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Transdisciplinary research has gained traction globally for mapping pathways for sustainable urbanisation. The involvement of local communities is believed to central to knowledge co-production needed to address sustainability challenges. But working with local communities can be challenging. This paper is structured around the authors' personal reflections on undertaking transdisciplinary household energy conservation projects in Ghana and South Africa. The paper reflects on the assumptions and challenges of doing transdisciplinary research in urban Africa and suggests some guidelines for consideration when doing transdisciplinary projects. An inductive analysis of our reflections showed five key challenges: lack of integration, divergent problem identification, tensions in knowledge co-production, asymmetrical power relations, and distrust and managing expectations. We draw on our collective experiences to develop guidelines for conducting transdisciplinary research in urban Africa. These guidelines are not prescriptive but can be useful for a growing and broader audience interested in undertaking transdisciplinary research. [ABSTRACT FROM AUTHOR]

Drawing on hooks' notion of 'homeplace', Ahmed's theorisation of 'strange encounter,' and Sharpe's rumination on Black being 'in the wake' or afterlife of slavery, this paper reflects on how Aidoo's The Dilemma of a Ghost can help examine the 'Year of Return' project in terms of dwelling. The paper argues that Aidoo's play proffers a pedagogy of intercultural communication and a radical deconstruction of home and kinship. By noting Aidoo's emphasis on intercultural communication, home, and dwelling, the paper demonstrates how the 'Year of Return' can be conceptually enriched and pragmatically organised in ways that seriously consider Aidoo's ethic of dwelling. The paper is, therefore, a corrective to the overemphasis in the 'Year of Return' celebrations on trade, capital, and investment. Finally, the paper sheds light on the relationship between literature and society. [ABSTRACT FROM AUTHOR]

Anti-corruption agencies in Ghana have failed over the years to deal with corruption and also take decisive steps in tackling the menace. For this reason inter alia, the New Patriotic Party (NPP) government in 2018 established the Office of the Special Prosecutor as an institutional response to deal assertively with the issue of corruption. This action expanded the scope and discourse on the fight against corruption in Ghana. Following from this, the paper conceptualised the new institutional endeavour to control corruption in Ghana, simply as the 'judicialization of corruption'. By judicialization of corruption, the paper meant to portray a phenomenon where there is the use of judiciary and judicial processes in fighting corruption. Coming on the back of a political campaign promise, the paper seemly tested Ghanaian voters' view on this new anti-corruption arrangement by the government and puts forward a broad-spectrum of views by voters regarding the creation of the OSP. The paper used mixed method to triangulate both qualitative and quantitative data. The result showed majority of voters backing government's idea to create the OSP albeit a sizeable number perceiving the OSP as a mere conduit to 'witch-hunt' erstwhile government officials. [ABSTRACT FROM AUTHOR]

Pharmaceutical sector corruption undermines patient access to medicines by diverting public funds for private gain and exacerbating health inequities. This paper presents an analysis of UN Convention Against Corruption (UNCAC) compliance in seven countries and examines how full UNCAC adoption may reduce corruption risks within four key pharmaceutical decision-making points: product approval, formulary selection, procurement, and dispensing. Countries were selected based on their participation in the Medicines Transparency Alliance and the WHO Good Governance for Medicines Programme. Each country’s domestic anti-corruption laws and policies were catalogued and analysed to evaluate their implementation of select UNCAC Articles relevant to the pharmaceutical sector. Countries displayed high compliance with UNCAC provisions on procurement and the recognition of most public sector corruption offences. However, several countries do not penalise private sector bribery or provide statutory protection to whistleblowers or witnesses in corruption proceedings, suggesting that private sector pharmaceutical dispensing may be a decision-making point particularly vulnerable to corruption. Fully implementing the UNCAC is a meaningful first step that countries can take reduce pharmaceutical sector corruption. However, without broader commitment to cultures of transparency and institutional integrity, corruption legislation alone is likely insufficient to ensure long-term, sustainable pharmaceutical sector good governance. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between child labour and educational attainment and explores the distinction between harmful and non-harmful agricultural cocoa work. We conduct a secondary analysis of data on 3,338 children who reported attending school in 2018 across cocoa growing regions of Ghana and Côte d’Ivoire. To address differences between harmful and non-harmful child labour, we differentiated work completed by a child by hazardous activity engagement. These groups of child labour were then modelled against educational attainment, defined by a whether or not the child needed to repeat a class. We then conducted mediation analysis to assess whether injury mediates this relationship. Our results show that hazardous child labour increases the odds of repeating a class and work-related injury compared to non-hazardous labour. The effect of hazardous child labour on academic attainment was also found to be mediated by work-related injuries by 14%. Educational attainment is associated with hazardous labour activities and the odds of injury and not the act of participation in agricultural labour alone. Programmes based on strong measures of harmful work will foster better protection for children who are most at risk and may inform global debates around the benefits versus the risks of child labour. [ABSTRACT FROM AUTHOR]

