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Background: The World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana. Methods: This was explanatory mixed methods research which started with a document review of Ghana's WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically. Results: Ghana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana's implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care. Conclusion: Ghana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to determine the economic cost of the management of glaucoma among patients seeking care in health facilities in Ghana. Design: A cross-sectional cost-of-illness (COI) study from the perspective of the patients was employed. Setting: The study was conducted in public and private eye care facilities in the Tema Metropolis of Ghana. Participants: About 180 randomly selected glaucoma patients seeking healthcare at two facilities participated in the study. Main outcome measure: Direct cost, including medical and non-medical costs, indirect cost, and intangible burden of management of glaucoma. Results: the cost per patient treated for glaucoma in both facilities was US$60.78 (95% CI: 18.66-107.80), with the cost in the public facilities being slightly higher (US$62.50) than the private facility (US$ 59.3). The largest cost burden in both facilities was from direct cost, which constituted about 94% of the overall cost. Medicines (42%) and laboratory and diagnostics (26%) were the major drivers of the direct cost. The overall cost within the study population was US$10,252.06. Patients paid out of pocket for the frequently used drug- Timolol, although expected to be covered under the National Health Insurance Scheme (NHIS). Patients, however, expressed moderate intangible burdens due to glaucoma. Conclusion: The cost of the management of glaucoma is high from the perspective of patients. The direct costs were high, with the main cost drivers being medicines, laboratory and diagnostics. It is recommended that the National Health Insurance Authority (NHIA) should consider payment for commonly used medications to minimize the burden on patients. [ABSTRACT FROM AUTHOR]

The cocoa swollen shoot virus disease persists in Ghana in spite of the implementation of an eradication campaign against the disease by the government since 1948. Two major factors are identified as limiting the success of the eradication campaign. First, the extension problem, namely, the low level of growers' knowledge (know-why) concerning the disease, including knowledge of the causal agent (3.8%), the vectors (2.3%), and the recommended preventive measures (8% to 67%). Second, the implementation problem, namely, the failure of growers and government-employed labourers to follow the recommended policy of cutting-out and replanting cocoa farms. Thus, about half (51%) of the affected farms were not correctly treated, despite the specialized labour provided and paid for by the government to implement treatment. In addition, about 73% of the growers who treated their affected farms without government support did so incorrectly. Other factors include the direct treatment cost (US $513.00 ha−1) to be borne by growers, as well as land tenure arrangements, and the waiting time of at least three years before the first harvest after replanting. A more researcher-grower collaborative approach in managing the disease could enhance growers' knowledge and the adoption of recommended practices to limit the spread of the disease. In addition, policy decisions on a nationwide disease management strategy that require growers' collective efforts should consider growers' socio-economic conditions like land tenure arrangements and disease treatment cost (direct and indirect) incurred by growers. [ABSTRACT FROM AUTHOR]

Diabetes remains a major, global clinical and public health threat with consistent rises in prevalence around the world over the past four decades. Two-thirds of the projected increases in global diabetes prevalence to 2045 are expected to come from low- and middle-income countries, including those in sub-Saharan Africa. Ghana is typical of this trend. However, there are gaps in evidence regarding the appropriate development of interventions and well-targeted policies for diabetes prevention and treatment that pay due attention to relevant local conditions and influences. Due consideration to community perspectives of environmental influences on the causes of diabetes, access to appropriate health services and care seeking for diabetes prevention and management is warranted, especially in urban settings. The 'Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana' project is a mixed methods study in Ga Mashie, Accra. An epidemiological survey is described elsewhere. Six qualitative studies utilising a range of methodologies are proposed in this protocol to generate a contextual understanding of type 2 diabetes mellitus in an urban poor population. They focus on community, care provider, and policy stakeholder perspectives with a focus on food markets and environmental influences, the demand and supply of health services, and the history of the Ga Mashie community and its inhabitants. The results will be shared with the community in Ga Mashie and with health policy stakeholders in Ghana and other settings where the findings may be usefully transferable for the development of community-based interventions for diabetes prevention and control. Paper Context: Main findings: Diabetes is a major, global health threat with rises in incidence projected in low- and middle-income countries, including Ghana, yet evidence gaps remain related to the development of contextually appropriate interventions and policies for diabetes prevention and treatment. Added knowledge: Sitting within a larger, mixed methods study entitled 'Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana', this study design paper introduces six complementary qualitative studies designed to address this gap in Ga Mashie, Accra. Global health impact for policy and action: Robust methods to describe diabetes burdens and dissemination of evidence are crucial for health policy and impact. [ABSTRACT FROM AUTHOR]

