BackgroundThe rising burden of chronic non-communicable diseases in low and middle income countries has major implications on the ability of these countries to achieve universal health coverage. In this paper we discuss the impact of cardiovascular diseases (CVD) on primary healthcare services in urban poor communities in Accra, Ghana.MethodsWe review the evidence on the evolution of universal health coverage in Ghana and the central role of the community-based health planning services (CHPS) programme and the National Health Insurance Scheme in primary health care. We present preliminary findings from a study on community CVD knowledge, experiences, responses and access to services.ResultsThe rising burden of NCDs in Ghana will affect the achievement of universal health coverage, particularly in urban areas. There is a significant unmet need for CVD care in the study communities. The provision of primary healthcare services for CVD is not accessible, equitable or responsive to the needs of target communities.ConclusionsWe consider these findings in the context of the primary healthcare system and discuss the challenges and opportunities for strengthening health systems in low and middle-income countries.

BackgroundIn Ghana, about 3.5 million cases of malaria are recorded each year. Urban poor residents particularly have a higher risk of malaria mainly due to poor housing, low socio-economic status and poor sanitation. Alternative treatment for malaria (mainly African traditional/herbal and/or self-medication) is further compounding efforts to control the incidence of malaria in urban poor communities. This study assesses factors associated with seeking alternative treatment as the first response to malaria, relative to orthodox treatment in three urban poor communities in Accra, Ghana.MethodsThis cross-sectional study was conducted in three urban poor localities in Accra, Ghana among individuals in their reproductive ages (15–59 years for men and 15–49 years for women). The analytic sample for the study was 707. A multinomial regression model was used to assess individual, interpersonal and structural level factors associated with treatment-seeking for malaria.ResultsOverall, 31% of the respondents sought orthodox treatment, 8% sought traditional/herbal treatment and 61% self-medicated as the first response to malaria. At the bivariate level, more males than females used traditional/herbal treatment and self-medicated for malaria. The results of the regression analysis showed that current health insurance status, perceived relative economic standing, level of social support, and locality of residence were associated with seeking alternative treatment for malaria relative to orthodox treatment.ConclusionsThe findings show that many urban poor residents in Accra self-medicate as the first response to malaria. Additionally, individuals who were not enrolled in a health insurance scheme, those who perceived they had a low economic standing, those with a high level of social support, and locality of residence were significantly associated with the use of alternative treatment for malaria. Multi-level strategies should be employed to address the use of alternative forms of treatment for malaria within the context of urban poverty.

Our study suggests high hypertension prevalence in Ghana, with low rates of awareness, treatment and control. Socio-economic and demographic factors are essential correlates of hypertension awareness and treatment in Ghana. The findings indicate the need to develop pragmatic intervention approaches such as rigorous education programs and use of the task-shifting system, in addressing hypertension and issues related to it.

This paper describes conceptual, methodological, and practical insights from a longitudinal social psychological project that aims to build cardiovascular disease (CVD) competence in a poor community in Accra, Ghana's capital. Informed by a social psychology of participation approach, mixed method data included qualitative interviews and household surveys from over 500 community members, including people living with diabetes, hypertension, and stroke, their caregivers, health care providers, and GIS mapping of pluralistic health systems, food vending sites, bars, and physical activity spaces. Data analysis was informed by the diagnosis‐psychosocial intervention‐reflexivity framework proposed by Guareschi and Jovchelovitch. The community had a high prevalence of CVD and risk factors, and CVD knowledge was cognitive polyphasic. The environment was obesogenic, alcohol promoting, and medically pluralistic. These factors shaped CVD experiences and eclectic treatment seeking behaviours. Psychosocial interventions included establishing a self‐help group and community screening and education. Applying the “AIDS‐competent communities” model proposed by Campbell and colleagues, we outline the psychosocial features of CVD competence that are relatively easy to implement, albeit with funds and labour, and those that are difficult. We offer a reflexive analysis of four challenges that future activities will address: social protection, increasing men's participation, connecting national health policy to community needs, and sustaining the project.