Bioethics provides various models of fair allocation of scarce health resources like COVID-19 vaccines. Even though these models are grounded in some ethical principles like justice and beneficence, there were severe inequalities in global access to COVID-19 vaccines. In Ghana, about 21.5 million COVID-19-doses have been administered but comprise mainly members of the adult population. As a result, ethical issues related to vaccinating children have been largely ignored in the country. This paper explores some of the ethical implications related to children's exclusion in the initial COVID-19 vaccination programs in Ghana. It provides a general overview of the COVID-19 pandemic in Ghana and how it related to children and discusses the risks to which Ghanaian children were exposed by delaying their COVID-19 vaccination. A guide to facilitating the full rollout of COVID-19 vaccination in Ghana for children has been proposed that indicates that a fair vaccine distribution for children should prioritize children on admission at health facilities, those diagnosed with severe underlying health conditions, and children who could play an instrumental role in promoting vaccine uptake. It concludes that children must not be placed at the peripheries of the COVID-19 vaccination program in Ghana. [ABSTRACT FROM AUTHOR]

Provisioning ecosystem services are under threat in peripheral areas in African cities due to urbanisation pressures. Previous studies have focused on land conversion and food crop production. How urbanisation pressures intertwine with the provisioning ecosystem services availability to peri-urban households is an empirical question, which this paper answered using Wa in Ghana as a case. The mixed method research approach was employed involving 400 randomly selected households with the aid of a questionnaire, while interviews were also conducted with relevant stakeholders. Descriptive statistics and a five-point Likert scale were used to analyse the household data, while interview responses were thematised. We observed that urbanisation adversely affected ecosystems, reducing the availability of wild fruits, fuelwood, and game to farmer households. From the households' perspective, most of these services will disappear in the future as urbanisation intensifies. We recommend the restoration of degraded lands for the conservation of natural habitats. [ABSTRACT FROM AUTHOR]

This paper examined the dynamics of urban land use and land cover change, and their implications for livelihoods in peri-urban Tamale, Ghana. The study employed household data and Landsat Thematic Mapper (TM) for 1986, Enhanced Thematic Mapper Plus (ETM +) for 2004 and Landsat 8 Operationalised Landsat Imager/Thermal Infrared Sensor (OLIS/TIRS) for 2019. The findings show that the urban expansion process witnessed a transition from agricultural livelihood to a more complex and monetised urban economy, which presented mixed impacts on the livelihoods of the peri-urban households. We argued that the horizontal expansion of urban areas into prime agricultural lands could be halted by promoting vertical development in the form of multi-storey buildings rather than the horizontal multiplication of individual housing units. Supporting the peri-urban households to diversify their livelihood portfolios by venturing into beekeeping, poultry farming, and livestock keeping, which do not require large tracts of land is recommended. [ABSTRACT FROM AUTHOR]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

In this paper, I seek to evaluate the impact of the COVID-19 pandemic on voter behaviour in the 2020 general elections in Ghana using survey data compiled in Greater Accra between July and August 2020. The COVID-19 pandemic became a major campaign issue in last year's election prompting varied responses and support from both the government and the main opposition parties. Though a majority of the electorate were satisfied (83.5%) and grateful (82%) for the relief items they received, only 3 out of every 10 of the respondents think the intervention had an effect on the way they voted. Using the rally-effect theory, the paper finds that the political leadership and incumbent government were able to rally support for their campaign as a result of the social intervention policies implemented in the wake of the Covid-19 pandemic, yet were unable to sustain and translate that support into electoral victory in the Greater Accra Region, a major swing region with the highest number of Covid-19 cases and one of the only two regions that witnessed a lockdown during the height of the pandemic. [ABSTRACT FROM AUTHOR]

Regarding controversies and debates around 'witch camps' and whether or not they should be abolished, there are several issues that directly speak to the gaps in development scholarship, policy and practice. These gaps manifest in how individuals experience and understand their circumstances and how development interventions are designed, planned, and executed. In this article, I explore how individuals accused of witchcraft speak about themselves and their circumstances from three levels: rumour/gossip, accusation/confrontation, and eviction/banishment. I assert that there is discord between the perceived over-concentration of development interventions in the communities that offer refuge after displacement compared to other levels. Though intervening in such communities is essential, I argue that the broader debates are fixated on the existence (or lack thereof) of witchcraft. This leads to conversations that centre around whether such communities should be closed, and individuals accused of witchcraft allowed to return home. In these debates, the experiences of persons accused of witchcraft are footnotes in the argument. Although the study of witchcraft beliefs and practices is significant and has generated an impressive body of theories and debates, the issue of development intervention is relatively unexplored at the three levels mentioned above. Based on ethnographic fieldwork conducted in the Gnani community of northern Ghana, this paper highlights the implications of the problematic development constructs and subjectivities that are framed around the closure of receiving communities, eliding a more nuanced understanding of individual persons' concerns and desires at each of the three levels. There is a need for development to be more responsive to how individuals express themselves and understand their circumstances before support or intervention can be leveraged. [ABSTRACT FROM AUTHOR]