Background: The routine surveillance of asymptomatic malaria using nucleic acid-based amplification tests is essential in obtaining reliable data that would inform malaria policy formulation and the implementation of appropriate control measures. Methods: In this study, the prevalence rate and the dynamics of Plasmodium species among asymptomatic children (n = 1697) under 5 years from 30 communities within the Hohoe municipality in Ghana were determined. Results and discussion: The observed prevalence of Plasmodium parasite infection by polymerase chain reaction (PCR) was 33.6% (571/1697), which was significantly higher compared to that obtained by microscopy [26.6% (451/1697)] (P < 0.0001). Based on species-specific analysis by nested PCR, Plasmodium falciparum infection [33.6% (570/1697)] was dominant, with Plasmodium malariae, Plasmodium ovale and Plasmodium vivax infections accounting for 0.1% (1/1697), 0.0% (0/1697), and 0.0% (0/1697), respectively. The prevalence of P. falciparum infection among the 30 communities ranged from 0.0 to 82.5%. Following artesunate-amodiaquine (AS + AQ, 25 mg/kg) treatment of a sub-population of the participants (n = 184), there was a substantial reduction in Plasmodium parasite prevalence by 100% and 79.2% on day 7 based on microscopy and nested PCR analysis, respectively. However, there was an increase in parasite prevalence from day 14 to day 42, with a subsequent decline on day 70 by both microscopy and nested PCR. For parasite clearance rate analysis, we found a significant proportion of the participants harbouring residual Plasmodium parasites or parasite genomic DNA on day 1 [65.0% (13/20)], day 2 [65.0% (13/20)] and day 3 [60.0% (12/20)] after initiating treatment. Of note, gametocyte carriage among participants was low before and after treatment. Conclusion: Taken together, the results indicate that a significant number of individuals could harbour residual Plasmodium parasites or parasite genomic DNA after treatment. The study demonstrates the importance of routine surveillance of asymptomatic malaria using sensitive nucleic acid-based amplification techniques. [ABSTRACT FROM AUTHOR]

This paper presents a typology to highlight and describe the variation in attitudes among young farmers in rural Ghana, a group that has been treated in policy discourses and in development practice as largely homogenous. It further identifies motivations and aspirations associated with each type. A cluster analysis of survey data from 120 respondents yielded two types of young farmers: 'positive' and 'resigned'. The likelihood of being in either category was found to be related to marital status, location, and whether one had a secondary occupation. Further, the 'positive' group was more likely to report being influenced by adult role models and more likely to aspire to stay in farming. Our findings underscore the relevance of socio-economic and ecological environment on young people's attitudes to and decisions regarding farming and, consequently, on the outcome of policy and programmatic interventions meant to increase their participation in agriculture. [ABSTRACT FROM AUTHOR]

Background: There is a worldwide shortage of health workers against WHO recommended staffing levels to achieve Universal Health Coverage. To improve the performance of the existing health workforce a set of integrated human resources (HR) strategies are needed to address the root causes of these shortages. The PERFORM2Scale project uses an action research approach to support district level management teams to develop appropriate workplans to address service delivery and workforce-related problems using a set of integrated human resources strategies. This paper provides evidence of the feasibility of supporting managers at district level to design appropriate integrated workplans to address these problems. Methods: The study used content analysis of documents including problem trees and 43 workplans developed by 28 district health management teams (DHMT) across three countries between 2018 and 2021 to identify how appropriate basic planning principles and the use of integrated human resource and health systems strategies were used in the design of the workplans developed. Four categories of HR strategies were used for the analysis (availability, direction, competencies, rewards and sanctions) and the relationship between HR and wider health systems strategies was also examined. Results: About half (49%) of the DHMTs selected service-delivery problems while others selected workforce performance (46%) or general management (5%) problems, yet all workplans addressed health workforce-related causes through integrated workplans. Most DHMTs used a combination of strategies for improving direction and competencies. The use of strategies to improve availability and the use of rewards and sanctions was more common amongst DHMTs in Ghana; this may be related to availability of decision-space in these areas. Other planning considerations such as link between problem and strategy, inclusion of gender and use of indicators were evident in the design of the workplans. Conclusions: The study has demonstrated that, with appropriate support using an action research approach, DHMTs are able to design workplans which include integrated HR strategies. This process will help districts to address workforce and other service delivery problems as well as improving 'health workforce literacy' of DHMT members which will benefit the country more broadly if and when any of the team members is promoted. [ABSTRACT FROM AUTHOR]

