facilities namely public and private allopathic health facilities relative to home delivery. In pa...
It is also a potential recipe for impaired cognitive development and the advent of chronic diseas... more It is also a potential recipe for impaired cognitive development and the advent of chronic diseases in later life including diabetes and coronary heart disease (Bale et al. 2003). Other known triggers of LBW include maternal malnutrition, biological conditions such as multiple births, sex of the child, malaria episodes during pregnancy, complicated pregnancy due to pre-eclampsia or antepartum haemorrhage and behavioural or life style factors such as smoking (Vahdaninia, et al. 2008; Alderman and Behrman 2006; Bhargava et al. 2004). The literature on low birth weight on the African continent is on the ascendancy (see Mwabu 2008; Okurut 2009). In Botswana, Ubomba-Jaswa and Ubomba-Jaswa (1996) found that multiple births, birth order (first order), marital status and mothers' stature were important predictors for low birth weight. A study by Vahdaninia (2008) reports that primary and secondary education and non-smokers are highly correlated with low birth weights.
The study investigated the effect of household socioeconomic factors on the choice of treatment f... more The study investigated the effect of household socioeconomic factors on the choice of treatment for childhood fever among children under age five in Ghana. Data from the 2008 Ghana Demographic and Health survey was used employing the multinomial probit model. Three treatment choices were considered: Government facility, Private facility and traditional/self-medication. The results suggest that the treatment of childhood fever is related to household wealth, health insurance status and residence. Government health facilities are mostly used by household's with higher wealth and household's with health insurance. Rural households are more likely to use traditional/self-medication, except those with health insurance who use government facilities. The age of the mother and birth order of the child were also found to influence the choice of treatment facility for childhood fever.
The study investigates the effect of wealth on maternal health care utilization in Ghana via its ... more The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and heal...
Though fertility in Ghana has declined from an average of 8 children per woman over the past thre... more Though fertility in Ghana has declined from an average of 8 children per woman over the past three decades to 4 per woman in recent times, the current rate of population growth is still unmatched by the requisite economic growth. Recent evidence suggests that the use of contraceptives have increased marginally despite the considerable decline in fertility rate. This paper revisits the determinants of contraceptive use among Ghanaian women, aged 15-49 using the 2008 GDHS. Empirically, the logistic and multinomial logistic regressions are used. Our results indicate that wealth status, level of education, ownership of health insurance, number of surviving children, marital status, location and geographical area of residence, religion and women autonomy are significant correlates of contraceptive use in Ghana. The finding reveals that, women who take health decisions jointly with their partners are more likely to use modern contraceptives as compared to women who take health decisions a...
This commentary draws on sub-Saharan African health researchers' accounts of their countries' res... more This commentary draws on sub-Saharan African health researchers' accounts of their countries' responses to control the spread of COVID-19, including social and health impacts, home-grown solutions, and gaps in knowledge. Limited human and material resources for infection control and lack of understanding or appreciation by the government of the realities of vulnerable populations have contributed to failed interventions to curb transmission, and further deepened inequalities. Some governments have adapted or limited lockdowns due to the negative impacts on livelihoods and taken specific measures to minimize the impact on the most vulnerable citizens. However, these measures may not reach the majority of the poor. Yet, African countries' responses to COVID-19 have also included a range of innovations, including diversification of local businesses to produce personal protective equipment, disinfectants, test kits, etc., which may expand domestic manufacturing capabilities and deepen self-reliance. African and high-income governments, donors, non-governmental organizations, and businesses should work to strengthen existing health system capacity and back African-led business. Social scientific understandings of public perceptions, their interactions with COVID-19 control measures, and studies on promising clinical interventions are needed. However, a decolonizing response to COVID-19 must include explicit and meaningful commitments to sharing the power-the authority and resources-to study and endorse solutions. Harriet Chemusto is deceased.
Financing healthcare in sub-Saharan Africa (SSA) is characterized by high levels of out-of-pocket... more Financing healthcare in sub-Saharan Africa (SSA) is characterized by high levels of out-of-pocket (OOP) payments for healthcare. This renders many individuals vulnerable to poverty and deviates from the Universal Health Coverage (UHC) goal of providing financial protection for healthcare. We examined the relative effects of public and external health spending on OOP healthcare payments in SSA. We used the system generalized method of moments (GMM) estimator and data from the World Bank’s World Development Indicators for 43 SSA countries from 2000 to 2017. The results show that reductions in OOP payments are higher with increases in public spending than external spending. This means increases in public health spending, compared with external health spending, will increase the pace towards achieving the financial protection goal of UHC in SSA. But since government spending is limited by fiscal space and parliamentary approval, public health spending through social health insurance mig...
