Sociodemographic factors associated with time to discharge for hospitalised patients with asthma and asthma exacerbation using the Ghana Health Service District Information Management System 2 (DHIMS-2) database, 2012–2017

ObjectiveData on asthma hospitalisations are a useful source of patient morbidity information. In Ghana, the length of stay (LoS) and sociodemographic factors of patients hospitalised for asthma and its exacerbation are understudied. We aimed to investigate the time to discharge and assessed factors associated with length of hospital stays of asthmatics in Ghana.MethodsRetrospective analysis of hospitalised patient with asthma records between 2012 and 2017 from the nationwide Ghana Health Service District Health Information Management System 2 database. We calculated the cumulative incidence function for discharge stratified by age group and sex. Multivariable Cox regression was used to investigate the association of sociodemographic characteristics with the LoS.ResultsOf 19 926 asthma-associated hospitalisations, 730 (3.7%) were due to asthma exacerbation. Overall mean age was 34 years (SD=24.6), in 12 000 (60.2%) hospitalisations, patients were female. There were 224 deaths (1.1%). Median LoS was 2 days (IQR: 1–3) with almost 90% of all patients discharged by the seventh day. Age and region were among the covariates showing significant association with LoS. Age below 10 years (HR: 1.39 (1.11 to 1.78)) was associated with early discharge while comorbidity and health insurance ownership were associated with late discharge (p<0.001). LoS did not vary by sex. Compared with the Greater Accra region, patients in other regions had shorter LoS, especially the Ashanti and Upper West regions (p<0.001). LoS increased annually, but was highest in 2016 (HR: 0.94 (0.90 to 0.98)).ConclusionDisparities in LoS across regions, and an overall increasing annual trend in Ghana call for tailored healthcare resource allocation. Longer LoS implies that patients are often absent from school or work leading to substantial financial and emotional costs to individuals and families.

The cost of health workforce gaps and inequitable distribution in the Ghana Health Service: an analysis towards evidence-based health workforce planning and management

Background Despite tremendous health workforce efforts which have resulted in increases in the density of physicians, nurses and midwives from 1.07 per 1000 population in 2005 to 2.65 per 1000 population in 2017, Ghana continues to face shortages of health workforce alongside inefficient distribution. The Ministry of Health and its agencies in Ghana used the Workload Indicators of Staffing Needs (WISN) approach to develop staffing norms and standards for all health facilities, which is being used as an operational planning tool for equitable health workforce distribution. Using the nationally agreed staffing norms and standards, the aim of this paper is to quantify the inequitable distribution of health workforce and the associated cost implications. It also reports on how the findings are being used to shape health workforce policy, planning and management. Methods We conducted a health workforce gap analysis for all health facilities of the Ghana Health Service in 2018 in which we compared a nationally agreed evidence-based staffing standard with the prevailing staffing situation to identify need-based gaps and inequitable distribution. The cost of the prevailing staffing levels was also compared with the stipulated standard, and the staffing cost related to inequitable distribution was estimated. Results It was found that the Ghana Health Service needed 105,440 health workers to meet its minimum staffing requirements as at May 2018 vis-à-vis its prevailing staff at post of 61,756 thereby leaving unfilled vacancies of 47,758 (a vacancy rate of 41%) albeit significant variations across geographical regions, levels of service and occupational groups. Of note, the crude equity index showed that in aggregate, the best-staffed region was 2.17 times better off than the worst-staffed region. The estimated cost (comprising basic salaries, market premium and other allowances paid from central government) of meeting the minimum staffing requirements was estimated to be GH¢2,358,346,472 (US$521,758,069) while the current cost of staff at post was GH¢1,424,331,400 (US$315,117,566.37), resulting in a net budgetary deficit of 57% (~ US$295.4 million) to meet the minimum requirement of staffing for primary and secondary health services. Whilst the prevailing staffing expenditure was generally below the required levels, an average of 28% (range 14–50%) across the levels of primary and secondary healthcare was spent on staff deemed to have been inequitably distributed, thus providing scope for rationalisation. We estimate that the net budgetary deficit of meeting the minimum staffing requirement could be drastically reduced by some 30% just by redistributing the inequitably distributed staff. Policy implications Efficiency gains could be made by redistributing the 14,142 staff deemed to be inequitably distributed, thereby narrowing the existing staffing gaps by 30% to 33,616, which could, in turn, be filled by leveraging synergistic strategy of task-sharing and/or new recruitments. The results of the analysis provided insights that have shaped and continue to influence important policy decisions in health workforce planning and management in the Ghana Health Service.