Background: Malaria remains a common course of morbidity in many sub-Saharan African countries. While treatment options have improved in recent times, inappropriate prescription seems conventional among providers, increasing the burden on patients and society. This study examined the cost of inappropriate prescriptions for uncomplicated malaria treatment in Ghana. Methods: This study used retrospective data collected from January to December 2016 in 27 selected facilities, under different ownership in three regions of the country, mainly Volta, Upper East and Brong Ahafo. Stratified random sampling technique was used to extract 1625 outpatient folders of patients diagnosed and treated for malaria. Two physicians independently reviewed patient folders according to the stated diagnoses. Malaria prescriptions were described as inappropriate when they do not adhere to the standard treatment guidelines. The economic cost was mainly treatment cost which was sourced as medication cost. Total and average costs for country were calculated using sample estimates and the total number of uncomplicated malaria cases that received inappropriate prescriptions. Results: The study revealed that patients received an average of two prescriptions per malaria episode. Artemether-lumefantrine (AL) was the major malaria medication (79.5%) prescribed to patients. Other medications usually antibiotics and vitamins and minerals were included in the prescription. More than 50% of prescribers did not follow the guidelines for prescribing medications to clients. By facility type, inappropriate prescription was high in the CHPS compounds (59.1%) and by ownership, government (58.3%), private (57.5%) and mission facilities (50.7%). Thus, about 55% of malaria prescriptions were evaluated as inappropriate during the review period, which translates into economic cost of approximately US$4.52 million for the entire country in 2016. The total cost of inappropriate prescription within the study sample was estimated at US$1,088.42 while the average cost was US$1.20. Conclusion: Inappropriate prescription for malaria is a major threat to malaria management in Ghana. It presents a huge economic burden to the health system. Training and strict enforcement of prescribers' adherence to the standard treatment guideline is highly recommended. [ABSTRACT FROM AUTHOR]

Mycotoxigenic fungi can infect and produce potent mycotoxins in foodstuffs prior to harvest, during harvest (field fungi), and in storage after harvest (storage fungi), which when ingested, can result in adverse health effects. This study was aimed at assessing the knowledge, attitudes, and practices adopted by the Ghanaian populace to help mitigate the occurrence of molds and mycotoxins in foods. A cross-sectional survey involving a structured questionnaire was conducted with 642 respondents from twelve regions of Ghana. Descriptive statistics and analyses of variance were calculated. Correct Classification Rate (CCR) was measured to assess the utility of a logistic regression model. The results of the study showed that the majority of 299 (46.6%) of the respondents were between the ages of 18–25. Age and educational level were related to knowledge about the occurrence of fungi and mycotoxins in foods (p < 0.05). More than half the respondents, 50% indicated that they knew of aflatoxins as a major mycotoxin present in food. Higher education directly influenced on the knowledge of mycotoxicosis and the management of stored food to present intoxication by fungal metabolites. 502 (32.9%) knew that consuming foods with toxins could cause stomach aches. The most commonly consumed food commodity despite the presence of visible growth of fungi was bread (35.3%). The average KAP score for knowledge showed that, out of 100%, there was adequate knowledge (63.8%) among the members of the Ghanaian populace. Favorable environmental conditions of high humidity (> 85% ERH) and temperature (> 28–32 °C) enhance the proliferation of fungi in most foods and the attendant production of mycotoxins such as aflatoxins, ochratoxins, and fumonisins are associated with several severe human and animal health conditions; mycotoxicosis was associated with high fever, pain, vomiting, suppression of immunity, cancer, etc. when these foods are consumed on regular basis for a prolonged length of time. Future examination of the food items used for the School Feeding Programme in Ghana will offer opportunities to examine the risks of feeding youth with fungal-contaminated food preparations from providers. [ABSTRACT FROM AUTHOR]

