Understanding the paradox of high health insurance enrolment in a hungry region: Food insecurity and health insurance in the Upper West region of Ghana
Roger Antabe, Kilian Atuoye, Yuiro Sano, Sierra Vercillo, Vincent Kuuire and Isaac Luginaah
As the world evaluates the impact of the MDGs in member countries in preparation for Sustainable Development Goals (SGDs), Ghana has been touted as a shining example in sub-Saharan Africa for meeting the goal on reducing hunger by halve ahead of schedule. Meanwhile there are marked in-country disparities that mask national statistics. The Upper West Region in Ghana is the poorest yet the region with the highest National Health Insurance Scheme (NHIS) enrolment. This study examines the association between household food insecurity and NHIS enrolment to further explore the paradoxical relationship between high poverty (food insecurity) and high NHIS enrolment in the region. Data for the study was derived from a representative survey of 1,438 households conducted in the Upper West Region of Ghana in 2014. Using binary logistics regression models to fit the data, we found food insecurity status of a household is a significant predictor of NHIS utilization. Households that are food secure and moderately food insecure are more likely to enrol into the NHIS compared with households that are severely food insecure (OR=2.70, p<0.1 and OR=1.50, P<0.01, respectively). Education, wealth, and religion are also significant predictors of NHIS enrolment. Even though Ghana has made significant progress in universal health access and reduction in extreme hunger, there are still worrying intra-country disparities. Our findings suggest a comprehensive approach to reducing poverty and food security as a way of sustaining and improving gains made on health access in poverty endemic areas such as the Upper West Region of Ghana.
Keywords: MDGs, SDGs, NHIS, Food in/security, Ghana, Sub-Saharan Africa
Household food insecurity as a social determinant of mental health among household heads in the Upper West Region of Ghana
Kilian Nasung Atuoye and Isaac Luginaah
Food insecurity is a global health problem and sub-Saharan Africa (SSA) has the greatest burden. Theoretical and empirical studies suggest various relationships between food insecurity and mental health, which are mostly mediated by contextual factors. This association is underexplored in low and middle-income countries even though they carry the greatest burden of food insecurity and ill health. Food as a social determinant of health is also an underserved research area in SSA. Developing interventions for food security, health and wellbeing will require an understanding of the complex relationship between these variables. In response, this paper examines the relationship between household food insecurity and perceived mental health of household heads in the Upper West Region (UWR) of Ghana. The study used cross-sectional data collected from 1,438 household heads from May to August 2014 as part of a bigger food security project. The data was analyzed using ordinary least squares regressions and margins post-estimation. The findings show that heads of moderately food insecure (b = 0.175, p<0.001) and food secure households (b = 0.934, p<0.001) report higher scores of optimal mental health compared with heads of severely food insecure households. Also females, those who reported consuming alcohol, and those who report receipt of remittance reported lower perceived mental health scores. Distance to health facility was the strongest predictor of perceived optimal mental health and mediates the relationship between food insecurity and perceived mental health. These results highlight the psychosocial effects of food insecurity in this context, and suggest the need for policy intervention.
Key Words: Food insecurity, mental health, Africa, Ghana, Social Determinants of Health
Correlates of discriminatory attitudes towards PLWH in Nigeria: Does gender matter?
Lucia Hussey, Yujiro Sano, Roger Antabe, Killian Atuoye, and Isaac Luginaah
Although the determinants of HIV-related stigma has been explored, there is limited research examining how these factors differ by gender, particularly in sub-Saharan Africa. Local contextual factors have strong influence in shaping different understanding of psychosocial constructs such as HIV stigma among males and females. Consequently this study examines the gender differences in factors associated with HIV-related stigma in Nigeria. Using the 2013 Nigeria Demographic and Health Survey and applying logistic regression model, this study makes an important contribution to the literature. Our findings indicate that more than 60% of both males and females have discriminatory attitudes towards people living with HIV (PLWH). Further, while women who were married were 10% more likely to stigmatise compared to those never married, there was no significant difference among their male counterparts. Also, while Muslim women were less likely (OR=0.800, p<0.001), Muslim men were more likely (OR=1.167, p<0.001) to stigmatise PLWH. Moreover, men who were working were less likely to have HIV-related stigma compared to those who were not, although this was not significant for women. These findings call for gender and context specific strategies in addressing HIV-related stigma and discrimination.