Although corporations have been propelled to adapt eco-innovation strategies including decent work practices, responsible consumption and production, and transition from linear economy to circular economy model to integrate natural ecosystems, businesses, and waste management, inversely, the actual impact of the circular economy implementation (CEI) in Ghana is yet to be felt. This paper aims to analyse the implications of corporate green culture (CGC) on CEI behaviour, and to design a model that explains the mediating roles of environmental innovativeness (EI) and green intellectual capital (GIC) on the relation between CGC and CEI behaviour from the perspective of a lower resource economy context. Our paper is positioned on positivists' reasoning and quantitative research approach. A survey-based structured questionnaire has been used to collect data from 300 manufacturing firms in Ghana. Our hypotheses have been tested with the aid of SMART-PLS and structural equation modelling. The indicative results have shown that CGC positively affect CEI behaviour. Moreover, EI and GIC have significant and positive effects on CEI behaviour, Besides, GIC serves as a medium through which CGC indirectly impacts on CEI behaviour. The implications of the study include the emergence of baseline model to encourage CEI behaviour in Ghana and other Sub-Saharan African countries. The paper recommends that the newly developed model be used by practitioners to explain coordinated economic, ecological and social development, and restore ecological environment. Policymakers are encouraged to facilitate the reinforcement of environmental policies and subsequent realization of Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

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]

Health Technology Assessment (HTA) has been institutionalized in Ghana with structures, processes, and methods. This paper identifies and analyzes the policy players involved; the way in which issues were framed; and the manner in which administrative structures were used to set the agenda for, adopt, and implement HTA. It shows that the Ministry of Health, supported by other players, led HTA agenda-setting through training activities and discussions on evidence of selection pharmaceuticals, medical devices, and other health-related technologies. HTA was then captured in a health sector aide memoire that summarized the decisions made at a national health summit. In implementing the HTA policy, technical working groups and a steering committee were constituted to provide recommendations to the minister of health on high-level decisions. The ability of agenda influencers to maneuver existing administrative and bureaucratic structures, align them with national strategic goals, and sustain HTA implementation enabled Ghana to institutionalize HTA. Limited financial support and a dearth of in-country expertise are being addressed through capacity building and funding. To ensure early national buy-in and uptake, policy makers and agenda influencers need to understand each country's health system and align HTA with national policy decision-making processes. [ABSTRACT FROM AUTHOR]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

This paper explores how biometric payment practices in Ghana reinforce historically grown, patriarchal frames of representing women's economic participation. As central modes of participation in social life, payment practices tie closely into national narratives of modernity and economic development. In this light, Ghana's current biometric identification agenda, of which biometric payment constitutes a central element, has come to associate female entrepreneurs with normative gender identities which question their discipline, autonomy, and meaningful contribution to the economy. Two different institutions seeking to classify Ghanaian women in the interest of altering their behavior will be at the heart of the discussion. In the first case, I will focus on development experts' routine representation of (Ghanaian) women as "dependent" on assistance. In the second case, I focus on the regulatory institutions of Ghana's financial sector and the pursuit to formalize what is generally framed as "deviant" female entrepreneurship. The article addresses how the articulation of these normative gender identities reproduces historically rooted conceptions of Ghanaian women's autonomy and economic participation, to the effect of their continued exclusion from relevant public decision-making processes. The paper finally explores the unconventional ways in which female Ghanaian entrepreneurs-turned-activists index emancipatory gender identities to seek recognition for their economic contribution. [ABSTRACT FROM AUTHOR]

The integration and mandatory study of research method courses by university students is a global phenomenon. However, students demonstrate apprehension and disinterest in research methods courses. Consequently, this study investigated the interplay among research methods anxiety, positive disposition toward research, perception of usefulness, self-efficacy, and academic effort in research. Paper-and-pencil questionnaires were used to collect data from a convenience sample of 636 technical university students in Ghana. Based on partial least squares structural equation modeling results, research anxiety reduces students' self-beliefs (β = −0.172; t = 2.729; p =.000) and negatively affects perception of research usefulness (β = −0.172; t = 2.729; p =.000). A positive disposition towards research enhances students' academic efforts in research (β = 0.919; t = 3.308; p = 0.001). Furthermore, self-efficacy drives students' efforts (β = −0.172; t = 2.729; p =.000), enhances positive disposition toward research (β = 0.191; t = 3.308; p =.001) and perception of research usefulness among students (β = 0.224; t = 3.064; p =.002). Students' perception of research usefulness mediates the relationship between anxiety and effort in research (β = −0.075; t = 3.653; p =.000), positive research disposition and effort (β = −0.056; t = 2.519; p =.012) as well as research self-efficacy and effort in studies (β = 0.083; t = 3.02; p =.003). [ABSTRACT FROM AUTHOR]

Health literacy has pushed the frontiers of self-care in recent decades, particularly among older adults. However, not much is known about self-medication for minor ailments and chronic conditions among older adults in developing countries. This paper addresses this knowledge gap by examining the prevalence, patterns, and associated factors of self-medication among older adults (aged 50 years and more) in Ghana. The study employed a cross-sectional survey within four communities in the Bosomtwe District, Ghana. Using the purposive, snowballing, and convenient techniques, 384 older adults were involved in the study. Multivariate logistic regressions were used to estimate the factors associated with self-medication. Up to 54.4% of the respondents had self-medicated at least 3 months before the survey, while 60.2% self-medicated at least once every month. Open markets (43%) were the dominant drug sources, while quick relief (26.6%) and cheap cost (22.7%) were the reasons for self-medication. Females (AOR: 2.626, CI: 0.015-0.030, p = 0.022), tertiary graduates (AOR: 1.825, CI: 0.007-0.045, p = 0.045) and uninsured older adults (AOR: 3.293, CI: 0.015-0.026, p = 0.007) were more likely to self-medicate. Furthermore, those with no past illness (AOR: 0.036, CI: 0.007-0.033, p = 0.013) and without non-communicable disease (AOR: 0.008, CI: 0.001-0.012, p = 0.020) were less likely to self-medicate. Policy recommendations targeting the educated, uninsured, female older adults as well as stiffening the sale of medicines without prescription will be necessary for reducing the prevalence of self-medication among older adults. Subjects: Health & Development; Aging; Aging and Health; Health Education and Promotion [ABSTRACT FROM AUTHOR]

