This document summarizes a case study on Ghana's Community-based Health Planning and Services (CHPS) policy and the challenges of communicating change. It discusses how 6 communication mechanisms were used to bridge the gap between enthusiasm for the policy and slow implementation progress. The mechanisms included implementation guides, a newsletter, national forums, peer advocacy visits between districts, and videos - aiming to facilitate information sharing in a bottom-up and horizontal manner. Exposure to these different sources directly correlated with faster CHPS implementation progress across districts.
Community perspectives on task-shifting/ sharing: a multi-country survey to i...gnpplus
This document summarizes the results of a global survey on community perspectives regarding task-shifting of HIV services from doctors to nurses and community health workers. The survey received responses from over 1000 people in 122 countries. While most respondents supported task-shifting if nurses and health workers received proper training, their views differed on which specific tasks should be shifted. Respondents identified lack of training, inadequate pay, and unsupportive policies as barriers to effective task-shifting. The survey provided insights into community acceptance of task-shifting but had limitations due to its online format and non-random sampling.
Going to Scale with Effective Community-based Primary Health Care Kureshy and...CORE Group
The document summarizes the key findings and recommendations of an expert panel on community-based primary health care (CBPHC) in improving maternal, neonatal, and child health. The panel recommends that CBPHC should be a priority for strengthening health systems, achieving universal health coverage, and ending preventable child and maternal deaths. Resources for CBPHC need to increase and be tracked at national levels. Communities are an undervalued resource and their full participation through partnerships with health systems is essential to effectively reach those most in need. Prioritizing CBPHC in populations with the highest mortality can achieve greater impact.
This qualitative study examined community members' knowledge of emergency medical conditions like obstetric and neonatal complications in northern Ghana. The study aimed to understand barriers to utilizing emergency referral services and inform the development of a community education program. Focus group discussions revealed varying and sometimes inaccurate understandings of different medical emergencies. Certain conditions were believed to be spiritual or traditional problems requiring non-medical treatment. The discussions identified misconceptions and cultural practices that hindered emergency care seeking. The results provided guidance on addressing knowledge gaps and misperceptions through community education materials and programs to improve emergency service utilization.
A retrospective review of the Honduras AIN-C program guided by a community he...HFG Project
Factors that influence performance of community health workers (CHWs) delivering health services are not well understood. A recent logic model proposed categories of support from both health sector and communities influence CHW performance and program outcomes. This logic model has been used to review a growth monitoring program delivered by CHWs in Honduras, known as Atención Integral a la Niñez en la Comunidad (AIN-C). A retrospective review of AIN-C was conducted through a document desk review and supplemented with in-depth interviews. Documents were systematically coded using the categories from the logic model, and gaps were addressed through interviews. Authors reviewed coded data for each category to analyze program details and outcomes as well as identify potential issues and gaps in the logic model.
This report summarizes a study that explored health literacy and factors influencing cancer outcomes in the Grampians region of Victoria, Australia. The Grampians population has lower socioeconomic status and higher rates of cancer incidence and mortality compared to state averages. The study aimed to understand health literacy challenges residents face and identify service improvements. Surveys and interviews assessed residents' health literacy and experiences with cancer screening and care. Workshops with residents and providers generated 56 ideas to better support patients, improve services, and facilitate engagement in health activities. Recommendations address enhancing community, primary care, cancer services, regional partnerships, and policy efforts.
- The study assessed factors influencing the utilization of voluntary HIV counseling and testing (VCT) services among youth in Awassa town, Ethiopia using a Health Belief Model approach.
- Through focus group discussions and interviews, the major factors found to inhibit VCT utilization were fear of stigma and discrimination, fear of coping with a positive HIV test result, and high HIV risk perception. The factors found to enhance utilization were having marriage plans, access to care and support including antiretroviral therapy, and persuasion by health professionals.