Background: Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving 'Health for All.' The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana's flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services. Objectives: This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved. Method: Three dimensions of access to CHPS care were investigated: geographic, social, and financial. Focus group data were collected in 40 sessions conducted in eight communities located in two districts each of the Northern and Volta Regions. Groups were comprised of 327 participants representing four types of potential clientele: mothers and fathers of children under 5, young men and young women ages 15-24. Results: Posting trained primary health-care nurses to community locations as a means of improving primary health-care access is emphatically supported by focus group participants, even in localities where CHPS is not yet functioning. Despite this consensus, comments on CHPS activities suggest that CHPS services are often compromised by cultural, financial, and familial constraints to women's health-seeking autonomy and by programmatic lapses constrain implementation of key components of care. Respondents seek improvements in the quality of care, community engagement activities, expansion of the range of services to include emergency referral services, and enhancement of clinical health insurance coverage to include preventive health services. Conclusion: Improving geographic and financial access to CHPS facilities is essential to UHC, but responding to community need for improved outreach, and service quality is equivalently critical to achieving this goal.

Despite the crucial role played by informal markets in food distribution globally, the sector is ignored and marginalized. This study examined vegetable traders, the trading infrastructure available to them in the market, and how they conduct their businesses to explain the high food safety challenges in the sector. This paper is based on a survey, a learning journey, and transformation labs with market traders in Kumasi, Ghana. The study revealed that most traders were self-employed women with low education who worked for long hours. Access to electricity, water, refrigerators, and storage facilities was limited in the market. Vegetable spoilage was the highest cost associated with their trade. Due to the high spoilage rate, the traders sold the best vegetables at high prices and sold the bruised and rotten vegetables to local eateries and animal farms. The women made no losses through these strategies but used unsafe food handling practices and highly-priced wholesome vegetables. Their actions can reduce urban food security, especially in low-income households. Access to market infrastructure was influenced by availability, power and cost. Vegetable trading was the predominant livelihood of the traders. To improve the efficiency of the sector, efforts can be made toward the provision of services at the markets, and advocacy of the traders about food security implications of their actions by the municipal assemblies and market leaders.

Background: The United Nations 2030 Sustainable Development Goals have reaffirmed the international community's commitment to maternal, newborn, and child health, with further investments in achieving quality essential service coverage and financial protection for all. Objective: Using a modified version of the 1978 Tanahashi model as an analytical framework for measuring and assessing health service coverage, this paper aims to examine the system of care at the community level in Ghana's Volta Region to highlight the continued reforms needed to achieve Universal Health Coverage.Methods: The Tanahashi model evaluates health system coverage through five key measures that reflect different stages along the service provision continuum: availability of services; accessibility; initial contact with the health system; continued utilization; and quality coverage. Data from cross-sectional household and health facility surveys were used in this study. Immunization and antenatal care services were selected as tracer interventions to serve as proxies to assess systems bottlenecks. Results: Financial access and quality coverage were identified as the biggest bottlenecks for both tracer indicators. Financial accessibility, measured by enrollment in Ghana's National Health Insurance Scheme was poor with 16.94% presenting valid membership cards. Childhood immunization was high but dropped modestly from 93.8% at initial contact to 76.7% quality coverage. For antenatal care, estimates ranged from 65.9% at initial visit to 25.1% quality coverage. Conclusion: Results highlight the difficulty in achieving high levels of quality service coverage and the large variations that exist within services provided at the primary care level. While vertical investments have been prioritized to benefit specific health services, a comprehensive systems approach to primary health care needs to be further strengthened to reach Ghana's Universal Health Coverage objectives. ARTICLE HISTORY

Background Increasing access to safe abortion methods is crucial for improving women’s health. Understanding patterns of service use is important for identifying areas for improvement. Limited evidence is available in Ghana on factors associated with the type of method used to induce abortion. This paper examined the methods and sources of services used for abortion by women living in poor urban settings of Accra. Methods Data are from a survey that was conducted in 2018 among 1233 women aged 16–44 years who reported ever having had an induced abortion. We estimated a multinomial logistic regression model to examine factors associated with the type of abortion methods women used. We further generated descriptive statistics for the source of abortion services. Results About 50% women used surgical procedures for their last abortion, 28% used medication abortion (MA), 12% used other pills, 3% used injection, and 7% used non-medical methods. However, nearly half (46%) of the women who terminated a pregnancy within the year preceding the survey used medication abortion (MA), 32% used surgical procedures, while 5% used non-medical methods. Women who terminated a pregnancy within three years preceding the survey had a 60% lower chance of using surgical procedures if they did not use MA compared to those who terminated a pregnancy more than 3 years before the survey (Relative Risk Ratio [RRR] 0.4; 95% CI 0.3–0.5). The vast majority (74%) of women who used MA obtained services from pharmacies. Conclusions The use of MA pills to terminate pregnancies has increased in recent years in Ghana and these pills are mostly accessed from pharmacies. This suggests a need for a review of the national guidelines to include pharmacists and chemists in the provision of MA services.