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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This paper aims to explore the determinants of maternal healthcare services (MHS) utilisation in Ghana.
Abstract
Purpose
This paper aims to explore the determinants of maternal healthcare services (MHS) utilisation in Ghana.
Design/methodology/approach
In this paper, logit and negative binomial regressions were used to model data from a recent nationally representative survey (the 2017 Ghana Maternal Health Survey). The analysis is observational, without causal implications. The authors measure MHS utilisation by four indicators: antenatal care (ANC) use, the number of ANC clinic visits, choice of health facility delivery and postnatal care (PNC) use.
Findings
Age, parity, education, marital status, wealth, residence and health facilities concentration proved to be significant predictors of MHS use in Ghana. Specifically, older, married and educated women; women of lower parity; those living in urban areas and women from wealthier households were more likely to use MHS. The authors also find that health facilities and personnel predicted higher MHS use. Lastly, women with frequent stillbirths had higher MHS use.
Practical implications
The results for health facilities and personnel suggest that increasing the supply of health centres and workers may enhance MHS use. The authors conclude that women of lower socio-economic status have worse MHS use, meaning empowering such women might increase such women's MHS use.
Originality/value
Existing data suggest falling MHS use in Ghana. Yet, the extant works are based on relatively old data or lack external validity (besides using limited MHS indicators). This paper provides recent and generalisable evidence for public health policies. Additionally, this paper tests the statistical significance of some supply-side factors that have yet to be emphasised in the literature.
Peer review
The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-03-2022-0199.
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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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Samuel Gyamerah, Zheng He, Enock Mintah Ampaw, Dennis Asante and Lydia Asare-Kyire
Drawing upon the institutional theory, the present study investigated whether or not small and medium-sized enterprises (SMEs) in East Africa benefit from the Belt and Road…
Abstract
Purpose
Drawing upon the institutional theory, the present study investigated whether or not small and medium-sized enterprises (SMEs) in East Africa benefit from the Belt and Road Initiative (BRI), and how the latter influences the internationalization of the former.
Design/methodology/approach
An in-depth interview was conducted by using 26 SME managers/owners who are engaged in international activities in the “Belt and Road” countries. The sample was chosen from four East African countries across three industries. The theoretical framework emerged from the grounded theory analysis of the primary data.
Findings
The authors found that the BRI as a formal institutional force generates both direct and indirect influences on SMEs' internationalization. Three key driving forces, namely partnerships, specialized services and innovativeness underpin the internationalization of SMEs. Additionally, sectoral analysis of the similarities and differences in responses reveals no remarkable differences in the drivers and impact of the BRI on SMEs in all the three industries investigated.
Research limitations/implications
The internationalization process of East African SMEs could be augmented through formal institutions like the BRI, and the internationalization of SMEs along the “Belt and Road” countries mimic an integrative approach. The theoretical framework demonstrates significant potential for further benefits that SMEs may obtain through the BRI by taking advantage of certain BRI opportunities and adopting crucial strategies to internationalize rapidly.
Originality/value
This is the first study to employ a qualitative approach to study the influence of the BRI at the firm-level. Specifically, the paper covered the hub of BRI countries in East Africa. Hence, the study makes substantial theoretical and policy contributions to the literature.
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José González-Nuñez, Salomón Domínguez and Karl J. Zimmermann
This research highlights the importance of understanding the characteristics of the uninsured population in Mexico, as it is closely related to economic growth. Those…
Abstract
Purpose
This research highlights the importance of understanding the characteristics of the uninsured population in Mexico, as it is closely related to economic growth. Those characteristics that are not economic but behavioral are especially important to incentivize insurance purchases in the population with sufficient resources.
Design/methodology/approach
Considering the main reason for not having insurance, this research classifies the Mexican adult population into four categories using a multinomial logit model and the National Survey of Financial Inclusion (2021).
Findings
The adult Mexican population can be divided into four categories: No money, Not aware or does not trust, No need, Other; this division allows comparisons between categories at 95% confidential level. The statistically significant variables were Mobile phone-ownership, Education level, Age, Financial behavior and Locality, while the variables, Financial literacy and Gender, were not. The variables that strongly characterize the uninsured population with sufficient resources (42.1%) are associated with economic factors (mobile phone ownership) and people’s behavior (Education level, Age, Financial behavior and Locality). This presents an excellent opportunity for policymakers to develop public policies encouraging insurance purchases.