- HIV risk perception was a debated factor, with some seeing it as enhancing utilization by raising awareness, and others seeing it as inhibiting due to low perceived risk. Tailored interventions
Weight loss interventions for adults who are obese on mortality and morbidity...Health Evidence™
Health Evidence™ hosted a 60 minute webinar examining the effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease and cancer. Follow this link to access to the audio recording for this webinar: https://youtu.be/olF1bvaofXE
Dr. Alison Avenell, Clinical Chair in Health Services Research, and Sam (Chenhan) Ma, from the Health Services Research Unit at the University of Aberdeen presented an overview of findings from their latest systematic review and meta-analysis:
Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, et al. (2017). Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: Systematic review and meta-analysis. BMJ, 359, j4849.
Adults with obesity have an increased risk of premature mortality, cardiovascular disease, some cancers, type 2 diabetes, and many other diseases. This review assesses whether weight loss intervention for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight. Fifty-four randomized controlled trials (RCTs) with 30,206 participants were identified in the review. High quality evidence showed that weight loss interventions decrease all cause mortality, with six fewer deaths per 1000 participants. Moderate quality evidence showed an effect on cardiovascular mortality, and very low quality evidence showed an effect on cancer mortality. Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.
Community perspectives on task-shifting/ sharing: a multi-country survey to i...gnpplus
This document summarizes the results of a global survey on community perspectives regarding task-shifting of HIV services from doctors to nurses and community health workers. The survey received responses from over 1000 people in 122 countries. While most respondents supported task-shifting if nurses and health workers received proper training, their views differed on which specific tasks should be shifted. Respondents identified lack of training, inadequate pay, and unsupportive policies as barriers to effective task-shifting. The survey provided insights into community acceptance of task-shifting but had limitations due to its online format and non-random sampling.
Going to Scale with Effective Community-based Primary Health Care Kureshy and...CORE Group
The document summarizes the key findings and recommendations of an expert panel on community-based primary health care (CBPHC) in improving maternal, neonatal, and child health. The panel recommends that CBPHC should be a priority for strengthening health systems, achieving universal health coverage, and ending preventable child and maternal deaths. Resources for CBPHC need to increase and be tracked at national levels. Communities are an undervalued resource and their full participation through partnerships with health systems is essential to effectively reach those most in need. Prioritizing CBPHC in populations with the highest mortality can achieve greater impact.
This qualitative study examined community members' knowledge of emergency medical conditions like obstetric and neonatal complications in northern Ghana. The study aimed to understand barriers to utilizing emergency referral services and inform the development of a community education program. Focus group discussions revealed varying and sometimes inaccurate understandings of different medical emergencies. Certain conditions were believed to be spiritual or traditional problems requiring non-medical treatment. The discussions identified misconceptions and cultural practices that hindered emergency care seeking. The results provided guidance on addressing knowledge gaps and misperceptions through community education materials and programs to improve emergency service utilization.
A retrospective review of the Honduras AIN-C program guided by a community he...HFG Project
Factors that influence performance of community health workers (CHWs) delivering health services are not well understood. A recent logic model proposed categories of support from both health sector and communities influence CHW performance and program outcomes. This logic model has been used to review a growth monitoring program delivered by CHWs in Honduras, known as Atención Integral a la Niñez en la Comunidad (AIN-C). A retrospective review of AIN-C was conducted through a document desk review and supplemented with in-depth interviews. Documents were systematically coded using the categories from the logic model, and gaps were addressed through interviews. Authors reviewed coded data for each category to analyze program details and outcomes as well as identify potential issues and gaps in the logic model.
This report summarizes a study that explored health literacy and factors influencing cancer outcomes in the Grampians region of Victoria, Australia. The Grampians population has lower socioeconomic status and higher rates of cancer incidence and mortality compared to state averages. The study aimed to understand health literacy challenges residents face and identify service improvements. Surveys and interviews assessed residents' health literacy and experiences with cancer screening and care. Workshops with residents and providers generated 56 ideas to better support patients, improve services, and facilitate engagement in health activities. Recommendations address enhancing community, primary care, cancer services, regional partnerships, and policy efforts.