There are a number of genotypes/varieties of kenaf (Hibiscus cannabinus L) fibre in Ghana. The kenaf fibre is used in both engineering and social products and its properties improve its choice. This paper reports the tensile strength and elongation of five genotypes of the kenaf fibre in Ghana. The fibres are cultivated and harvested at maturity and prepared with water retting. A gauge length of 20 mm was used and cardboard as the initial support. The fibre diameters are found for each genotype to be 34.2 μm, 40.4 μm, 38.2 μm, 43.2 μm and 39.2 μm for EB31, TN11, EN31, PN11 and HN11 respectively. The densities are 0.53 g/cm³ for EB31; 0.60 g/cm³ for TN11; 0.63 g/cm³ for EN31; 0.94 g/cm³ for PN11 and 1.00 g/cm³ for HN11. The tensile strengths are 734.53 MPa for EB31, 1292.37 MPa for TN11, 1241.53 MPa for EN31, 979.35 MPa for PN11 and 1365.14 MPa for HN11. The corresponding percentage elongations are found to be 10.88 for EB31; 12.23 for TN11; 14.66 for EN31; 15.81 for PN11 and 13.13 for HN11. These results will make the application of fibre in various engineering applications, especially in composites, more predictive in properties and performance. [ABSTRACT FROM AUTHOR]

The objective of this research paper is to determine the critical success factors (CSFs) influencing the success of public road construction projects from the perspective of a developing nation. A self-administered questionnaire was used to gather data on the extent to which critical success factors gathered from literature impact the success of public road construction projects from sector practitioners' perspectives in Ghana. The data was then analysed using factor analysis. The study revealed that external environmental factors have the highest influence (46.23%) on public road construction project success, followed by project management factors (12.25%) while procurement-related factors have the least impact (6.97%). Public construction project management organisations and the government will now have a deeper understanding of CSFs that influence the success of public construction projects and use them as a guide to enhance the successful delivery of public road construction projects. Even though numerous studies have been undertaken to enhance the success of construction projects in Ghana, very little attention has been given to procurement-related factors. Thus, the study outcome will add value to sector practitioners and the Government of Ghana in the management of public road construction projects. [ABSTRACT FROM AUTHOR]

Primary healthcare (PHC) has become a concern in most resource constraint economies particularly in the global south where meeting this important economic need has become a burden. Given this, blockchain technology (BT), a promising transformation in contemporary service delivery, has become an alternative for service-oriented institutions to meet their desired goals. In primary healthcare, BT has been utilised to lessen the burden on medical supply chain and data management. Nonetheless, the technology seems to be a preserve of the developed economies. In the global south, not only has the complexities of the technology hindered the implementation of the technology but the understanding of its affordances has also been nascent. This study extends Task-technology fit model with the perceived e-readiness model. Drawing on the best-worst method, this paper investigates PHC managers' decision to embrace BT for PHC delivery in Ghana. The study finds that, in order of relevance, task-technology, infrastructure and individual characteristics are the main drivers of BT adoption and implementation. The study proposes the implementation of various strategies relevant to ensuring a sustainable BT for the management of PHC in resource constraint economies. [ABSTRACT FROM AUTHOR]

It depends on both the pedestrians and the building whether they can be evacuated from a building safely and quickly in any situation. Understanding pedestrian behavior is crucial when designing buildings for safe evacuation in emergencies like earthquakes and fires. Since this topic has yet to be fully explored in Ghana, we conducted experiments in a classroom to capture the characteristics of pedestrian movements during an emergency. In this experimental study, students were asked to pretend to evacuate during an emergency. The simulation and comparison of the evacuation of students from a classroom were conducted using a multi-grid model in our study. The study examines several factors that influence evacuation characteristics. These factors include pedestrian density, speed, time, door width, body mass index, and classroom capacity. The paper describes in detail all study phases, including planning, preliminary work, observational studies, empirical data collection, and statistical analysis. It thoroughly examines premovement time, group density, and velocities for groups and individuals moving through doorways, traveling distances, and walking in educational settings. A person's state of mind and psychological abilities are also taken into account, as well as their level of emotional involvement in the movement. The obtained results are also discussed for evacuation planning in educational institutions under different conditions. [ABSTRACT FROM AUTHOR]

Teenage motherhood is a social occurrence that presents itself in every country. This paper explored lived experiences of teenage mothers in the Adaklu District of Ghana. The study was a phenomenological qualitative study. Data for the study were obtained through narratives, and photovoices; using an in-depth interview guide. The thematic data analysis technique was employed to present the findings. The study purposively sampled 30 teenage mothers. Teenage mothers used pictures such as trees by the riverside, stacked blocks, and electrical sockets to explain their motherhood experiences. Codes from the data revolved around instruction, and communicative learning lived experiences. Teenage motherhood experiences were largely on issues such as the irresponsible attitude of a child's father, rape, remorsefulness, engagement in apprenticeship, supportive partners, and relatives. It can be concluded that teenage mothers have different perspectives on their lived experiences which could either help or hinder how they make meaning of their lives. [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]

