Christian Kwaku Osei, Edward Nketiah-Amponsah and Monica Puoma Lambon-Quayefio
In 2016, the World Health Organization (WHO) revised upwards the recommended contacts for antenatal care (ANC) by expectant mothers with a health provider from a minimum of four…
Abstract
Purpose
In 2016, the World Health Organization (WHO) revised upwards the recommended contacts for antenatal care (ANC) by expectant mothers with a health provider from a minimum of four to eight over the pregnancy period. Although Ghana is yet to adopt the new recommendation, some women choose to adhere to the new protocol because of its enormous health benefits to the expecting mother and the unborn child. As part of ANC, family planning services are also provided to ensure child spacing and birth control. To reduce health costs, government introduced the free maternal health policy, Community-based Health Planning Services, Livelihood Empowerment Against Poverty and established the Northern Development Authority to increase access to healthcare and also create wealth. Given these interventions, the study hypothesizes that household wealth would not have a significant influence on antenatal visits and modern contraceptive use. Therefore, this paper aims to examine whether household wealth would play any significant role on the new minimum contacts proxied by antenatal visits and also on the use of modern contraceptives as a family planning counselling tool during ANC visits. The study further examines a possible heterogeneity effect of paternal characteristic on maternal health service utilization.
Design/methodology/approach
The study used data from the most recent Ghana Demographic and Health Survey (GDHS, 2014). Both bivariate and multivariate analyses were used to investigate the effects of household wealth on the number of antenatal visits and modern contraceptive use. The bivariate analysis employed the use of chi-square test whiles, the multivariate analysis involved estimations using logistic regressions.
Findings
The findings show that household wealth would play a critical role given the revised WHO minimum ANC contacts by expectant mothers. Household wealth exerts a positive and significant effect on ANC for all wealth quintiles for women who attended at least eight ANC visits, but was insignificant for the poorer and middle quintiles of those who attended four to seven visits. Wealth, however, had an insignificant relationship with modern contraceptive use. Generally, education, age, birth order, media exposure as well as geographical locations had a significant influence on both ANC visits and modern contraceptive use. The study further revealed a heterogeneous effect on ANC attendance. In particular, despite the relatively poor conditions, women in rural areas whose partners/husbands have attained a minimum of secondary education are about twice more likely to attend 4–7 antenatal visits compared to their counterparts whose husbands/partners are without education. Hence, a holistic health education, which includes husbands/partners in the rural areas as well as strengthening interventions that improve livelihoods, is crucial.
Originality/value
Health guidelines are constantly reviewed, and government policies must adapt accordingly. This paper looks at the significant role household wealth still plays on modern contraceptive use and ANC visits, given the revised WHO minimum ANC contacts and uniquely underscores the influence of paternal characteristics on the utilization of these maternal health services.
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Samuel Ampaw, Edward Nketiah-Amponsah, Frank Agyire-Tettey and Bernardin Senadza
Equity in access to and use of healthcare resources is a global development agenda. Policymakers’ knowledge of the sources of differences in household healthcare spending is…
Abstract
Purpose
Equity in access to and use of healthcare resources is a global development agenda. Policymakers’ knowledge of the sources of differences in household healthcare spending is crucial for effective policy. This paper aims to investigate the differences in the determinants of household healthcare expenditure across space and along selected quantiles of healthcare expenditure in Ghana. The determinants of rural-urban healthcare expenditure gap are also explored.
Design/methodology/approach
Data was obtained from the sixth round of the Ghana Living Standards Survey (GLSS 6) conducted in 2013. An unconditional quantile regression (UQR) and a decomposition technique based on UQR, adjusted for sample selection bias, were applied.
Findings
The results indicate that differences in the determinants of household healthcare expenditure across space and along quantiles are driven by individual-level variables. Besides, the rural-urban health expenditure gap is greatest among households in the lower quantiles and this gap is largely driven by differences in household income per capita and percentage of household members enrolled on health insurance policies.
Originality/value
The findings show that there are differences in the determinants of household health expenditure along with the income distribution, as well as between rural and urban localities, which would call for targeted policies to address these inequalities.
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Samuel Ampaw, Edward Nketiah-Amponsah, Nkechi Srodah Owoo and Bernardin Senadza
Rural poverty remains high in many developing countries, Ghana inclusive. This has implications for healthcare affordability and utilization, and thus the attainment of universal…
Abstract
Purpose
Rural poverty remains high in many developing countries, Ghana inclusive. This has implications for healthcare affordability and utilization, and thus the attainment of universal health coverage. Nonfarm diversification is seen as a means by which rural farm households can increase incomes and smooth consumption including healthcare. The purpose of this paper is to investigate the impact of nonfarm enterprise participation on healthcare expenditure among farm households in rural Ghana.
Design/methodology/approach
Using nationally representative household data from the sixth round of the Ghana Living Standards Survey (GLSS 6), the paper employs endogenous switching regression and propensity score matching techniques to account for potential selectivity bias.
