Search

Establishing effective pharmaceutical governance is a challenge for government agencies, private enterprises, and professionals working on the ground, demanding complex ethical decisions from the actors involved, especially in a lower-middle-income country like Ghana. This letter aims to share the author's perspectives and additional considerations on the analyses of the reports in the paper "It is very difficult in this business if you want to have a good conscience": pharmaceutical governance and on-the-ground ethical labor in Ghana by Hampshire et al. The letter's authors discuss the need to advance universal health coverage in Ghana, the everyday ethics, and the disparities between the collective and individual moral consciousness of the participants, as well as other aspects of governance in the pharmaceutical sector. [ABSTRACT FROM AUTHOR]

The governance of pharmaceutical medicines entails complex ethical decisions that should, in theory, be the responsibility of democratically accountable government agencies. However, in many Low- and Middle-Income Countries (LMICs), regulatory and health systems constraints mean that many people still lack access to safe, appropriate and affordable medication, posing significant ethical challenges for those working on the "front line". Drawing on 18 months of fieldwork in Ghana, we present three detailed case studies of individuals in this position: an urban retail pharmacist, a rural over-the-counter medicine retailer, and a local inspector. Through these case studies, we consider the significant burden of "ethical labour" borne by those operating "on the ground", who navigate complex moral, legal and business imperatives in real time and with very real consequences for those they serve. The paper ends with a reflection on the tensions between abstract, generalised ethical frameworks based on high-level principles, and a pragmatic, contingent ethics-in-practice that foregrounds immediate individual needs – a tension rooted in the gap between the theory and the reality of pharmaceutical governance that shifts the burden of ethical labour downwards and perpetuates long-term public health risks. [ABSTRACT FROM AUTHOR]

Climatic impacts on the environment, land cover and land use change such as urbanisation and deforestation affect rainfall and change riverflow responsiveness and seasonal flows as a result of their influence on nonlinear behaviour of the catchments of rivers. Water supply is seriously affected which invariably impacts on domestic activities and agriculture. In some countries river transportation, hydropower, irrigation and fish farming are at risk due to these impacts. Within this paper, a review of existing hydrological and climatic studies in Africa and Ghana in particular is presented. The paper highlights the knowledge gaps identified in the review, such as rainfall-riverflow processes and their controls in the country, estimation of cycles in evapo-transpiration and solar radiation time series, together with the complete characterisation of the temporal and spatial fluctuations within the climate cycles. The establishment of a monograph of catchment response characteristic across the Ghanaian latitudinal gradient and if possible across the tropics is recommended. This could be used for the prediction of hydrologic response of ungauged catchments in the country. [ABSTRACT FROM AUTHOR]

Previous research has consistently highlighted the importance of stakeholder engagement in identifying and developing solutions to ethical challenges in genomic research, especially in Africa where such research is relatively new. In this paper, we examine what constitutes good ethical practice in research, from the perspectives of genomic research participants in Uganda. Our study was part of a multi-site qualitative study exploring these issues in Uganda, Ghana and Zambia. We purposively sampled various stakeholders including genomic research participants, researchers, research ethics committee members, policy makers and community members. This paper presents the findings from in-depth interviews with 27 people with diabetes who had participated in a diabetes genomic study. Data were collected using semi-structured interviews. Manual thematic content analysis was conducted using a framework approach. Findings indicate three key requirements that research participants see as vital for genomic research to be more responsive to research participants' needs and contextual realities: (1) de-emphasising the role of experts and institutions in the consenting process, (2) clarity about the timing and nature of feedback both of findings relevant to the health of individuals and about the broad progress of the study, and (3) more effective support for research participants during and after the study. [ABSTRACT FROM AUTHOR]

Genomic research and biobanking present several ethical, social and cultural challenges, particularly when conducted in settings with limited scientific research capacity. One of these challenges is determining the model of consent that should support the sharing of human biological samples and data in the context of international collaborative research. In this paper, we report on the views of key research stakeholders in Ghana on what should count as good ethical practice when seeking consent for genomic research and biobanking in Africa. This study was part of a multi-country qualitative case study conducted in three African countries: Ghana, Uganda and Zambia under the auspices of the Human Heredity and Health in Africa initiative (H3Africa). Our study suggests that while participants are willing to give consent for their samples and associated data to be used for future research purposes, they expect to receive feedback about the progress of the research and about the kinds of research being undertaken on their samples and data. These expectations need to be anticipated and discussed during the consent process which should be seen as part of an ongoing communication process throughout the research process. [ABSTRACT FROM AUTHOR]

