For the past 10 years the Ghana Government has been trying to replace the old user fee system with an overall health insurance scheme, but one problem of the old system continues to bedevil the new policy: exemption of the poor. This paper presents data from empirical fieldwork and also puts forward an opinion. It discusses how past experiences of user fee exemptions for the poor can inform exemptions under the new 'National Health Insurance Scheme' (NHIS) as a means to ensuring equity in health care. Drawing on a study of exemptions in the three regions of northern Ghana, and utilizing both qualitative and quantitative methods and data, the findings show that exemptions were applied in favour of under-fives, antenatal care, the aged and public servants to the disadvantage of the poor. As a result, the poor had very little access to exemptions. Exemptions therefore failed to address equity concerns in health care, the very reason for which they were introduced. Thus, although the paper acknowledges that provision for the enrolment of the poor into the NHIS is a step in the right direction, it underscores that effective enrolment will be essential for attaining the equity goal of the policy. Informed by past experiences that undermined the equity goal of exemptions, three policy recommendations are put forward for improving exemptions for the poor under the NHIS. These are: (1) effective community education for enhancing premium paying enrolments into the NHIS alongside education on exemptions for the poor; (2) reviewing and clarifying policy guidelines for guiding local-level identification of the poor based on communities' own understanding of poverty; and (3) providing the requisite resources to enable the Department of Social Welfare to discharge its core mandate of identifying the poor for exemptions.

Background: The Community Benefits Health (CBH) program introduced a community-based behavior change intervention to address social norms and cultural practices influencing maternal health and breastfeeding behaviors in rural Ghana. The purpose of this study was to determine if CBH influenced maternal health outcomes by stimulating community-level support in woman’s social networks.Methods: A mixed-methods study was conducted to evaluate changes in six antenatal/postpartum care, birth attendance, and breastfeeding behaviors in response to the CBH intervention and to assess how the program was implemented and to what extent conditions during implementation influenced the results.Results: We found increases in five of the six outcomes in both the intervention and control areas. Qualitative findings indicated that this may have resulted from program spillover. We considered the dose of exposure to program activities and found that women were significantly more likely to practice maternal health behaviors with increased exposure to program activities while controlling for study area and time.Conclusions: Overall, we determined that exposure to the CBH program significantly improved uptake of three of the six study outcomes, indicating that efforts aimed at increasing communication across women and their social networks may lead to improved health outcomes.

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Meeting multiple, often competing objectives when seeking to sustainably intensify their agricultural operations is a constant challenge for smallholder farmers in Sub-Saharan Africa. Trade-offs between social, economic and environmental goals at different time and spatial scales need to be reconciled, making best use of scarce resources. This study explored how different types of farm households in Northwest Ghana, Eastern Burkina Faso and Central Malawi make choices about resource allocation and farming strategies, and how they manage the trade-offs encountered. It used both quantitative (questionnaire survey) and qualitative (household case studies) methods to identify trade-offs experienced by farmers and to analyse tradeoff management strategies used by them. The 10 main trade-offs identified across the 3 countries occurred across sustainability domains, across time, across spatial scales, across types of farmers or a combination of these. Famers were disincentivized from prioritizing long-term sustainability in their farming operation by resource constraints to meet multiple farming and livelihood objectives, mainstream agricultural policies encouraging short-term productivity gains and adoption-focused interventions, which disregard the diversity of farming households.

This article analysed vulnerability of smallholder agriculture to climate variability, particularly the alternating incidences of drought and heavy precipitation events in Ghana. Although there is an unmet need for understanding the linkages between climate change and livelihoods, the urgent need for climate change adaptation planning (CCAP) in response to climate change makes vulnerability assessment even more compelling in development research. The data for analysis were collected from two complementary studies. These included a regional survey in the Upper West Region and an in-depth study in three selected communities in the Sissala East District. The results showed that smallholder agriculture is significantly vulnerable to climate variability in the region and that three layers of vulnerability can be identified in a ladder of vulnerability. Firstly, farmers are confronted with the double tragedy of droughts and heavy precipitation events, which adversely affect both crops and livestock. Secondly, farmers have to decide on crops for adaptation, but each option – whether indigenous crops, new early-maturing crops or genetically modified crops – predisposes farmers to a different set of risks. Finally, the overall impact is a higher-level vulnerability, namely the risk of total livelihood failure and food insecurity. The article recommended CCAP and an endogenous development (ED) approach to addressing agriculture vulnerability to climate variability within the framework of decentralisation and local governance in Ghana.

Studies on peri-urban development have not paid enough attention to the strategies and dynamics of diversifying livelihoods among  indigenous women in the Global South. This paper explores the dynamics of livelihood diversification strategies among indigenous women in response to peri-urban development in Wa, Ghana. The mixed-methods design guided the study, while the sample consisted 399 respondents selected from a sample frame of 1494 women. Data analyses involved descriptive statistics, non-parametric and thematic analyses. The study found that peri-urban development had led to the loss of access to farmland among indigenous women. In response, women have resorted to switching from farm-based to non-farm-based livelihoods amidst multiple production challenges.There is, therefore, the need to support the sustainability of women’s livelihoods through the Municipal Assembly and, in particular, through policy interventions such as support for skills training and financial support to enable indigenous people to make a sustainable living. Keywords: Diversification, Ghana, Livelihoods, Peri-Urbanization, Women

PurposeThe purpose of this paper is to analyze how farmers are reducing vulnerability of rain‐fed agriculture to drought through indigenous knowledge systems (IKS) in the Atankwidi basin, north‐eastern Ghana.Design/methodology/approachThis paper draws on combined qualitative and quantitative research methods and data. First, the paper draws on qualitative data generated from in‐depth interviews and focus group discussions from purposively sampled farmers in the Atankwidi basin. It also draws on a survey conducted on 131 systematically and randomly sampled households in three communities of the basin, namely Yua, Pungu and Mirigu.FindingsThe results show that farmers are planting multiple indigenous drought resilient crop varieties and employing different rounds of seeding and or staggering planting between multiple farms. They are also applying indigenous forms of organic manure, checking soil erosion through grass strips and stone terracing and adopting paddy farming for improving soil and water conservation towards enhancing plant adaptation to drought. The paper therefore, asserts that through conscientious effort, farmers are reducing vulnerability of rain‐fed agriculture to drought through indigenous knowledge systems of drought risk management.Practical implicationsThe paper recommends that capacity for managing vulnerability to drought at the local level, including the Atankwidi basin, can be enhanced by incorporating IKS into District Development Planning (DDP) and giving priority to the strategic role of IKS in climate change adaptation planning.Originality/valueThis paper fulfills a need for researching the relevance of IKS for reducing vulnerability of rain‐fed agriculture to drought in particular, and enhancing adaptation to climate change in general in the quest for promoting Endogenous Development (ED) in Africa.

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