- The study assessed factors influencing the utilization of voluntary HIV counseling and testing (VCT) services among youth in Awassa town, Ethiopia using a Health Belief Model approach.
- Through focus group discussions and interviews, the major factors found to inhibit VCT utilization were fear of stigma and discrimination, fear of coping with a positive HIV test result, and high HIV risk perception. The factors found to enhance utilization were having marriage plans, access to care and support including antiretroviral therapy, and persuasion by health professionals.
- HIV risk perception was a debated factor, with some seeing it as enhancing utilization by raising awareness, and others seeing it as inhibiting due to low perceived risk. Tailored interventions
Weight loss interventions for adults who are obese on mortality and morbidity...Health Evidence™
Health Evidence™ hosted a 60 minute webinar examining the effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease and cancer. Follow this link to access to the audio recording for this webinar: https://youtu.be/olF1bvaofXE
Dr. Alison Avenell, Clinical Chair in Health Services Research, and Sam (Chenhan) Ma, from the Health Services Research Unit at the University of Aberdeen presented an overview of findings from their latest systematic review and meta-analysis:
Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, et al. (2017). Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: Systematic review and meta-analysis. BMJ, 359, j4849.
Adults with obesity have an increased risk of premature mortality, cardiovascular disease, some cancers, type 2 diabetes, and many other diseases. This review assesses whether weight loss intervention for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight. Fifty-four randomized controlled trials (RCTs) with 30,206 participants were identified in the review. High quality evidence showed that weight loss interventions decrease all cause mortality, with six fewer deaths per 1000 participants. Moderate quality evidence showed an effect on cardiovascular mortality, and very low quality evidence showed an effect on cancer mortality. Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.
This proposal aims to evaluate approaches for scaling up cervical cancer screening and treatment in Tanzania. It will assess health system capacity, train nursing staff to provide screening and cryotherapy, and implement an awareness campaign. The study compares outcomes between sites receiving no intervention, training only, and training plus awareness raising. The goal is to increase screening coverage and utilization, and ultimately reduce cervical cancer mortality in Tanzania over 10 years.
Speaking at the 2015 CCIH Annual Conference, Juli Hedrick, MPH, Design and Development Officer, World Vision gives advice on how to strengthen health systems in post-conflict areas and other fragile contexts. She addresses issues such as human resources, the use of mobile technology and security.
The document discusses methods for measuring vital events like births and deaths. It describes the SAVVY (Sample Vital Registration with Verbal Autopsy) approach used by MEASURE Evaluation to strengthen civil registration and vital statistics systems in countries. SAVVY involves a census, registration of vital events, and verbal autopsies to determine causes of death. The document discusses case studies of SAVVY implementation in Tanzania and Zambia, noting achievements like improved data quality and integration into national health information systems. It also covers maternal mortality estimation using surveys and census data, challenges in ascertaining causes of maternal death, and a study of indirect causes like HIV/malaria in Mozambique.
This document discusses global health monitoring and evaluation (M&E) and outlines what may come next. It notes the progress made in bending the curve of HIV/AIDS and tuberculosis incidence through programs like PEPFAR and PMI. It then describes MEASURE Evaluation's contributions in measuring change, building workforce capacity, strengthening health systems, guiding resource allocation, and creating tools and methods. The document concludes by suggesting areas of future focus, including scaling up successful systems, approaches and tools; filling gaps like interoperable data systems and evaluating structural interventions; incorporating more systems thinking; and focusing on developing a strong and sustainable M&E workforce.