Findings
Results indicate that households that participate in nonfarm enterprises earn higher incomes and expend more on healthcare. Total household income and region of residence are significant determinants of healthcare expenditure among farm households in rural Ghana. In addition, while in nonfarm enterprise nonparticipating households the marital status of the head of household is important, for participating households the head having at least secondary education significantly influences healthcare expenditure.
Practical implications
Promoting nonfarm activities and hence raising the incomes of households in rural areas of Ghana has the potential of increasing health capital through increased investments in health. It will also positively impact access to and utilization of healthcare and ultimately contribute towards increased farm and non-farm productivity.
Originality/value
Previous studies have only examined the determinants of nonfarm enterprise participation or its impact on household welfare, poverty, inequality, food security and agricultural investments. While evidence abounds on the positive impact of rural nonfarm enterprise participation on household income, which in turn has implications for household health expenditure, the potential positive link between rural nonfarm enterprise participation and household healthcare expenditure remains unexamined.
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Ashiabi Nicholas, Nketiah-Amponsah Edward and Senadza Bernardin
The purpose of this paper is to investigate the effect of public and private health expenditures on selected maternal-child health outcomes in Sub-Saharan Africa (SSA).
Abstract
Purpose
The purpose of this paper is to investigate the effect of public and private health expenditures on selected maternal-child health outcomes in Sub-Saharan Africa (SSA).
Design/methodology/approach
The study utilizes panel data on 40 SSA countries spanning the period 2000-2010. The data are analyzed using the fixed effects estimation technique.
Findings
The results indicate that public health expenditure is inversely and significantly related to infant (IMRR) and under-five (U5MR) mortalities in SSA. Though public health expenditure has the a priori negative sign, it has no significant effect on maternal mortality (MMR) in SSA. Further, private health expenditure did not prove to be significant in improving maternal-child health outcomes (IMRR, U5MR and MMR) in SSA.
Practical implications
The implication of the findings is that a percentage point increase in public health expenditure (as a share of GDP) across the region will result in saving the lives of about 7,040 children every year. Hence, it is important for governments in SSA to increase their shares of health expenditure (public health expenditure) in order to achieve improved health outcomes.
Originality/value
Previous studies have not adequately explored the effect of various components of health expenditures – public and private – on health outcomes in the context of SSA. In addition to the focus on maternal-child health variables such as infant, under-five and maternal mortalities, the study accounts for the possibility of a non-linear and non-monotonic relationship between healthcare expenditures and health outcomes.
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Samuel Ampaw, Edward Nketiah-Amponsah and Nkechi Srodah Owoo
Against the background that Ghanaians seldom purchase insurance policies, the purpose of this paper is to investigate the determinants of life insurance uptake among male and…
Abstract
Purpose
Against the background that Ghanaians seldom purchase insurance policies, the purpose of this paper is to investigate the determinants of life insurance uptake among male and female household heads in Ghana.
Design/methodology/approach
The study employs data on 775 male and 233 female household heads from the sixth round of the Ghana Living Standards Survey. Adjusted Wald test statistics and logistic regressions are employed for the empirical estimations.
Findings
Results from the adjusted Wald test show that the sampled male household heads significantly differ from their female counterparts in terms of the selected socioeconomic and demographic characteristics. Though ill health status, higher wealth, being self-employed or in wage or salaried employment and residing in either of the three northern regions (upper east, upper west and northern regions) in Ghana broadly affect the demand for life insurance among both male and female heads, other factors are peculiar to either parties. Particularly, whereas female heads who are married and those with more dependants have a higher propensity of purchasing life insurance policies, their male counterparts with higher education are more likely to buy life insurance policies.
Research limitations/implications
The paper adds to the paucity of cross-sectional studies on life insurance demand in Africa.
Practical implications
Based on the explored determinants, insurers could better regulate the purchase of their products by taking into consideration the gender differences to maximize their sales and enhance economic growth and development.
Originality/value
This paper explores the gender dynamics in the determinants of life insurance demand in a developing country, Ghana. Besides, findings from related literature are reported to be mixed. Though the current paper is not wholly nationally representative, it utilizes data from across all the ten administrative regions of Ghana. To the best of the authors’ knowledge, no prior study has been conducted in this manner.
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Edward Nketiah‐Amponsah, Bernardin Senadza and Eric Arthur
The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.
Abstract
Purpose
The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.
Design/methodology/approach
The paper utilizes the most recent Ghana Demographic and Health Survey (GDHS V) data. The dependent variable is the intensity of utilization (number) of antenatal care visits. Hence, the negative binomial regression is employed to investigate the socio‐economic and demographic correlates of the intensity of antenatal care utilization in Ghana.
Findings
The study finds that wealth status, age, ownership of health insurance (especially for rural women), educational attainment, birth order, religion and administrative region of residence are significant predictors of the intensity of antenatal care services utilization. In particular, the utilization rate increases in wealth status. The authors also found significant statistical relationship between residence and antenatal care utilization. This finding reinforces the differences in health facilities between the rural and urban areas of Ghana. The authors did not, however, find evidence for proxies for financial and physical access.