Key words: HIV; Stigma; Gender; DHS; Logistic Regression; Nigeria
Adaptation Information Management Study in the Philippines
Katherine Laycock & Carrie Mitchell
As the effects of climate change become more evident the need for effective adaptation increases as well. Although many organization are researching adaptation projects, few are looking at the most effective way to disseminate the lessons learned. This project attempts to do exactly that with climate change officials throughout the Philippines. In collaboration with the International Development Research Centre (IDRC), Coastal Cities at Risk (CCaR), and the International Council for Local Environmental Initiatives (ICLEI), this project aims to determine the most effective method of information delivery to local Philippines officials. To date, our online survey has received 55 responses from various Local Government Units (LGUs) and conducted 30 in-depth, follow-up interviews with select officials throughout the country. The preliminary results from this data show a need for: more hands-on training; greater focus on local capacity building rather than collaboration with external experts; less reliance on internet access; and more local and specific information sources. While these results are specific to Philippines’ information management needs, findings can, in many ways, relate to other developing countries’ needs for development action and more effective collaboration in the face of climate change impacts.
Gender-responsive evaluation of water, sanitation, and hygiene interventions in low- and middle-income countries: a meta-evaluation
Stephanie K. Lu & Susan J. Elliott
2.3 billion people gained access to improved drinking-water between 1990 and 2012; that leaves 748 million without access and 2.5 billion without access to improved sanitation (WHO/UNICEF 2014). These millions of affected individuals, living primarily in low- and middle-income countries (LMICs), are the world’s most vulnerable, with women being affected disproportionally. Women have unique needs with respect to water, sanitation, and hygiene (WaSH); for example, cultural expectations for women to collect water for their families and defecate in the open when private sanitation facilities are unavailable have serious implications on women’s health and well-being. In response, a wide range of agencies (governmental, NGO, faith-based) have undertaken interventions in LMICs. However, there is some doubt as to whether these interventions have accounted for/addressed the unique needs of women given our failure to meet Target 7.C of the MDGs. Evidence suggests that a lack of appreciation for the role of gender in WaSH may be a contributing factor. To explore the gap between our understanding of women’s unique needs and how they are translated into WaSH intervention design, we conducted a meta-evaluation of the literature. Key-findings indicate that gender-responsive evaluation is an underutilized approach. Going forward, we propose a transdisciplinary approach to WaSH evaluation that allows a truly gendered perspective (i.e., incorporating views of both men and women) in order to assess success/impact of interventions. This has four key components: 1) encouraging evaluators to work with scientists and experts from all disciplines to determine research priorities and best practices in WaSH; 2) holding evaluators accountable to examining interventions within a broader context, including the social, environmental, economic, and political dimensions of water; 3) using theoretical frameworks to inform evaluation methodology; and 4) privileging local/indigenous knowledge by using participatory methods to facilitate the evaluation process.
Pwojè Piti Wazo: Harnessing local experience and indigenous knowledge to reduce maternal mortality in rural Haiti
Tonya MacDonald RM, MPH
The 2010 United Nations data on Haiti’s maternal mortality ratio indicate a ratio of 350 maternal deaths per 100,000 live births, although these data lack complete registration of maternal deaths (UN). The number of women dying in pregnancy and childbirth in Haiti remains unacceptably high.
The purpose of this project, Pwojè Piti Wazo, was to explore a rural Haitian community’s perspectives on maternal mortality within their community. Through a community-based action research approach this project aimed to harness the local experience and indigenous knowledge of community members to understand the socio-ecological determinants of maternal health and to identify community-driven solutions to reduce maternal mortality. It was hoped that through local ownership and engagement in the project that community-based accountability of maternal mortality (the “fourth delay”) would be optimized.
This project involved research collaboration of a “South-North” partnership: four community members, a Haitian Co-Lead (nurse-midwife), and a Canadian Co-Lead (midwife/student researcher) formed the Community Research Team. The research collaboration was meant to create a sustainable South-North partnership for future community-based research within the same community. This project also aimed to bridge a current literature gap where there is a paucity of research that combines a local perspective on the determinants of maternal mortality and the impact of the “fourth delay”.
The poster presentation will provide background on Pwojè Piti Wazo, study methods and findings, and will be of particular interest to participants who value South-North global partnerships aimed at improving women’s health through community participation.
Reference: United Nations (UN). The Official United Nations site for the MDG indicators: Haiti. Available at http://mdgs.un.org/unsd/mdg/Data.aspx.