The recent surge in the marketisation of the commons in Africa – especially of water bodies – warrants careful political economic analysis. Three questions remain intractable: (1) Were there markets in the beginning? If so, how have they transformed and if not, how did markets arise and transform over the years? (2) what are the outcomes of such markets for people, their livelihoods, and their environment? And (3) how to interpret the outcomes of water markets and whether water should be commodified at all. For new institutional economists, water markets have arisen because of the inferior nature of Indigenous or customary systems which are incapable of offering precisely what water markets offer Africa: economic and ecological fortunes. Using an institutional political economy approach and drawing on experiences in Ghana, the paper investigates the social history of marketisation of the commons and probes the effects of marketisation in terms of absolute, relative, and differential/congruent outcomes as well as the opportunity cost of the current water property rights regime. The empirical evidence shows that markets have been socially created through imposed and directed policies. Some jobs have been created through investment, but such employment is not unique to marketisation and private investment. Indeed, the private model of property rights has worsened the distribution of water resources not only within different property relations in Africa but also between diverse property relations. Water markets have been responsible for much displacement and trouble not only for communities but also nature. Overall, there is no necessary congruence between the promises made by new institutional economists and how communities experience water markets. Tighter regulations for the use of inland and transboundary water sources might temporarily halt the displacement of communities sparked by marketisation of the commons, but only one fundamental change can guarantee community well-being: to regard the access to and community control of water as constitutionally sanctioned human rights and asres communis. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence about the prevalence of depression among older people in sub-Saharan Africa, about access to treatment or the potential efficacy of community-based interventions. Objective: Using nationally representative data from the WHO SAGE survey, we examine the prevalence of and factors associated with depression among people aged 50 and over in Ghana. Compare self-reported diagnosis and a symptom algorithm to assess treatment gaps and factors associated with the size of gap. Assess the feasibility of a small community-based intervention specifically for older people. Method: Prevalence and treatment data were taken from the WHO SAGE 2007 survey in Ghana, including 4,725 people aged 50 or over. Outcomes of interest were self-reported depression and diagnosis of depression derived from a symptom-based algorithm. The data were subjected to bivariate and multivariate analysis. In parallel, a pilot intervention was conducted with 35 older people, which included screening by a trained psychiatrist and follow-up group sessions of psychotherapy. Results: The symptomatic algorithm reported an overall rate of 9.2 per cent for the study population, with associations with female sex and older age. The treatment gap for these cases was found to be 83.0 per cent. The implementation of the pilot study was perceived as effective and replicable by stakeholders and there was some evidence of enhanced outcomes for people with mild depression. Conclusions: Large numbers of older people in Ghana experience depression, but very few have access to treatment. There is an urgent need to develop and validate community-based services for older people experiencing this condition. [ABSTRACT FROM AUTHOR]

Social and environmental factors are increasingly recognized for their ability to influence health outcomes at both individual and neighborhood scales in the developing urban world. Yet issues of spatial heterogeneity in these complex environments may obscure unique elements of neighborhood life that may be protective or harmful to human health. Resident perceptions of neighborhood effects on health may help to fill gaps in our interpretation of household survey results and better inform how to plan and execute neighborhood-level health interventions. We evaluate differences in housing and socioeconomic indicators and health, environment, and neighborhood perceptions derived from the analysis of a household survey and a series of focus groups in Accra, Ghana. We then explore how neighborhood perceptions can inform survey results and ultimately neighborhood-level health interventions. Eleven focus groups were conducted across a socioeconomically stratified sample of neighborhoods in Accra, Ghana. General inductive themes from the focus groups were analyzed in tandem with data collected in a 2009 household survey of 2,814 women. In-depth vignettes expand upon the three most salient emergent themes. Household and socioeconomic characteristics derived from the focus groups corroborated findings from the survey data. Focus group and survey results diverged for three complex health issues: malaria, health-care access, and sense of personal agency in promoting good health. Three vignettes reflecting community views about malaria, health-care access, and sense of personal agency in promoting good health highlight the challenges facing community health interventions in Accra and exemplify how qualitatively derived neighborhood-level health effects can help shape health interventions. [ABSTRACT FROM AUTHOR]