Ghana is a lower-middle-income economy that has made significant efforts to improve its health system, in order to achieve universal health coverage. Ghana has adopted strategic health purchasing as an important tool for efficient utilization of resources. This paper focuses on Ghana's National Health Insurance Scheme (NHIS) analyzing its governance arrangements and purchasing functions; and providing recommendations for improvement. The study applied the Strategic Health Purchasing Progress Tracking Framework co-created by the Strategic Purchasing Africa Resource Center (SPARC) and its partners to collect data from secondary and primary sources between September 2019 and June 2020. A descriptive and narrative approach was used to synthesize information on the NHIS governance arrangements and purchasing functions based on the framework. Benchmarks were used to describe the NHIS on the continuum from passive to strategic purchasing and to identify steps to make purchasing more strategic. Strengths and weaknesses were found in governance and purchasing functions. Progress was seen in how the NHIS selects the services in the benefit package, regularly reviewing the package to respond to the health needs of the population, and in how it selectively contracts with providers, particularly private providers, to ensure that standards for quality of care are met. However, challenges remain in performance monitoring, due to claims being mostly processed manually, and provider payment, due to frequent unbundling and upcoding of services Ghana has made significant strides toward the achievement of universal health coverage, but there is room for improvement in provider payment and performance monitoring. [ABSTRACT FROM AUTHOR]

Safe and adequate water supply and sanitation in schools are pre-requisites for the right to basic education for school children and the achievement of goal 4 and 6 of the Sustainable Development Goals. Nonetheless, Water, Sanitation and Hygiene (WASH) in schools is fraught with inadequacy of toilet and handwashing facilities, and poor sustainability mechanisms that threaten its success. This paper, therefore, assesses the operation and sustainability of WASH in schools in the Nabdam District of Ghana. Adopting a qualitative approach, thirty-seven semi-structured interviews were held to capture the understanding and experiences of students, head teachers, health officers, officials of the Ghana Health Service and District Education Directorate on the phenomena. Fifteen focus group discussions were further held with students in the basic schools. The findings indicate that WASH is poorly managed even though the schools studied had some established WASH facilities. WASH in the schools was bedeviled with challenges such as inadequate toilets and handwashing facilities, poor funding and ineffective WASH committees. The WASH committees lacked the capacity to raise funds and carry out their duties in accordance with the WASH implementation guidelines. The study recommends that the Ghana Education Service organizes periodic capacity building programs for WASH committees to address this shortcoming. The Ministry of Education should support basic schools in districts in their efforts to provide WASH facilities and fund WASH activities. The study also calls for the formation of student WASH clubs and sanitation brigades to promote the operation and sustainability of WASH in schools. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the determinants of health insurance, healthcare utilisation, healthcare expenditure, and health status simultaneously. The study used secondary data from the Ghana Socioeconomic Panel Survey. Health insurance, healthcare utilisation, healthcare expenditure, and health status were estimated simultaneously using the conditional mixed process (CMP) framework. The CMP corrects for likely heterogeneity and sample selection bias. The results revealed a significant association between insurance, healthcare utilisation, healthcare expenditure, and health status, implying that regressing these models apart would yield bias and inconsistent estimates making CMP estimates superior to single estimations. The results discovered that gender, age, education, obesity, physical activity, wealth index, household size, dependency ratio, formal-sector work, and savings significantly drive NHIS enrolment. Gender, age, education, obesity, chronic illness, physical activity, wealth index, risky behaviour, and type of illness influenced individuals' visits to a health facility. The determinants of out-of-pocket payments were gender, chronic illness, wealth index, risky behaviour, distance to a health facility, and fever and diarrhoea sufferers. Finally, drivers of self-assessed health were gender, age, education, chronic illness, physical activity, wealth index, risky behaviour, fever, cold/cough and diarrhoea. [ABSTRACT FROM AUTHOR]

Increasing global Internet penetration and technological advancement have stimulated the adoption of online mode of data collection by scholars across different disciplines. Web-based surveys are popular in the Western world, however, their usage among Ghanaian hospitality and tourism scholars is rare despite the several advantages of web-based surveys. This research note compares the demographics of a web-based sample with previous hotel employee studies conducted in Ghana, and in so doing, highlights the advantages and limitations of using a web-based survey in a developing country context. Relative to paper-and-pencil questionnaires, it was less costly using the web-survey to investigate the psychological impact of COVID-19 on hotel employees in Ghana. Furthermore, the web-survey relatively produced quick results as well as reaching respondents in different locations in the country. The demographics of the web-survey appeared comparable to those reported in previous studies conducted in the country. However, employees with college degrees working in star-rated facilities were overly represented in the web-survey sample. Duplicate responses were also observed in the web-survey sample. Web-based surveys provide a viable option for hospitality and tourism research work in Ghana, particularly in the period of COVID-19 and its associated social distancing, lockdowns, and high risk of infection. However, there are potential challenges regarding representativeness, sampling bias and multiple submissions. [ABSTRACT FROM AUTHOR]