Originality/value
Various empirical studies have focused on determining the economic, demographic and institutional factors that determine insurance tenure. Still, no empirical evidence has been found to characterize the uninsured population. This study aims to help policymakers develop public policy for the uninsured population to encourage them to purchase insurance. This research contributes to empirical theory in three ways: First, it identifies a large market in Mexico; the uninsured population in this country is about 80%. Second, it segments the adult population into categories to analyze better. Third, the characteristics of the population that has sufficient resources to take out insurance but has none can be found.
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Debora Sarno, Bo Enquist, Francesco Polese, Roberta Sebastiani, Samuel Petros Sebhatu and Anna Maria Viljakainen
Sustainability transitions (STs) refer to large-scale step changes in complex systems required to face sustainability issues. We aim to delineate how they can unfold in service…
Abstract
Purpose
Sustainability transitions (STs) refer to large-scale step changes in complex systems required to face sustainability issues. We aim to delineate how they can unfold in service ecosystems, especially when inspired by regenerative thinking.
Design/methodology/approach
We develop a conceptual framework based on a processual view of STs and provide a propositional inventory based on literature leveraging deductive reasoning. Moreover, we contextualize our conceptualizations by showing illustrative examples of cities coping with STs.
Findings
We connect the perception of unsustainability with the shift toward service-dominant (S-D) logic and identify them as triggers of an ST; we focus on the role of nested service ecosystems and the adoption of regenerative thinking in STs; finally, we highlight the domino effect that can drive continuous change towards sustainability in service ecosystems. Future research could be focused on (loss of) sensemaking for driving STs, practical approaches to deal with institutional tensions in nested service ecosystems and the possible fractality of ST processes in service ecosystems.
Originality/value
This study supports the understanding of STs in cities and other systems such as industries, markets and organizations. It contributes to ST literature by suggesting the adoption of S-D logic and system lenses to identify, drive and cope with system changes toward sustainability, showing implications for policymakers and practitioners. Furthermore, it contributes to S-D logic by unfolding the self-adjustment of service ecosystems and the focus of sustainability initiatives on nested service ecosystems to sustain the broader systems. Finally, it contributes to transformative service research by identifying how the procedural and inspirational principles characterizing regenerative thinking can support design for STs.
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Shartriya Collier, Betty Burston and Aarika Rhodes
A review of current initiatives to increase science, technology, engineering and mathematics (STEM) achievement among American youth and young adults reveals the presence of…
Abstract
Purpose
A review of current initiatives to increase science, technology, engineering and mathematics (STEM) achievement among American youth and young adults reveals the presence of “IQism”. That is, whether such interventions are directed toward low-income minorities and/or the disproportionate number of higher-income youth who have selected liberal arts majors over an STEM major, the country has reserved STEM as a field for “the best and the brightest”. Utilizing the Theory of Multiple Intelligences, this article argues that STEM content is accessible to all students including those whose first language is informal rather than formal English. Based upon these premises, this conceptual paper aims to introduce the framework of Teaching STEM as a Second Language as a strategy for elevating STEM achievement among students who would otherwise be excluded from the STEM movement.
Design/methodology/approach
This paper utilizes a review of both classic and current literature on second language acquisition to identify strategies that can be adopted by STEM instructors to increase STEM achievement among youth and young adults who are viewed as “average” and/or “below-average” academic performers.
Findings
Using quotes that confirm the thesis that STEM subject matter has been historically viewed as the domain of those whose cognitive skills place them among the “best and the brightest”, the second language acquisition (SLA) strategy of “scaffolding” is introduced as a pedagogy for producing “comprehensible output” when STEM content is taught to students whose first language is informal English. Constructivism, a concept currently used to guide the teaching of STEM contents is introduced as a framework that merges best practices in STEM and SLA. Using Cummins’ (1991) Common Underlying Proficiency Model, other strategies are also proposed for exporting SLA pedagogies and approaches to elevate equity in the quest to improve STEM achievement levels among youth and adults in the USA.
Originality/value
SLA theories and concepts have not been applied as a potential tool for teaching STEM. This is a unique and powerful lens that can be used to more effectively support the needs of underrepresented populations.