Background: The need to scale up public health interventions in low- and middle-income countries to ensure equitable and sustainable impact is widely acknowledged. However, there has been little understanding of how projects have sought to address the importance of scale-up in the design and implementation of their initiatives. This paper aims to gain insight into the facilitators of the scale-up of a district-level health management strengthening intervention in Ghana, Malawi and Uganda. Methods: The study took a comparative case study approach with two rounds of data collection (2019 and 2021) in which a combination of different qualitative methods was applied. Interviews and group discussions took place with district, regional and national stakeholders who were involved in the implementation and scale-up of the intervention. Results: A shared vision among the different stakeholders about how to institutionalize the intervention into the existing system facilitated scale-up. The importance of champions was also identified, as they influence buy-in from key decision makers, and when decision makers are convinced, political and financial support for scale-up can increase. In two countries, a specific window of opportunity facilitated scale-up. Taking a flexible approach towards scale-up, allowing adaptations of the intervention and the scale-up strategy to the context, was also identified as a facilitator. The context of decentralization and the politics and power relations between stakeholders involved also influenced scale-up. Conclusions: Despite the identification of the facilitators of the scale-up, full integration of the intervention into the health system has proven challenging in all countries. Approaching scale-up from a systems change perspective could be useful in future scale-up efforts, as it focuses on sustainable systems change at scale (e.g. improving district health management) by testing a combination of interventions that could contribute to the envisaged change, rather than horizontally scaling up and trying to embed one particular intervention in the system. [ABSTRACT FROM AUTHOR]

Farmers' knowledge of major insect pests and their occurrence in cocoa plantations in Ghana as well as common practices of farmers to control these pests were assessed. It was found that 52%, 41%, and 74% of the respondents could not recognize mirid bug (Sahlbergella singularis), stink bug (Bathycoelia thalassina), and coreid bug (Pseudotheraptus devastans), respectively, when they saw these insects in pictures. Also, over 50% of the respondents could not describe the damage symptoms of mirid bugs. Farmers who accurately identified insect pests mostly observed a peak in the presence and damage of mirid bugs in August, and high presence of stink bugs and coreid bugs from April to June on cocoa farms. Most respondents (72%) mentioned the use of insecticides for pest management in their farms without any support by local institutes. Training is needed to enhance farmers' knowledge of the biology and behaviour of key pests in cocoa for effective pest management. A participatory research approach is also necessary to increase farmers' competence in the identification of those key pests and improve pest control practices. Consideration of these observations from farmers is necessary to support a review of the insecticide spray recommendation on cocoa farms in Ghana. [ABSTRACT FROM AUTHOR]

Despite the numerous health and social problems associated with alcohol use, its use is increasing in many African countries. This study assessed the direct cost and socio-demographic factors associated with alcohol use among adults in a coastal commercial community in Ghana. A cross-sectional survey of 412 adults was undertaken. Data were collected using adapted questions from validated standard tools. Logistic regression analysis was used to determine the association between alcohol use and socio-demographic factors. Kruskal-Wallis and Wilcoxon Rank Sum tests were used to determine statistical significance in mean cost differences of alcohol use. Averagely, participants spent US$5.06 daily on alcohol. Most men (39.3%) and women (44.6%) consume beer more than other alcoholic beverages. Men were more likely to consume alcohol compared to women. Also, people with no formal education and those with tertiary education have equal likelihood of consuming alcohol. Alcohol use among people with higher monthly income was 1.72 (95% CI:0.94–3.15) times higher compared to those with lower income. The cost of alcohol use varies among men and women. Socio-demographic factors influence alcohol use. Hence, public health intervention to reduce alcohol use in these communities should take cognizance of these factors. [ABSTRACT FROM AUTHOR]