The incidence of occupational injuries and diseases among informal welders demands an understanding of a wider perspective that goes beyond the identification of hazards and preventive measures to minimize their effects. The literature on economic cost at the workplace has mainly focused on the formal sector with very little attention to the informal work environment. This paper fills this gap by estimating lost man-days and the economic cost among informal welders. The cross-sectional survey design employing a quantitative approach was used for the study. The data were collected from 220 informal master welders and their apprentices. Musculoskeletal injuries, malaria, hypertension and respiratory diseases were the major injuries and diseases leading to the highest days (35 days and above) lost for masters and apprentices. The master welders spent more days off work than the apprentices because they performed most of the technical work and were exposed to hazards for a longer period. These occupational-related injuries and diseases led to a total economic cost of 7.7% and 9.4% of masters and apprentices' total earnings, respectively. Environmentally safe working conditions of informal welders would reduce the occurrence of injuries and diseases and give them an opportunity to sustain themselves and their dependents and contribute to national development. [ABSTRACT FROM AUTHOR]

Globally, the agenda is to end tuberculosis (TB) by 2030. The emic (local) perspective about causes, signs and symptoms, and management of the disease has implications in service utilization and health-seeking. This research paper examines the local beliefs about TB and how this affects case detection and treatment. The analysis triangulates data from eight focus group discussions (N = 72), 15 in-depth interviews (IDIs) with patients with TB, and four traditional healers. TB described locally as Kɔrongkpong, kɔrongpilah (in Dagaare), and Kusibine (in Sissalla) is believed to be caused by curses, bewitchment, breaking local taboos, and a sin against the gods. The ethnosemantics depict TB as a condition of the lungs which presents with severe cough, caused by spiritual factors with fatal health outcome. In that regard, traditional medicine to exorcise the spirit is required before modern medicine can be effective. Initial symptoms such as cough and fever of TB are often self-managed and later traditional remedies sought. Furthermore, some of the signs are misconstrued for conditions such as asthma and whooping cough. The worldview of the community also dictates that these conditions have spiritual aetiologic factors and should be managed as such. This health-seeking pattern results in delays in receiving appropriate treatment. As an infectious disease, the delays in health-seeking will hinder progress towards achieving the end TB global agenda. Incorporating local beliefs into the design of interventions and social and behavioural change communication strategies can help improve case detection and treatment. [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]

Witchcraft-related violence in Ghana has been the subject of international media attention for decades. In the past few years, increasing interest in the sensational stories of Ghana’s northern witch camps have enthralled readers and elicited furore. While much of this outcry is motivated by concern, it is also greatly misinformed regarding local realities, witchcraft phenomena, and the impact of international interventionism in general, and in Ghana specifically. This paper aims to stress the importance of informed and reflexive engagement with the subject of witchcraft in Ghana and elsewhere. Based in part on my own doctoral research on the subject of witchcraft and witchcraft-related violence in Ghana, this paper stresses the power of language of international actors, looking specifically at the discursive interventions of one non-governmental organization, ActionAid International, that have led the charge against the witch camps in Northern Ghana. This paper concludes that a critical discourse analysis of Action Aid International’s ‘anti-witch camp campaign’ reveals numerous layers of neo-colonial intervention. [ABSTRACT FROM AUTHOR]

Expanding access to sexual and reproductive health (SRH) services is one of the key targets of the Sustainable Development Goals. The extent to which sexual and reproductive health and rights (SRHR) targets will be achieved largely depends on how well they are integrated within Universal Health Coverage (UHC) initiatives. This paper examines challenges and facilitators to the effective provision of three SRHR services (maternal health, gender-based violence (GBV) and safe abortion/post-abortion care) in Ghana. The analysis triangulates evidence from document review with in-depth qualitative stakeholder interviews and adopts the Donabedian framework in evaluating provision of these services. Critical among the challenges identified are inadequate funding, non-inclusion of some SRHR services including family planning and abortion/post-abortion services within the health benefits package and hidden charges for maternal services. Other issues are poor supervision, maldistribution of logistics and health personnel, fragmentation of support services for GBV victims across agencies, and socio-cultural and religious beliefs and practices affecting service delivery and utilisation. Facilitators that hold promise for effective SRH service delivery include stakeholder collaboration and support, health system structure that supports continuum of care, availability of data for monitoring progress and setting priorities, and an effective process for sharing lessons and accountability through frequent review meetings. We propose the development of a national master plan for SRHR integration within UHC initiatives in the country. Addressing the financial, logistical and health worker shortages and maldistribution will go a long way to propel Ghana's efforts to expand population coverage, service coverage and financial risk protection in accessing essential SRH services. [ABSTRACT FROM AUTHOR]

In Northern Ghana, the microfinance company DKM convinced large segments of the population to give them money based on spectacular rates, only to fail spectacularly and leave many people bankrupt in 2016. Such Ponzi schemes are anything but unusual, in Africa and elsewhere, and have been studied as manifestations of an ever-accelerating neoliberal capitalism. Yet, the affected people remember DKM and its manager fondly, and they have abandoned the wait to get their money back. Instead of exploring economic questions, this paper will explore practices of waiting in the context of the scheme to understand the connection between social relationships and imagined futures. In DKM, actors engaged in deeply social forms of waiting, and these were part of late-modern financial schemes, leading to various forms of synchronization. When the tension between the social and instrumental aspects of this waiting emerged after the scheme's collapse, actors – in Northern Ghana at least – ultimately decided to preserve their relationships. Looking back, actors speak about this period as a time of hope, a time in which waiting seemed to be over in a more existential sense. [ABSTRACT FROM AUTHOR]