EXCLUSIVE BREASTFEEDING PRACTICES AMONG NURSES WORKING IN THE UPPER WEST REGIONAL HOSPITAL OF GHANA

Health workers are in general the first advocate of health benefits and are regarded as role models in whatever they teach especially when it comes to exclusive breastfeeding (EBF) practices. This study sought to find out the current breastfeeding practices of nurses (mothers) in the Upper West Regional Hospital. The study used a descriptive survey design involving 80 female health workers of the Wa Regional Hospital with a child aged more than 6 months. A structured questionnaire was administered to respondents. The study found out that majority of the respondents practiced exclusive breastfeeding. This means that majority of the female nurses working at the Wa Regional Hospital practiced exclusive breastfeeding. The study also found out that majority of the respondents' current feeding practice is breast milk with formula and they also used more than one (1) week in doing exclusive breastfeeding. The study found out that the level of maternal education, social class, mother’s comfort in breastfeeding, father’s occupation, religion, and hospital-related (obstetric and pediatric) factors inform mother’s decision to initiate and continue exclusive breastfeeding. It emerged from the study that the attitudes of mothers regarding breastfeeding, mother-infant bonding, mode of delivery, and family support are also important in initiation and sustaining breastfeeding. Based on the findings of the study, it is recommended that Ministry of Health and Ghana Health Service workers especially female nurses working in the Wa Regional Hospital shouldeducate females who are mothers in the Wa Municipality of the Upper West Region of Ghana on the importance of exclusive breastfeeding practices. The study further recommends that the Ministry of Health and Ghana Health Service should empower health care providers (females) with skill and knowledge on exclusive breastfeeding practices and to initiate campaign on the importance of exclusive breastfeeding through social and developments women groups.Keywords: Breastfeeding Practices, Nurses, Upper West, Regional Hospital, Ghana

THE EFFECTS OF STRESS ON PERFORMANCE OF WORKERS IN GHANA HEALTH SERVICE IN WA MUNICIPAL

In today’s competitive global environment, employee performance is an essential element of a company’s success. Employee performance can be significantly hindered by high levels of stress experienced in the work environment. Stress is a universal element and persons from nearly every walk of life have to face it. Employers today are critically analyzing the stress management issues that contribute to lower job performance of employees. The main aim of the study was to evaluate stress and its effect on employees’ performance. The study was conducted at Ghana Health Service, Wa Municipal. Descriptive survey was adopted as the research design. Purposive and simple random sampling techniques were used in selecting a sample size of 50 out of a population of 100. Questionnaires were used as data collection instrument. From the results obtained, it was evident that there were many stress factors that the respondents endured, and the enquiry proved that stress has an effect on performance. Majority of the respondents reported to work under pressure and that they feel uncared for by the organization. The fact that majority of respondents thought of leaving their job, and felt that the organization did not care about them was a reflection of huge dissatisfaction that undoubtedly lowered performance. It was recommended that Management must conduct an analysis of the organizational mood and climate by assessing the reasons why the employees think Ghana Health Service does not care about its employees and what they can do to change it. It was also suggested that an Employee Assistance Programme be introduced for early identification and intervention on problems so that performance levels do not decrease.Keywords: Stress, Performance, Ghana Health Service Workers, Wa Municipal.

The cost of health workforce gaps and inequitable distribution in the Ghana Health Service: An analysis towards evidence-based health workforce planning and management.