Break-out session slides Session 1: 1.1 Population health management in pract...NHS England
Population health management aims to improve the health outcomes of an entire population through proactive care. It uses data-driven strategies like segmentation, stratification, and impactability modeling to identify at-risk groups and design targeted interventions. The National Health Service in England is promoting population health management approaches across integrated care systems to help systems better understand health needs and match services accordingly. Primary care networks will assess their local populations and work with communities to support those most at risk of poor health outcomes through proactive approaches.
"Preferred methods of assisted Partner Notification Services in Seme and Kisu...IJSRED
The document summarizes a study that examined the preferred methods of assisted partner notification services among HIV-positive clients in Kisumu County, Kenya. The study found that 40.4% of participants indicated that provider referral was the preferred notification method. Client referral was also preferred by 26% of participants. There was no statistically significant association found between participation in partner notification services and preferred notification method. The study concluded that provider referral should be adopted for implementing assisted partner notification services.
This document summarizes a presentation on monitoring and evaluation given at an end-of-phase event on May 22, 2014. It discusses responsive M&E systems for program success and the importance of building national M&E capacity. It provides examples of tools and approaches used by MEASURE Evaluation to support countries, including developing M&E guidelines, training curricula, and providing technical assistance. Challenges in M&E like implementation, coordination and measuring achievements are also noted. The presentation emphasizes adapting local M&E systems as contexts change from malaria control to elimination.
Impact of voucher system on access to maternal and child health services in E...Jeff Knezovich
John Bua of Makerere University presents on a voucher scheme in Eastern Uganda to transport pregnant women to the care facility at iHEA 2011 in Toronto, Canada.
Over the past decade, consumers have been exposed to many new digital health technologies and their use in clinical care. These technologies have helped make health information more accessible, especially for underserved populations. Health workers and healthcare systems now use technology as a tool to reach and engage these groups for health education, disease prevention, and care management. Population health approaches aim to improve outcomes for entire groups and reduce disparities. These approaches consider social factors and engage multiple sectors. Incorporating technology into population health requires understanding that people should come first, and using technology to identify community strengths and tailor strategies based on community feedback.
mHealth for Family Planning_Lairmore_finalKate Lairmore
Mobile health (mHealth) tools show promise in increasing access to family planning services and education by leveraging the widespread availability of mobile phones. However, while mHealth applications are growing rapidly, evidence of their effectiveness remains limited. This paper examines the potential uses of mHealth strategies in family planning programs and presents examples to address unmet needs for information and services. The goal is to provide an overview of how adding mobile phone tools could help reduce high unmet need levels.
Evaluation of egypt population project eppkehassan
This document provides an independent evaluation of Parts A and B of the Egypt Population Project (EPP). It finds that the EPP achieved several objectives including breaking down social barriers to family planning, improving service provision, increasing contraceptive prevalence and vaccinations. It analyzes the effectiveness of project components like social change agents and microloans. Challenges included sustainability after phasing out funds. Lessons learned included the importance of partnerships and decentralized management. Further interventions were still needed in some communities.
INFLUENCE OF HEALTH SERVICE PROVIDER COMPETENCY ON UTILIZATION OF UNIVERSAL H...Premier Publishers
This study assessed the influence of healthcare provider competency on universal health coverage utilization in Seme Sub-County, Kenya. A cross-sectional study was conducted using a sample of 377 community members and 8 health facility managers. Logistic regression found that healthcare provider competency statistically influenced utilization of universal health coverage. Respondents who perceived that providers had adequate health knowledge were over twice as likely to use universal health coverage services. Those who experienced misdiagnosis were half as likely to solely rely on universal health coverage. Most respondents agreed that providers had sufficient knowledge, though some raised concerns about competency in pharmacy departments due to staffing shortages. In conclusion, healthcare provider competency levels significantly impact utilization of universal health coverage.