Global demand for capacity building has increased interest for eLearning. As eLearning resources become more common, effective implementation is required to scale up utilization in Low- and Middle-Income Countries (LMICs). This paper describes the process of implementing a malnutrition eLearning course, effectiveness of course delivery models devised, factors affecting course completion, and cost comparison between the models and face-to-face training at healthcare and academic institutions in Ghana. Four delivery models: Mobile Training Centre (MTC), Online Delivery (OD), Institutional Computer Workstation (ICW) and Mixed Delivery (MD) – a combination of OD and ICW – were determined. Participants were enabled to access the course using one of the four models where contextually appropriate. Pre and post-assessments and questionnaires were administered to compare participants' course completion status and knowledge gain between delivery models. The effect of access to computer and Internet at home and relevance of course to job and academic progression on course completion were further investigated. Comparison of delivery model costs against face-to-face training was also undertaken. Of 7 academic and 9 healthcare institutions involving 915 people, 9 used MTC (34.8%), 3 OD (18.8%), 3 ICW (34.2%) and 1 MD (12.2%). Course completion was higher among institutions where the course was relevant to job or implemented as part of required curriculum activities. Knowledge gain was significant among most participants, but higher among those who found the course relevant to job or academic progression. The implementation costs per participant for training with MTC were £51.0, OD £2.2, ICW £1.2 and MD £1.1, compared with a face-to-face training estimate of £105.0 (1 GHS = 0.14 GBP). The malnutrition eLearning course makes global capacity building in malnutrition management achievable. Adopting contextually appropriate delivery models and ensuring training is relevant to job/academic progression can enhance eLearning effectiveness in LMICs. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Mining companies often deliver various health interventions for respective mining enclaves yet, majority of these services often apply a top-down approach with limited community involvement. Thus, this paper explored communities' satisfaction of health interventions by the Newmont Ghana Gold Limited (NGGL) in Asutifi South and North Districts of Ghana. A descriptive cross-sectional and mixed-method study involving a convenience sample of 145 community members was conducted. Approximately, 60%, 52%, 51% and 52% of the respondents were respectively satisfied with dust suppression measures, health education/awareness creation, malaria control programmes and provision of alternative sources of drinking water by the NGGL. While health promotion and prevention strategies have been helpful, these were far below the expectations of the community members. More importantly, the participants expected to be provided with modern health facilities and opportunity to participate in local institutions' decision-making process in the delivery of these services. We, therefore, recommend that the NGGL should intensify its efforts towards public health improvement in its enclaves as part of its corporate social responsibility. [ABSTRACT FROM AUTHOR]

The trafficking of cocaine has become a global challenge now and Ghana is no exception. Cocaine is a whitish powder, which is, produced both from natural and synthetic means. This paper studied the metal content of seized cocaine in Ghana and the data used for batch identification. Ten metals, namely, Pb, Cu, Mg, Mn, Cr, As, Ni, Fe, Co and Ca were analyzed in 37 samples which were sampled from 2010 to 2014. Analyses of the metals were done using ICP-MS and data was analyzed using statistical tools. The results showed that, calcium recorded the highest amount in all the samples with a mean of 64.94mg/kg followed by Magnesium, Zinc and Iron with mean values of 24.35mg/kg, 6.25mg/kg and 2.65mg/kg, respectively. All the samples, within-seizure classification under class A showed to significant differences between each pair at a confidence level of 95%. With three sample pairs under class B in the within-seizure classification, one of the pairs; 103A and 105B showed no significant differences between them even though they were sampled from two different packages from the same seizure. Five samples from five different seizures also showed a significant difference among them showing that they came from different batches or origin. It is confirmed that seized cocaine contained poisonous heavy metals like Lead, Arsenic and Chromium, which have the amount that could affect the user-provide figures. Based on the data gathered from the within-seizure class A group, it could be proposed that a missing cocaine could be identified by its metal content. [ABSTRACT FROM AUTHOR]

The need to improve the sexual and reproductive health (SRH) and rights of women with disabilities is increasingly acknowledged. Unfortunately, women with disabilities in low- and middle-income settings, including Ghana, face several barriers (including structural, financial, physical, social and attitudinal) to accessing SRH services and care. This paper explores the enablers and barriers to accessing SRH services and care among visually impaired women in the Ashanti and Brong Ahafo Regions of Ghana. Qualitative data from in-depth interviews and focus group discussions were collected from 21 visually impaired women, selected through purposive and snowballing sampling techniques. Thematic analysis was used to develop codes, and data were further grouped into emerging themes. The barriers to accessing SRH services and care were financial difficulties and lack of preferential treatment. The enablers which facilitated access to SRH services and care were the support provided by caregivers and friendly relationships with health providers. To address these challenges and promote access, SRH related policies, services and programmes should be inclusive of the needs of visually impaired women, and measures to remove financial challenges to service utilisation and foster positive relationships with health workers, church and community members should be adopted. [ABSTRACT FROM AUTHOR]

Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women’s perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to “correct” disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman’s experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth. [ABSTRACT FROM AUTHOR]