Background: Safety climate is an essential component of achieving Universal Health Coverage, with several organisational, unit or team-level, and individual health worker factors identified as influencing safety climate. Few studies however, have investigated how these factors contribute to safety climate within health care settings in low- and middle-income countries (LMICs). The current study examines the relationship between key organisational, unit and individual-level factors and safety climate across primary health care centres in Ghana, Malawi and Uganda.Methods: A cross-sectional, self-administered survey was conducted across 138 primary health care facilities in nine districts across Uganda, Ghana and Malawi. In total, 760 primary health workers completed the questionnaire. The relationships between individual (sex, job satisfaction), unit (teamwork climate, supportive supervision), organisational-level (district managerial support) and safety climate were tested using structural equation modelling (SEM) procedures. Post hoc analyses were also carried out to explore these relationships within each country.Results: Our model including all countries explained 55% of the variance in safety climate. In this model, safety climate was most strongly associated with teamwork (β = 0.56, p < 0.001), supportive supervision (β = 0.34, p < 0.001), and district managerial support (β = 0.29, p < 0.001). In Ghana, safety climate was positively associated with job satisfaction (β = 0.30, p < 0.05), teamwork (β = 0.46, p < 0.001), and supportive supervision (β = 0.21, p < 0.05), whereby the model explained 43% of the variance in safety climate. In Uganda, the total variance explained by the model was 64%, with teamwork (β = 0.56, p < 0.001), supportive supervision (β = 0.43, p < 0.001), and perceived district managerial support (β = 0.35, p < 0.001) all found to be positively associated with climate. In Malawi, the total variance explained by the model was 63%, with teamwork (β = 0.39, p = 0.005) and supportive supervision (β = 0.27, p = 0.023) significantly and positively associated with safety climate.Discussion/conclusions: Our findings highlight the importance of unit-level factors-and in specific, teamwork and supportive supervision-as particularly important contributors to perceptions of safety climate among primary health workers in LMICs. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

The use of kola nut, including natural or alternative medicinal sources, has inevitably created an increased global market demand in excess of its production and provides great prospects for the growth of the kola nut industry in producing countries like Ghana. Nonetheless, there is a great dearth of information on Ghana's kola nut supply-side practices and constraints that can provide a basis for the development of the industry. This study fills the research gap by describing the practices and constraints of farmers, processors, and marketers of kola nut in Ghana. Using a survey methodology, results showed that nearly all (99.5%) farmers interviewed had not received any extension training on agronomic practices. Low market price of nuts (61.5%) and pests and diseases (60.4%) were the most reported constraints to kola nut production. Chiefs among motivating factors for cultivating kola nut were alternative livelihood support (58%). Some processors (28.6%) who rinsed nuts after depulping used a solution of Akate Master (bifenthrin) and others (51.0%) used fumigation tablets (aluminium phosphide) (91.0%) for storing the nuts. However, these chemicals may be dangerous to the health of consumers in the long run. The low selling price of kola nuts was perceived to be the most (74.8%) constraint to kola nut processing and marketing. Respondents noted that the red nuts were preferred for their durability during transportation and longer shelf life, while the white nuts were preferred for their taste. The results suggest the need for further agronomic, postharvest handling, preservation, and storage, as well as breeding research to provide recommendations to farmers and processors. To overcome some marketing challenges, there is a need for policy support to standardize pricing and grading systems for the mutual benefit of all the stakeholders. [ABSTRACT FROM AUTHOR]

District Health Management Teams (DHMTs) are often entry points for the implementation of health interventions. Insight into decision-making and power relationships at district level could assist DHMTs to make better use of their decision space. This study explored how district-level health system decision-making is shaped by power dynamics in different decentralised contexts in Ghana, Malawi and Uganda. In-depth interviews took place with national- and district-level stakeholders. To unravel how power dynamics influence decision-making, the Arts and Van Tatenhove (2004) framework was applied. In Ghana and Malawi, the national-level Ministry of Health substantially influenced district-level decision-making, because of dispositional power based on financial resources and hierarchy. In Uganda and Malawi, devolution led to decision-making being strongly influenced by relational power, in the form of politics, particularly by district-level political bodies. Structural power based on societal structures was less visible, however, the origin, ethnicity or gender of decision-makers could make them more or less credible, thereby influencing distribution of power. As a result of these different power dynamics, DHMTs experienced a narrow decision space and expressed feelings of disempowerment. DHMTs' decision-making power can be expanded through using their unique insights into the health realities of their districts and through joint collaborations with political bodies. [ABSTRACT FROM AUTHOR]