Online and Virtual Health Information Use, Health Empowerment and Health Risksasclepiuspdfs
Access to virtual health information is associated with improved knowledge about health issues. In this commentary, we present the challenges associated with the use of the virtual sources of information including eHealth and mHealth for health purposes. We analyze the difficulties caused by a set of individual-level constraints - lack of technology skills, chronic condition, and a distinction between lifestyle and healthcare goals that prevent the effective use of eHealth and mHealth sources. We propose that institutional level efforts encouraging the use of virtual health sources toward increased health empowerment and self-management practices should account for these individual-level constraints. By doing so, institutional health-care providers will be more likely to increase the quality in the delivery of health services and health programs, improve the likelihood of effective self-management practices, and reduce the risk of inducing secondary digital divide effects.
The document discusses harm reduction interventions for people who use drugs. It recommends including a package of nine evidence-based interventions in Global Fund proposals, with a focus on needle and syringe programs, opioid substitution therapy, and antiretroviral therapy. Successful proposals should involve people who use drugs in planning, ensure accessibility of services, and address gender equity through gender-sensitive programming.
Increasing Access to Institutional Deliveries Using Demand and Supply Side In...IDS
The document discusses a study that aims to increase institutional deliveries in Uganda by using demand and supply side incentives. The study uses a cluster randomized trial across 4 sub-districts, with 2 as intervention and 2 as control. The intervention provides vouchers for transport and maternity services to address barriers like cost and distance that prevent the poor from accessing facilities. The study assesses the effectiveness of the voucher system in increasing facility deliveries, especially among the poor. It also evaluates impacts on birth outcomes, antenatal care, and postnatal care utilization.
This paper presents analysis of a Kent ‘whole population’ dataset, linking wholepopulation demographics with activity and cost data for the population from acute, community, mental health and social care providers. The data helps commissioners to understand the impact of different selections methods for people with ‘very complex’ health and social care needs, particularly in relation to the development of a LTC year of care currency.
This document should be seen alongside the ‘Recovery, Rehabilitation and Reablement – step-by-step guide’ which describes how providers can carry out the audit in their own organisation. Other documents and learning materials This document is part of a suite of learning materials being produced by the LTC Year of Care Commissioning Programme to support the spread and adoption of capitated budgets for people with complex care needs.
This document summarizes the field of veterinary epidemiology and techniques used. It discusses the goals of field epidemiology to quickly inform and implement interventions to prevent illness. Emerging diseases require rapid response. The document also discusses strategies to control endemic diseases, including reducing spread and losses. Epidemiological studies explore risk factors and associations to evaluate impacts on production, economics, and societies. A variety of epidemiological techniques are used, including multivariable analysis, simulation modeling, spatial-temporal analysis, and network analysis.
The advantages and disadvantages of the 2011 new patent “first to-file” systemAlexander Decker
This document discusses the changes to the US patent system enacted by the America Invents Act of 2011, which shifted it from a "first-to-invent" to a "first-to-file" system. It explores the perceived advantages and disadvantages of this change, noting it has created significant discussion around its potential impacts on intellectual property rights, patent litigation, and how patent applications will be handled. The document provides background on the previous first-to-invent system and an overview of the new first-to-file process enacted in 2011.
This proposal aims to evaluate approaches for scaling up cervical cancer screening and treatment in Tanzania. It will assess health system capacity, train nursing staff to provide screening and cryotherapy, and implement an awareness campaign. The study compares outcomes between sites receiving no intervention, training only, and training plus awareness raising. The goal is to increase screening coverage and utilization, and ultimately reduce cervical cancer mortality in Tanzania over 10 years.
Speaking at the 2015 CCIH Annual Conference, Juli Hedrick, MPH, Design and Development Officer, World Vision gives advice on how to strengthen health systems in post-conflict areas and other fragile contexts. She addresses issues such as human resources, the use of mobile technology and security.