Research limitations/implications
The GDHS survey lacks data on the distance to the nearest health facility where ANC is sought and a variable for the price of ANC visit. Proxies had to be used to capture these variables.
Practical implications
The fact that ownership of health insurance in rural areas increases the number of ANC visits makes it imperative to intensify health insurance awareness and enrollment campaigns in the rural areas so as to bridge the rural‐urban gap in ANC utilization. Also, while the free maternal health care policy for expecting mothers is laudable, a minimum level of wealth is required to induce antenatal care visitations. This is because household wealth status still plays a major role even in a free maternal health regime.
Originality/value
A new finding of the paper is the significant effect that ownership of health insurance has on the utilization of ANC services among rural women. While generally rural women have a lower propensity to use ANC services compared to urban women, the intensity of usage of ANC services tends to increase for rural women who own health insurance.
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Bismark Osei, Mark Edem Kunawotor and Paul Appiah-Konadu
The purpose of this paper is to investigate the effect of flood occurrence on mortality rate and life expectancy amongst 53 African countries.
Abstract
Purpose
The purpose of this paper is to investigate the effect of flood occurrence on mortality rate and life expectancy amongst 53 African countries.
Design/methodology/approach
The study utilizes panel data from the period 2000–2018 on 53 African countries and system generalized method of moments (system GMM) for the analysis.
Findings
The result indicates that flood occurrence causes the destruction of health facilities and the spread of diseases which reduces life expectancy. In addition, flood occurrence increases mortality rate amongst 53 African countries.
Research limitations/implications
Practical implications
The study recommends that governments amongst African countries should implement strategies being enshrined in Conference of Parties (COP, 2021) on climate change. This will help to reduce the level of climate change and flood occurrence.
Originality/value
Previous studies focussed on the adverse effect of flood occurrence without considering the issue of life expectancy amongst African countries. This study contributes to existing empirical studies by examining the effect of flood occurrence on mortality rate and life expectancy amongst African countries.
Peer review
The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-07-2022-0508.
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Emmanuel Adjei and Monica Mensah
The purpose of this study is to determine the extent to which total quality management (TQM) initiatives can improve the quality of services delivery at the medical records unit…
Abstract
Purpose
The purpose of this study is to determine the extent to which total quality management (TQM) initiatives can improve the quality of services delivery at the medical records unit of the Korle-Bu Teaching Hospital (KBTH) to help meet the expectations and aspirations of patients and customers of the hospital.
Design/methodology/approach
This research adopted the survey strategy as its research design. The total study population consisted of 114 medical records staff of the KBTH. Questionnaires and personal observations were employed as the data collection instruments. The study recorded a response rate of 98 per cent. Data gathered from respondents were analysed in qualitative terms.
Findings
The overall finding of this study was that, although the medical records department of the KBTH had a fair degree of understanding on the benefits of TQM to records management service delivery, the exiting values for TQM did not meet the framework of good TQM practice, principles and standards.
Research limitations/implications
Even though the subjects for the study were from the biggest hospital in Ghana, the findings of this study may not be generalised to the whole country.
Practical implications
The study has demonstrated the need for the medical records department of the KBTH to have and develop good TQM standards to improve the quality of services to patients and varied customers of the hospital.
Originality/value
The literature reviewed indicated that this study is a maiden attempt to examine how TQM initiatives including sensitivity, customer satisfaction, commitment of top management, team work, effective leadership and participatory management, people development and effective and open communication can improve the quality of medical records service delivery at the KBTH in Ghana.
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Ruhee Mittal, Tanu Kathuria, Mohit Saini, Barkha Dhingra and Mahender Yadav
Fintech plays a prominent role in augmenting the financial inclusion of the population and increasing the money supply, which calls for the intervention of monetary policy. This…
Abstract
Purpose
Fintech plays a prominent role in augmenting the financial inclusion of the population and increasing the money supply, which calls for the intervention of monetary policy. This article is an attempt to examine the relationship between the financial inclusion, fintech and monetary policy effectiveness of the Indian economy, within the framework of wealth creation and transmission mechanism through the cost of capital.
Design/methodology/approach
On the quarterly data retrieved from multiple sources, autoregressive distributed lagged regression is used to examine the relationship between different variables as explained in four set models; after which the Toda–Yamamoto causality test is employed to capture the direction of the relationship.
Findings
The study finds a positive relationship between financial inclusion, fintech and inflation taken as a proxy for Monetary Policy Effectiveness (MPE) in the short as well as in the long run. However, the relationship between fintech and inflation is negative once the cost of capital is included in the models. The causality test exhibits the uni-directional causality from fintech to MPE and MPE to financial inclusion. Bi-directional causality exists between wealth and MPE. Similarly, bank rate and interbank rate are bound by bi-directional causality.
Research limitations/implications
Being financially included facilitates ease and boosts public access to more financial services and credit, leading to increased demand and hence inflation. Hence government and regulators need to take mindful measures to enhance the fintech development and financial inclusion to make the monetary policy effective.
Originality/value
As per the author's best knowledge, this is the first study to examine the relationship between fintech, financial inclusion and monetary policy effectiveness in the context of the Indian economy.