A Community Based Water Pollution Sampling Program in Zambian Mining Regions
Hillary Waters1 and Jack Powers2
- University of Minnesota, Department of Geography
- University of Minnesota, Department of Philosophy
In Zambian mining regions, serious baseline water pollution is punctuated by episodes of ecological and public health crisis. Residents are routinely hospitalized and critical water services are interrupted due to water pollution. We describe an upcoming community participation water sampling project that aims to make scientific knowledge more accessible and responsive to the concerns of Zambian women who are typically responsible for gathering water, but who may often not have access to scientific knowledge about local water quality. Interviews will provide a baseline understanding of how Zambian women access water, understand pollution, and their degree of local environmental knowledge and concern. A training workshop on water sampling techniques will provide the women with knowledge and materials to collect samples at water access points. The water samples will then be analyzed in a university laboratory. Focus groups will then be held to disseminate findings. Questions in the focus groups will aim to uncover what formal channels for reporting pollution residents know about and determine what, if any, political strategy women might be using to negotiate water pollution in their environment. Philosophers of science have argued that trustworthiness is an essential criterion of scientific objectivity. Thus, additional focus-group questions will aim to uncover the degree of trust that women have in the knowledge produced by the project in which they participated, and the degree to which they felt that the project was responsive to their concerns. Upon completion of the project, we will suggest strategies to improve the trustworthiness of future Zambian water pollution research.
Persistent Misconceptions about HIV transmission among male and females in Malawi
Yujiro Sano, Roger Antabe, Kilian Atuoye, Lucia Hussey, Jason Bayne, Paul Mkandawire, Sylvester Galaa and Isaac luginaah
Background: The prevalence of HIV in Malawi is one of the highest in sub-Saharan Africa, and misconceptions about HIV transmission are considered a major force for the continued spread of the virus. While misconceptions about HIV transmission are widely used as independent variables, only few studies explore the complex nature of endorsing such conceptions in sub-Saharan Africa, including Malawi.
Methods: Using data from the 2010 Malawi Demographic and Health Survey, this paper analyzes prevalence and correlates of misconception about HIV transmission among males and females in Malawi (N = 29,467; M = 6,978; F = 22,489). Binary logistic regression is employed to assess the association between misconceptions about HIV transmission and three sets of theoretically relevant variables, namely behavioural, demographic, and socioeconomic variables.
Results: Wealth status and educational background influence misconceptions about HIV transmission among both women and men. Specifically, wealthier and more educated Malawians are less likely to endorse such misconceptions than their poorer and less educated counterparts. The effects of religion and ethnicity on endorsing misconceptions are only significant among women. Compared to Christian and Tumbuka women, Muslim women and women from any other ethnic group are less likely to endorse such misconceptions. These results indicate sociocultural understanding of HIV transmission requires gender-specific attention. Finally, Malawians who have accurate knowledge about HIV transmission and experience of HIV testing are less likely to endorse misconceptions than those do not have.
Conclusions: Findings from this study can indicate three useful conclusions related to policy implications. First, it is important to provide employment and educational opportunities to reduce misconceptions about HIV transmission in Malawi. Second, rejecting such misconceptions is particularly important among women who belong to Islam and the Tumbuka tribe. Finally, more efforts should be put in providing opportunities for HIV testing and correct knowledge about HIV transmission. These directions may be helpful in reducing misconceptions about HIV transmission and new HIV infections.
Keywords: misconceptions; HIV transmission; Demographic and Health Survey; binary logistic regression; Malawi; sub-Saharan Africa (SSA)
Is Ghana’s Health Insurance Scheme Threatened By A Capitation Policy?
Kilian Nasung Atuoye, Siera Vercillo, Roger Antabe, Sylvester Zackaria Galaa, Isaac Luginaah
Policy makers in developing countries are frequently confronted with challenges of increasing health access for poor populations while improving the financial viability of health insurance schemes. This paper examines the claims and counter-claims about the capitation payment system within Ghana’s National Health Insurance Scheme using content analysis of public and parliamentary debates, and situating it within science, policy and health insurance literature. The ongoing capitation payment debate is about problems within the health care expense claims payment process that has emerged as part of broader systemic challenges facing health insurance in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims on capitation payments that are being contested. The findings show that the health of poor communities, women and children are used as a proxy for political and individual interests in the policy debate and not as an end in itself. The paper recommends a more holistic and participatory approach to health policy making in Ghana and other similar contexts.
Keywords: policy; science; content analysis; health insurance; health; Ghana