The document discusses methods for measuring vital events like births and deaths. It describes the SAVVY (Sample Vital Registration with Verbal Autopsy) approach used by MEASURE Evaluation to strengthen civil registration and vital statistics systems in countries. SAVVY involves a census, registration of vital events, and verbal autopsies to determine causes of death. The document discusses case studies of SAVVY implementation in Tanzania and Zambia, noting achievements like improved data quality and integration into national health information systems. It also covers maternal mortality estimation using surveys and census data, challenges in ascertaining causes of maternal death, and a study of indirect causes like HIV/malaria in Mozambique.
This document discusses global health monitoring and evaluation (M&E) and outlines what may come next. It notes the progress made in bending the curve of HIV/AIDS and tuberculosis incidence through programs like PEPFAR and PMI. It then describes MEASURE Evaluation's contributions in measuring change, building workforce capacity, strengthening health systems, guiding resource allocation, and creating tools and methods. The document concludes by suggesting areas of future focus, including scaling up successful systems, approaches and tools; filling gaps like interoperable data systems and evaluating structural interventions; incorporating more systems thinking; and focusing on developing a strong and sustainable M&E workforce.
Break-out session slides Session 1: 1.1 Population health management in pract...NHS England
Population health management aims to improve the health outcomes of an entire population through proactive care. It uses data-driven strategies like segmentation, stratification, and impactability modeling to identify at-risk groups and design targeted interventions. The National Health Service in England is promoting population health management approaches across integrated care systems to help systems better understand health needs and match services accordingly. Primary care networks will assess their local populations and work with communities to support those most at risk of poor health outcomes through proactive approaches.
"Preferred methods of assisted Partner Notification Services in Seme and Kisu...IJSRED
The document summarizes a study that examined the preferred methods of assisted partner notification services among HIV-positive clients in Kisumu County, Kenya. The study found that 40.4% of participants indicated that provider referral was the preferred notification method. Client referral was also preferred by 26% of participants. There was no statistically significant association found between participation in partner notification services and preferred notification method. The study concluded that provider referral should be adopted for implementing assisted partner notification services.
This document summarizes a presentation on monitoring and evaluation given at an end-of-phase event on May 22, 2014. It discusses responsive M&E systems for program success and the importance of building national M&E capacity. It provides examples of tools and approaches used by MEASURE Evaluation to support countries, including developing M&E guidelines, training curricula, and providing technical assistance. Challenges in M&E like implementation, coordination and measuring achievements are also noted. The presentation emphasizes adapting local M&E systems as contexts change from malaria control to elimination.
Impact of voucher system on access to maternal and child health services in E...Jeff Knezovich
John Bua of Makerere University presents on a voucher scheme in Eastern Uganda to transport pregnant women to the care facility at iHEA 2011 in Toronto, Canada.
Over the past decade, consumers have been exposed to many new digital health technologies and their use in clinical care. These technologies have helped make health information more accessible, especially for underserved populations. Health workers and healthcare systems now use technology as a tool to reach and engage these groups for health education, disease prevention, and care management. Population health approaches aim to improve outcomes for entire groups and reduce disparities. These approaches consider social factors and engage multiple sectors. Incorporating technology into population health requires understanding that people should come first, and using technology to identify community strengths and tailor strategies based on community feedback.
mHealth for Family Planning_Lairmore_finalKate Lairmore
Mobile health (mHealth) tools show promise in increasing access to family planning services and education by leveraging the widespread availability of mobile phones. However, while mHealth applications are growing rapidly, evidence of their effectiveness remains limited. This paper examines the potential uses of mHealth strategies in family planning programs and presents examples to address unmet needs for information and services. The goal is to provide an overview of how adding mobile phone tools could help reduce high unmet need levels.
Evaluation of egypt population project eppkehassan
This document provides an independent evaluation of Parts A and B of the Egypt Population Project (EPP). It finds that the EPP achieved several objectives including breaking down social barriers to family planning, improving service provision, increasing contraceptive prevalence and vaccinations. It analyzes the effectiveness of project components like social change agents and microloans. Challenges included sustainability after phasing out funds. Lessons learned included the importance of partnerships and decentralized management. Further interventions were still needed in some communities.