Having a good knowledge of family planning methods is vital for reducing maternal morbidity and mortality resulting from unintended pregnancies and unsafe abortions. In this paper, we highlight deaf people’s ability to discern various misconceptions about pregnancy, with the aim of assessing their level of knowledge on pregnancy prevention methods. The article is derived from a sexual and reproductive health (SRH) needs assessment involving participants residing in two cities and a senior high school in Ghana. The needs assessment involved three focus groups with 26 participants, a survey with 152 respondents, and an interview with one health professional. Apart from the health professional, all the remaining participants were deaf people. Findings from the study indicated that more than half the participants lacked familiarity with pregnancy prevention methods. The findings of this study confirm other studies that there is a general lack of knowledge on SRH issues among deaf people in Ghana. Thus, although this study focused on prevention of unwanted pregnancy, which is just one component of SRH issues, the study provides insights into the broader SRH needs of the deaf community and calls for making these issues visible for policy-making. [ABSTRACT FROM PUBLISHER]

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]

Purpose: Although social capital influences health-related decisions and behavioural patterns in many developing countries, minimal attention has been paid to the nuances of its effect on healthcare. This paper examines how bonding social capital affects healthcare delivery for inpatients in Ghana. Methods: Semi-structured in-depth interviews were used and thematic analysis method employed to analyse the data. Interviews were conducted with health professionals and relatives and close friends of inpatients in three public health facilities in Ashanti region. Results: Relatives and close friends of inpatients were a critical source of instrumental support such as provision of meals, laundry services, running errands and financial assistance as well as emotional support. These functions—that were both 'expected' and 'encouraged'— reduced the burden on the health facilities, which apparently had limited resources to offer adequate care. However, the relatives of inpatients sometimes inadvertently obstructed efficient healthcare delivery through actions such as extending 'unapproved' alternative care to patients. Moreover, the process of contributing towards health and well-being of the sick exposed the relatives to health risks due to poor living conditions. Conclusion: A well-defined and befitting role must be devised for at least an immediate social relation of inpatients to improve the positive effects of bonding social capital on healthcare delivery. [ABSTRACT FROM AUTHOR]

There is an alarming tide of cardiovascular and metabolic disease (CMD) sweeping across Africa. This may be a result of an increasingly urbanized lifestyle characterized by the growing consumption of processed and calorie-dense food, combined with physical inactivity and more sedentary behaviour. While the link between lifestyle and public health has been extensively studied in Caucasian and African American populations, few studies have been conducted in Africa. This paper describes the detailed methods for Phase 1 of the AWI-Gen study that were used to capture phenotype data and assess the associated risk factors and end points for CMD in persons over the age of 40 years in sub-Saharan Africa (SSA). We developed a population-based cross-sectional study of disease burden and phenotype in Africans, across six centres in SSA. These centres are in West Africa (Nanoro, Burkina Faso, and Navrongo, Ghana), in East Africa (Nairobi, Kenya) and in South Africa (Agincourt, Dikgale and Soweto). A total of 10,702 individuals between the ages of 40 and 60 years were recruited into the study across the six centres, plus an additional 1021 participants over the age of 60 years from the Agincourt centre. We collected socio-demographic, anthropometric, medical history, diet, physical activity, fat distribution and alcohol/tobacco consumption data from participants. Blood samples were collected for disease-related biomarker assays, and genomic DNA extraction for genome-wide association studies. Urine samples were collected to assess kidney function. The study provides base-line data for the development of a series of cohorts with a second wave of data collection in Phase 2 of the study. These data will provide valuable insights into the genetic and environmental influences on CMD on the African continent. [ABSTRACT FROM AUTHOR]

Background: Financial risk protection against the cost of unforeseen healthcare has gained global attention in recent years. Although Ghana implemented a nationwide health insurance scheme with a goal of reducing financial barriers to accessing healthcare and addressing impoverishing effects of out-of-pocket (OOP) healthcare payments, there is a paucity of knowledge on the extent of financial catastrophe of such payments in Ghana. Thus, this paper assesses the catastrophic effect of OOP healthcare payments in Ghana. Methods: Ghana Living Standard Survey (GLSS 5) data collected in 2005/2006 are used in this study. Catastrophic effect of OOP healthcare payments is assessed using various thresholds of total household expenditure and non-food expenditure. Furthermore, four indices, namely the catastrophic payment headcount, catastrophic payment gap, weighted catastrophic payment headcount and weighted catastrophic payment gap, are defined and computed. Results: As at 2005/2006, it was estimated that 11.0% of households in Ghana spent over 5% of their total household expenditure on healthcare OOP. However, after adjusting for the concentration of such spending, it decreased to 10.9%. Also 10.7% of households spent more than 10% of their non-food consumption expenditure on OOP healthcare payments. Furthermore, about 2.6% of households are observed to have spent in excess of 20% of their total household income on healthcare OOP. With the exception of the 5% threshold of household expenditure, because the concentration indices of these expenditures are negative, the burden of such expenditures rests more on the poor. Conclusions: Significant levels of financial catastrophe existed in Ghana prior to the uptake of the national health insurance scheme. Poorer households were at a higher risk than the relatively well-off households. The results of this study present baseline assessment of the impact of Ghana’s health insurance policy on catastrophic healthcare payments. Thus, there is a need for continuous monitoring of financial catastrophe in the system to ensure that households are adequately protected. [ABSTRACT FROM PUBLISHER]