Background: The Ghana National Health Insurance Scheme was introduced in 2003 to provide financia... more Background: The Ghana National Health Insurance Scheme was introduced in 2003 to provide financial protection to the population. While the Scheme has made strides in improving access to healthcare there have been a few challenges including out of pocket charges to insured patients with weak client power. The study investigated the catastrophic nature of the out-of-pocket charges, the factors affecting the charges and the client power. Methodology: We used primary data collected in 3 administrative regions: Greater Accra, Ashanti and the Northern regions, within the period April and June 2022 to compute catastrophic expenditure of the out-of-pocket healthcare expenditure on household expenditure on food and non-food. In addition, multivariate logistic regressions and a linear regression were run to examine the incidence of the practice and client power. Results: The results showed that on average the insured paid out-of-pocket charges with a probability of 66%. The probability was hi...
The road to universal health coverage depends on resources committed to the health sector. In man... more The road to universal health coverage depends on resources committed to the health sector. In many cases, the political structure and strength of advocacy play an important role in setting budgets for health. However, this has, until recently, not been of interest to health system researchers and policymakers. In this study, we document the political path to the establishment of the Ghana National Health Insurance Scheme (NHIS) as well as continuous political interest in the scheme. To achieve our objectives, we used qualitative data from interviews with key stakeholders. These include stakeholders instrumental in the design and establishment of the NHIS. We also reviewed party manifestoes from the two main political parties in the country. Promises relating to the NHIS were extracted from the various manifestos and analysed. Other documents that account for the design and implementation of the scheme were reviewed. We found that the establishment of the NHIS was down to political c...
In many developing countries, financial risk protection for health is underdeveloped and negative... more In many developing countries, financial risk protection for health is underdeveloped and negative health outcomes can be impoverishing. In this study, we sought to investigate the impact of negative health outcomes on household welfare and the role of public health insurance in mitigating this impact. We used Ghana's public-funded National Health Insurance Scheme as a case study. Data was from the sixth round of the Ghana Living Standards survey (GLSS). To address the potentially non-random nature of the Ghana health insurance scheme, a two-stage least squares (2SLS) estimation technique was used. The results suggest that longer days of illness leads to less hours of labour supply and this result was statistically significant across all specifications. We found no evidence of heterogeneous impact of negative health outcomes through health insurance coverage on hours of labour supply. However, disaggregating the results into the urban and rural, and the gender samples, we find that for rural dwellers and males who experienced longer days of illness, labour supply was less when they had access to health insurance. The findings call for policy that focuses on reforming the NHIS to ensure effectiveness and achieving its primary objectives. One option is to ensure availability of prescription drugs and to enhance the procedure for accessing services at healthcare centres to encourage participation and continuous renewal of subscription by Ghanaians.
This study provides a comparative investigation of the onset of the Demographic Dividend (DD) in ... more This study provides a comparative investigation of the onset of the Demographic Dividend (DD) in Ghana, Sierra Leone and The Gambia. The paper examines the onset of the window of opportunity for harnessing the first DD in the three countries to inform relevant policy actions to reap its benefits. The study uses the National Transfer Accounts Approach, which measures at the aggregate level how individuals at each age acquire and use economic resources by examining the demographic transition alongside economic development in each country. The goal is to determine the commencement of the DD and its implications for policy action. While the window of opportunity of harnessing the labour DD of Ghana started in 1980s and expected to end in 2025, that of The Gambia and Sierra Leone began in 2000 and 2003 respectively, estimated to end by 2050. Sierra Leone and The Gambia have thirty years to make good use of this window of opportunity. Ghana on the other hand according to the data used has...
Background: Early initiation of breastfeeding and exclusive breastfeeding practices have been arg... more Background: Early initiation of breastfeeding and exclusive breastfeeding practices have been argued to be one of the important ways of ensuring child health. Unfortunately, owing to modernization, most nursing mothers fail to adhere to such practices. This is believed to be a factor contributory to poor child health in Ghana. Thus, this study investigated the effect of timely initiation of breastfeeding on child health in Ghana. Methods: Cross sectional data using secondary data based on the positivism approach to research was employed. The Ordinary least squares and the Instrumental variables approach were used in estimating the effect of breastfeeding and other socio demographic indicators on the health of the child. Data for the study was sourced from the 2008 round of the Ghana Demographic and Health Survey. Results: The results indicate that timely initiation of breastfeeding, both immediately and hours after birth are important factors that influence the child's health. Additionally, factors such as the wealth of the household, mother's education, age and size of the child at birth and age of the mother are important factors that also influence the health of the child in Ghana. Conclusion: The findings imply that efforts should be made on encouraging appropriate breastfeeding practices among nursing mothers to ensure proper child development and growth in Ghana.