Background: Despite tremendous health workforce efforts which have resulted in increases in the density of physicians, nurses and midwives from 1.07 per 1,000 population in 2005 to 2.65 per 1,000 population in 2017, Ghana continues to face shortages of health workforce alongside inefficient distribution. The Ministry of Health and its agencies in Ghana used the Workload Indicators of Staffing Needs (WISN) approach to develop staffing norms and standards for all health facilities, which is being used as an operational planning tool for equitable health workforce distribution. Using the nationally agreed staffing norms and standards, the aim of this paper is to quantify the inequitable distribution of health workforce and the associated cost implications. It also reports on how the findings are being used to shape health workforce policy, planning and management. Methods: We conducted a health workforce gap analysis for all health facilities of the Ghana Health Service in 2018 in which we compared a nationally agreed evidence-based staffing standard with the prevailing staffing situation to identify need-based gaps and inequitable distribution. The cost of the prevailing staffing levels was also compared with the stipulated standard, and the staffing cost related to inequitable distribution was estimated. Results: It was found that the Ghana Health Service needed 105,440 health workers to meet its minimum staffing requirements as at May 2018 vis-à-vis its prevailing staff at post of 61,756 thereby leaving unfilled vacancies of 47,758 (a vacancy rate of 41%) albeit significant variations across geographical regions, levels of service and occupational groups. Of note, the crude equity index showed that in aggregate, the best-staffed region was 2.17 times better off than the worst staffed region. The estimated cost (comprising basic salaries, market premium and other allowances paid from central government) of meeting the minimum staffing requirements was estimated to be GH¢2,358,346,472 (US$521,758,069) while the current cost of staff at post was GH¢1,424,331,400 (US$315,117,566.37), resulting in a net budgetary deficit of 57% (~US$295.4 million) to meet the minimum requirement of staffing for primary and secondary health services. Whilst the prevailing staffing expenditure was generally below the required levels, an average of 28% (range: 14-50%) across the levels of primary and secondary healthcare was spent on staff deemed to have been inequitably distributed, thus providing scope for rationalisation. We estimate that the net budgetary deficit of meeting the minimum staffing requirement could be drastically reduced by some 30% just by redistributing the inequitably distributed staff.Policy Implications: Efficiency gains could be made by redistributing the 14,142 staff deemed to be inequitably distributed, thereby narrowing the existing staffing gaps by 30% to 33,616, which could, in turn, be filled by leveraging synergistic strategy of task sharing and/or new recruitments. The results of the analysis provided insights that have shaped and continue to influence important policy decisions in health workforce planning and management in the Ghana Health Service.

The cost of health workforce gaps and inequitable distribution in the Ghana Health Service: An analysis towards evidence-based health workforce planning and management.

Background: Despite tremendous health workforce efforts which have resulted in increases in the density of physicians, nurses and midwives from 1.07 per 1,000 population in 2005 to 2.65 per 1,000 population in 2017, Ghana continues to face shortages of health workforce alongside inefficient distribution. The Ministry of Health and its agencies in Ghana used the Workload Indicators of Staffing Needs (WISN) approach to develop staffing norms and standards for all health facilities, which is being used as an operational planning tool for equitable health workforce distribution. Using the nationally agreed staffing norms and standards, the aim of this paper is to quantify the inequitable distribution of health workforce and the associated cost implications. It also reports on how the findings are being used to shape health workforce policy, planning and management. Methods: We conducted a health workforce gap analysis for all health facilities of the Ghana Health Service in 2018 in which we compared a nationally agreed evidence-based staffing standard with the prevailing staffing situation to identify need-based gaps and inequitable distribution. The cost of the prevailing staffing levels was also compared with the stipulated standard, and the staffing cost related to inequitable distribution was estimated. Results: It was found that the Ghana Health Service needed 105,440 health workers to meet its minimum staffing requirements as at May 2018 vis-à-vis its prevailing staff at post of 61,756 thereby leaving unfilled vacancies of 47,758 (a vacancy rate of 41%) albeit significant variations across geographical regions, levels of service and occupational groups. Of note, the crude equity index showed that in aggregate, the best-staffed region was 2.17 times better off than the worst staffed region. The estimated cost (comprising basic salaries, market premium and other allowances paid from central government) of meeting the minimum staffing requirements was estimated to be GH¢2,358,346,472 (US$521,758,069) while the current cost of staff at post was GH¢1,424,331,400 (US$315,117,566.37), resulting in a net budgetary deficit of 57% (~US$295.4 million) to meet the minimum requirement of staffing for primary and secondary health services. Whilst the prevailing staffing expenditure was generally below the required levels, an average of 28% (range: 14-50%) across the levels of primary and secondary healthcare was spent on staff deemed to have been inequitably distributed, thus providing scope for rationalisation. We estimate that the net budgetary deficit of meeting the minimum staffing requirement could be drastically reduced by some 30% just by redistributing the inequitably distributed staff.Policy Implications: Efficiency gains could be made by redistributing the 14,142 staff deemed to be inequitably distributed, thereby narrowing the existing staffing gaps by 30% to 33,616, which could, in turn, be filled by leveraging synergistic strategy of task sharing and/or new recruitments. The results of the analysis provided insights that have shaped and continue to influence important policy decisions in health workforce planning and management in the Ghana Health Service.