Routine medical and dental examinations are important and effective measures in the prevention of diseases and promotion of good health. A cross-sectional quantitative study was conducted among adult residents in Community 20, Tema. The study randomly sampled 216 adults aged over 18 years. These participants were interviewed after informed consent was obtained. Socio-demographic factors associated with routine medical and dental examinations were determined using multivariable logistic regression analysis. Weighted mean was used to determine the level of perceived importance of medical and dental examination. A total of 68.1% and 31.9% of the adults have ever undergone routine medical and dental examination, respectively. Personal reasons constituted 35.4% for medical examination and 55.1% for dental examination. Medical and dental examinations encourage adults to be health conscious was ranked highest with a weighted mean of 3.78. Routine medical and dental examinations were higher among adults over 50 years, males, higher educated adults, higher income earners and the unmarried. Most of the adults indicated that medical and dental examinations were very important. Routine medical and dental examinations encourage adults to be health conscious. Routine medical and dental examinations were higher among adults over 50 years. Public health education programs should educate and encourage the general public especially among the younger population to undergo routine medical and dental examinations annually. [ABSTRACT FROM AUTHOR]

Introduction: District health managers play a pivotal role in the delivery of basic health services in many countries, including Ghana, as they are responsible for converting inputs and resources such as, staff, supplies and equipment into effective services that are responsive to population needs. Weak management capacity among local health managers has been suggested as a major obstacle for responsive health service delivery. However, evidence on district health managers' competencies and its association with health system performance is scarce. Aim: To examine managerial capacity among district health managers and its association with health system performance in six districts in the Eastern Region of Ghana. Methods: Fifty-nine district health managers' in six different performing districts in the Eastern Region of Ghana completed a self-administered questionnaire measuring their management competencies and skills. In addition, the participants provided information on their socio-demographic background; previous management experience and training; the extent of available management support systems, and the dynamics within their district health management teams. A non-parametric one-way analysis was applied to test the association between management capacity and district performance, which was measured by 17 health indicators. Results: Shortcomings within different aspects of district management were identified, however there were no significant differences observed in the availability of support systems, characteristics and qualifications of district health managers across the different performing districts. Overall management capacity among district health managers were significantly higher in high performing districts compared with lower performing districts (p = 0.02). Furthermore, district health managers in better performing districts reported a higher extent of teamwork (p = 0.02), communication within their teams (p<0.01) and organizational commitment (p<0.01) compared with lower performing districts. Conclusion: The findings demonstrate individual and institutional capacity needs, and highlights the importance of developing management competencies and skills as well as positive team dynamics among health managers at district level. [ABSTRACT FROM AUTHOR]

Background: The main aim of the study was to explore the attitudes and health perceptions of faith healing users in Kumasi Metropolis, Ghana. This has become necessary because faith healing practice is an important area but remains neglected in the health care literature. In an age when biowestern medicine is touted as the cure for most diseases, understanding how and why individuals seek alternative treatment, specifically faith healing modalities may help to develop more effective health care interventions.Methods: We employed exploratory study design of purely qualitative research approach involving 40 conveniently selected participants from four different purposively selected faith healing centres to get a maximum variation of experiences and opinions on the time of consultation, perceived effectiveness and challenges of faith healing practices in Ghana. In-depth interviews were conducted from 10th June to 30th July, 2017. Data were thematically analysed and presented based on the a posteriori inductive reduction approach.Results: The main findings were that faith healers served as the first port of call for disease curing and prevention for most users. Consumers of faith healing perceived their health status to be good due to the perceived effectiveness of faith healing for curing of health problems. However, users faced challenges such as stigmatisation and victimisation in seeking health care.Conclusion: This study has provided the first baseline evidence in this important area of inquiry that has been neglected in the scholarly discourse in Ghana. By implication, users' positive attitudes and perceptions toward faith healing call for integration policies that allow formal medical services to have open idea to faith healing practices in Ghana. [ABSTRACT FROM AUTHOR]