Gordon Dugle

Free maternal healthcare policies (FMHP) result in enormous supply-side effects on care delivery in sub-Saharan Africa (SSA). This review synthesises the mechanisms adopted by supply-side actors to cope with the effects of FMHP and the results of coping mechanisms on policy objectives in seven SSA countries. We searched bibliographic databases for articles published in English for research that reported supply-side effects of FMHP, coping mechanisms, and effects of various coping mechanisms on attainment of reform objectives. Out of 215 studies identified, nine qualified for inclusion. Selected studies were exploratory in design and based on either mixed or qualitative methods. While local health system authorities and health facilities coping mechanisms that were intended to enhance implementation, facility managers and staff engaged in self-interest adaptation decisions and behaviours. Lack of explicit policy commitment to enhancing organisational and managerial capacity of local health authorities contribute to sustaining negative supply-side effects and adverse coping mechanisms. Without due consideration to governance and health system strengthening, FMHP are prone to perverse outcomes that undermine intended benefits. Context-specific empirical studies are needed to further conceptualise the supply- side effect - coping mechanism - consequential effect nexus of the policy.

Background Peer support has been proposed as a promising policy intervention for addressing adverse maternal and child healthcare (MCH) outcomes in sub-Saharan Africa (SSA). Existing reviews on peer support largely draw on evidence from high-income countries or focus on single services like breastfeeding, nutrition or postnatal care. In contrast, this review aims at providing a comprehensive overview of the empirical literature on peer support interventions across various MCH services in sub-Saharan Africa. Specifically, we aim to understand how, why, for whom, and in what circumstances different forms of MCH peer support interventions contribute to improving healthcare outcomes in sub-Saharan Africa. Methods Our realist review methodology involves various iterative processes of search, appraisal, selection and synthesis of the literature. Four databases–Cochrane Library, PubMed, CINAHL, and EMBASE–were repeatedly searched between March and June 2021. From a large volume of records ...

Promoting male participation in maternal healthcare is essential for improved maternal health outcomes. This study explored existing strategies to promote male participation in maternal healthcare and assessed their implementation challenges within healthcare facilities in the Jaman North District in Ghana. A qualitative approach was implemented in April 2020. Interviews were administered to a stratified purposive sample of 18 respondents comprising six midwives and 12 male partners of postnatal mothers. All interviews were audio‐recorded, transcribed, and manually analysed using thematic analysis. The findings revealed early service, male partner invitation, male partner incentivisation, public sensitization, and male informed education, as strategies to promote male participation in the district. The implementation of these strategies has been constrained by socio‐cultural and health system factors, namely, perception of pregnancy as non‐illness, perceived experiences gained by wo...

There has been growing advocacy for public‐private partnership (PPP) in healthcare in both policy and academic circles over the last 3 decades. However, our understanding of the tensions between the policy cycle and critical organisational trade‐offs that characterise alternative forms of healthcare PPPs remains limited. In this paper, we use Walt and Gilson's policy analysis triangle to explore the policy and practice of two alternative models of healthcare PPPs–autonomous and integrative partnerships–at the sub‐national level in Ghana, a typical case of a polycentric health management structure. The study is a sequential exploratory qualitative design, consisting of review of four policy documents and in‐depth interviews with 13 key informants, comprising health managers from the regional and district health directorates, and medical directors of selected private health facilities. Our findings reveal that in spite of the natural potential of integrative PPP models to present ...

Climate change has attracted the attention of all stakeholders, ranging from individuals in the household through to global organisations in the international community. As an inevitable phenomenon at the moment, adaptation is the key response to minimising the unfavourable effects of climate change. While there are several adaptation strategies, rural areas mostly use migration as an ultimate and most reliable option. Rural migration in Ghana is mostly from the north to the south. This paper examines the factors that influence individuals and households’ decision to use migration as an adaptation strategy to climate change effects in North-western Ghana. Data was collected using household questionnaire in four communities and analysed using statistical package for social science, version 20.0. The study established that although there are other reasons for migration, it is used essentially as an adaptation strategy to the effects of climate change on livelihood. The study concludes...

Background Health policy and systems research (HPSR) is an inherently cross-disciplinary field of investigation. However, conflicting conceptualisations about inter-, multi- and transdisciplinary research have contributed to confusion about the characteristics of cross-disciplinary approaches in HPSR. This review was conducted to (1) define the characteristic features of context–mechanism–outcome (CMO) configurations in cross-disciplinary HPSR, (2) develop criteria for evaluating cross-disciplinarity and (3) synthesise emerging challenges of the approach. Method The paper is a critical realist synthesis conducted in three phases, as follows: (1) scoping the literature, (2) searching for and screening the evidence, and (3) extracting and synthesising the evidence. Five databases, namely the International Bibliography of the Social Sciences and Web of Science, PubMed central, Embase and CINHAL, and reference lists of studies that qualified for inclusion in the review were searched. Th...

This paper uses Q Methodology to ascertain the views of project staff on how they could be involved in evaluation in order to enhance process use.  Structured interviews were conducted with twenty-five project staff who participated in two project evaluations within the context of participatory evaluation in Ghana. It emerged that the use of Q Methodology in evaluation studies enhances the mainstreaming of process use by helping to focus on the critical issues in participatory evaluation practice. Process use is enhanced when ample time is provided for intensive interaction with evaluation stakeholders from the formative stage of evaluation. Process use also requires evaluators to create an environment that is supportive of mutual interaction and closeness in working relations with stakeholders. The research concludes that process use in evaluation is attained through well-planned evaluation that gives voice to project staff and emphasises shared learning. The study recommends criti...