INFLUENCE OF HEALTH SERVICE PROVIDER COMPETENCY ON UTILIZATION OF UNIVERSAL H...Premier Publishers
This study assessed the influence of healthcare provider competency on universal health coverage utilization in Seme Sub-County, Kenya. A cross-sectional study was conducted using a sample of 377 community members and 8 health facility managers. Logistic regression found that healthcare provider competency statistically influenced utilization of universal health coverage. Respondents who perceived that providers had adequate health knowledge were over twice as likely to use universal health coverage services. Those who experienced misdiagnosis were half as likely to solely rely on universal health coverage. Most respondents agreed that providers had sufficient knowledge, though some raised concerns about competency in pharmacy departments due to staffing shortages. In conclusion, healthcare provider competency levels significantly impact utilization of universal health coverage.
Online and Virtual Health Information Use, Health Empowerment and Health Risksasclepiuspdfs
Access to virtual health information is associated with improved knowledge about health issues. In this commentary, we present the challenges associated with the use of the virtual sources of information including eHealth and mHealth for health purposes. We analyze the difficulties caused by a set of individual-level constraints - lack of technology skills, chronic condition, and a distinction between lifestyle and healthcare goals that prevent the effective use of eHealth and mHealth sources. We propose that institutional level efforts encouraging the use of virtual health sources toward increased health empowerment and self-management practices should account for these individual-level constraints. By doing so, institutional health-care providers will be more likely to increase the quality in the delivery of health services and health programs, improve the likelihood of effective self-management practices, and reduce the risk of inducing secondary digital divide effects.
The document discusses harm reduction interventions for people who use drugs. It recommends including a package of nine evidence-based interventions in Global Fund proposals, with a focus on needle and syringe programs, opioid substitution therapy, and antiretroviral therapy. Successful proposals should involve people who use drugs in planning, ensure accessibility of services, and address gender equity through gender-sensitive programming.
Increasing Access to Institutional Deliveries Using Demand and Supply Side In...IDS
The document discusses a study that aims to increase institutional deliveries in Uganda by using demand and supply side incentives. The study uses a cluster randomized trial across 4 sub-districts, with 2 as intervention and 2 as control. The intervention provides vouchers for transport and maternity services to address barriers like cost and distance that prevent the poor from accessing facilities. The study assesses the effectiveness of the voucher system in increasing facility deliveries, especially among the poor. It also evaluates impacts on birth outcomes, antenatal care, and postnatal care utilization.
This paper presents analysis of a Kent ‘whole population’ dataset, linking wholepopulation demographics with activity and cost data for the population from acute, community, mental health and social care providers. The data helps commissioners to understand the impact of different selections methods for people with ‘very complex’ health and social care needs, particularly in relation to the development of a LTC year of care currency.
This document should be seen alongside the ‘Recovery, Rehabilitation and Reablement – step-by-step guide’ which describes how providers can carry out the audit in their own organisation. Other documents and learning materials This document is part of a suite of learning materials being produced by the LTC Year of Care Commissioning Programme to support the spread and adoption of capitated budgets for people with complex care needs.
This document summarizes the field of veterinary epidemiology and techniques used. It discusses the goals of field epidemiology to quickly inform and implement interventions to prevent illness. Emerging diseases require rapid response. The document also discusses strategies to control endemic diseases, including reducing spread and losses. Epidemiological studies explore risk factors and associations to evaluate impacts on production, economics, and societies. A variety of epidemiological techniques are used, including multivariable analysis, simulation modeling, spatial-temporal analysis, and network analysis.
The advantages and disadvantages of the 2011 new patent “first to-file” systemAlexander Decker
This document discusses the changes to the US patent system enacted by the America Invents Act of 2011, which shifted it from a "first-to-invent" to a "first-to-file" system. It explores the perceived advantages and disadvantages of this change, noting it has created significant discussion around its potential impacts on intellectual property rights, patent litigation, and how patent applications will be handled. The document provides background on the previous first-to-invent system and an overview of the new first-to-file process enacted in 2011.