This article examines the effect of health insurance ownership among expectant mothers on facilit... more This article examines the effect of health insurance ownership among expectant mothers on facility-based delivery, having controlled for a host of socio-economic and demographic characteristics. Home deliveries often endanger the health of women, where complications are often referred to appropriate health facilities only when the condition has already deteriorated. Consequently, this study examines the extent to which expectant mothers’ access to health insurance influence their choice of delivery facilities broadly categorized into public health facilities, private health facilities and home delivery. Methodologically, the multinomial logistic regression is employed in the empirical estimation. Using the 2008 Ghana Demographic and Health Survey, we found at both the bivariate and multivariate level that women with access to health insurance are more likely to deliver in modern health facilities namely public and private allopathic health facilities relative to home delivery. In pa...
It is also a potential recipe for impaired cognitive development and the advent of chronic diseas... more It is also a potential recipe for impaired cognitive development and the advent of chronic diseases in later life including diabetes and coronary heart disease (Bale et al. 2003). Other known triggers of LBW include maternal malnutrition, biological conditions such as multiple births, sex of the child, malaria episodes during pregnancy, complicated pregnancy due to pre-eclampsia or antepartum haemorrhage and behavioural or life style factors such as smoking (Vahdaninia, et al. 2008; Alderman and Behrman 2006; Bhargava et al. 2004). The literature on low birth weight on the African continent is on the ascendancy (see Mwabu 2008; Okurut 2009). In Botswana, Ubomba-Jaswa and Ubomba-Jaswa (1996) found that multiple births, birth order (first order), marital status and mothers' stature were important predictors for low birth weight. A study by Vahdaninia (2008) reports that primary and secondary education and non-smokers are highly correlated with low birth weights.
The study investigated the effect of household socioeconomic factors on the choice of treatment f... more The study investigated the effect of household socioeconomic factors on the choice of treatment for childhood fever among children under age five in Ghana. Data from the 2008 Ghana Demographic and Health survey was used employing the multinomial probit model. Three treatment choices were considered: Government facility, Private facility and traditional/self-medication. The results suggest that the treatment of childhood fever is related to household wealth, health insurance status and residence. Government health facilities are mostly used by household's with higher wealth and household's with health insurance. Rural households are more likely to use traditional/self-medication, except those with health insurance who use government facilities. The age of the mother and birth order of the child were also found to influence the choice of treatment facility for childhood fever.
The study investigates the effect of wealth on maternal health care utilization in Ghana via its ... more The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and heal...
Though fertility in Ghana has declined from an average of 8 children per woman over the past thre... more Though fertility in Ghana has declined from an average of 8 children per woman over the past three decades to 4 per woman in recent times, the current rate of population growth is still unmatched by the requisite economic growth. Recent evidence suggests that the use of contraceptives have increased marginally despite the considerable decline in fertility rate. This paper revisits the determinants of contraceptive use among Ghanaian women, aged 15-49 using the 2008 GDHS. Empirically, the logistic and multinomial logistic regressions are used. Our results indicate that wealth status, level of education, ownership of health insurance, number of surviving children, marital status, location and geographical area of residence, religion and women autonomy are significant correlates of contraceptive use in Ghana. The finding reveals that, women who take health decisions jointly with their partners are more likely to use modern contraceptives as compared to women who take health decisions a...
This commentary draws on sub-Saharan African health researchers' accounts of their countries' res... more This commentary draws on sub-Saharan African health researchers' accounts of their countries' responses to control the spread of COVID-19, including social and health impacts, home-grown solutions, and gaps in knowledge. Limited human and material resources for infection control and lack of understanding or appreciation by the government of the realities of vulnerable populations have contributed to failed interventions to curb transmission, and further deepened inequalities. Some governments have adapted or limited lockdowns due to the negative impacts on livelihoods and taken specific measures to minimize the impact on the most vulnerable citizens. However, these measures may not reach the majority of the poor. Yet, African countries' responses to COVID-19 have also included a range of innovations, including diversification of local businesses to produce personal protective equipment, disinfectants, test kits, etc., which may expand domestic manufacturing capabilities and deepen self-reliance. African and high-income governments, donors, non-governmental organizations, and businesses should work to strengthen existing health system capacity and back African-led business. Social scientific understandings of public perceptions, their interactions with COVID-19 control measures, and studies on promising clinical interventions are needed. However, a decolonizing response to COVID-19 must include explicit and meaningful commitments to sharing the power-the authority and resources-to study and endorse solutions. Harriet Chemusto is deceased.
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Papers by Eric Arthur