The cost of health workforce gaps and inequitable distribution in the Ghana Health Service: An analysis towards evidence-based health workforce planning and management.

Background: Despite tremendous health workforce efforts which has resulted in increases in the density of physicians, nurses and midwives from 1.07 per 1,000 population in 2005 to 2.65 per 1,000 population in 2017, Ghana continue to face sub-optimal levels of health workforce alongside inefficient distribution. This paper reports on the use of a nationally agreed health facilities staffing standard to quantify the aggregate number of health workers who are inequitably distributed the associated cost implications as well as how the findings are being used to shape health workforce policy, planning and management. Methods: We conducted health workforce gap analysis for all health facilities of the Ghana Health Service in 2018 in which we compared a nationally-agreed evidence-based staffing standard with the prevailing staffing situation to identify need-based gaps and inequitable distribution. The cost of the prevailing staffing levels was also compared with the stipulated standard and the staffing cost related to inequitable distribution was estimated. Results: It was found that the Ghana Health Service needed 105,440 health workers to meet its minimum staffing requirements as at May 2018 vis-à-vis its prevailing staff at post of 61,756 thereby leaving unfilled vacancies of 47,758 (a vacancy rate of 41%) albeit significant variations across geographical regions, levels of service and occupational groups. Of note, the crude equity index showed that in aggregate, the best staffed region was 2.19 times better off than the worst staffed region. The estimated cost (comprising basic salaries, market premium and other allowances paid from central government) of meeting the minimum staffing requirements was estimated to be GH¢2,358,346,472 (US$521,758,069) while the current cost of staff at post was GH¢1,424,331,400 (US$315,117,566.37), resulting in a net budgetary deficit of 57% (~ US$295.4 million) to meet the minimum requirement of staffing for primary and secondary health services. Whilst the prevailing staffing expenditure is generally below the required levels, an average of 22% (range: 14–50%) across the levels of primary and secondary healthcare were spent on staff deemed to have been inequitably distributed, hence provides scope for rationalisation. We estimate that the net budgetary deficit of meeting the minimum staffing requirement could be drastically reduced by some 30% just by redistributing the inequitably distributed staff. Policy Implications: Efficiency gains could be made by redistributing the 14,142 staff deemed to be inequitably distributed, thereby narrowing the existing staffing gaps by 30% to 33,616, which could, in turn, be filled by leveraging synergistic strategy of task sharing and/or new recruitments. The results of the analysis provided insights that have shaped and continue to influence important policy decisions in health workforce planning and management in the Ghana Health Service.

An evaluation of tuberculosis surveillance system in a health district in Ghana

Background: Tuberculosis remains a major global health problem. It is one of the top 10 causes of death worldwide. In Africa, there were estimated 2.7 million new cases of tuberculosis and 450 thousand deaths in 2014. In Ghana, incidence rate of TB was estimated to be 152 per 100,000 populations in 2017 according to the WHO estimates. We evaluated a health district (Ejisu-Juaben) Tuberculosis surveillance system to describe its operations, attributes, determine its usefulness and whether its objectives were being met.Methods: This descriptive study was conducted using the Center for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems and the Ghana Health Service Standard Operating Procedures for priority diseases and conditions (2012). Study participants who were purposively sampled were interviewed with a semi-structured questionnaires and dataset from January 2016 to December 2018 were reviewed at various levels of the surveillance system. Data was collected and analyzed with Epi Info 7.2 between 1st February, 2019 and 30th April, 2019.Results: The surveillance system was useful and partially met its objectives and targets. It was well structured, simple, stable, flexible and of good data quality. It was also averagely acceptable and representative. However, it recorded poor sensitivity of 15.12% and poor predictive value positive (PVP) of 12.27% in 2018. The yearly total cost of operation of the TB surveillance system was ¢79,950.76 ($16,316.44 USD).Conclusions:The surveillance system was useful and met its objectives partially. The sensitivity, PVP, acceptability and representativeness need improvement in order to justify its relevance.