The dialectic of myth making in contemporary african novelAlexander Decker
This document summarizes and analyzes Ayi Kwei Armah's use of myth in his novels. It contends that Armah revises and recreates traditional African myths to serve as provocative catalysts for positive change. It examines how Armah incorporates myths like the Cargo Cult, Prometheus, and Plato's Cave into novels like Fragments and The Beautyful Ones Are Not Yet Born to symbolically critique contemporary African society and shape a vision for the future. The document argues Armah's myths function to establish new models of behavior and reconstruct the past to guide social development.
The effect of mobile money transfer on working capital managementAlexander Decker
The document summarizes a research study that analyzed the effect of M-Pesa mobile money transfers on debt collection at NAWASSCO, a water company in Kenya. Some key findings of the study include:
1) The debtor collection period was reduced from an average of 53.6 days in the pre-M-Pesa period to 27.7 days in the post-M-Pesa period, indicating more efficient debt collection.
2) There was an upward trend in the usage of M-Pesa for water bill payments over the study period from 2007-2011.
3) There was a weak correlation between M-Pesa usage for bill payments and debtor collection period, influenced by other
The degree of basic stage schools' teachers' practicing of personal, professi...Alexander Decker
This document summarizes a study that aimed to identify the degree to which teachers at basic stage schools in Jordan practice personal, professional, and social competencies. A questionnaire was developed and administered to 40 male and female teachers to measure these competencies. The study found that teachers generally practiced the competencies at a high level, with personal competencies being the highest and professional competencies the lowest. There were no significant differences found based on gender or academic qualification for most competencies, but personal competency practice was higher for bachelor's degree holders. The study recommends experience sharing to enhance competencies for teachers of deaf students.
Este documento presenta un plan para una lección sobre animales para niños. Los objetivos son identificar las concepciones de los niños sobre diferentes animales y profundizar sus conocimientos mediante cuentos y discusiones. La estrategia incluye mostrar imágenes de animales, leer un cuento, y luego diseñar un animal imaginario. La metodología implica clasificar animales terrestres, aéreos y acuáticos, leer un cuento para identificar sus características, y luego crear un animal ficticio con nombre y atributos.
The concept of moments of order invariant quantumAlexander Decker
The document summarizes key concepts related to moments of order invariant quantum Lévy processes. It begins by defining order equivalence and order invariant distributions for discrete random variables. It then states that if the distributions are order invariant, the moments of their sums converge as the number of variables increases. Similarly, for order invariant quantum Lévy processes, the document shows that limits exist for the moments and provides an expression involving these limits. It proves the existence of the limits for moments by induction on the length of index tuples.
Testing for fisher’s hypothesis in nigeria (1970 2012)Alexander Decker
This document summarizes a study that tested Fisher's hypothesis in Nigeria between 1970-2012. The study used quarterly data on interest rates and inflation rates to examine the causal relationship between the two variables. It employed cointegration and Granger causality tests and found that:
1) There is no significant long-run relationship between interest and inflation rates, violating Fisher's hypothesis in the long-run.
2) In the short-run, there is no causal link from interest rates to inflation, but there is a causal link from inflation to interest rates, supporting Fisher's hypothesis.
3) Fisher's hypothesis that nominal interest rates consist of expected inflation plus a real interest rate component is validated in the short-run
The effect of information technology on the quality of accounting information...Alexander Decker
This document summarizes a research paper that examines the effect of information technology on the quality of accounting information systems and the quality of accounting information. It provides background on accounting information systems and discusses how information technology impacts the quality of accounting information systems in terms of reliability, timeliness, flexibility, usefulness and sophistication. It then explores how the quality of accounting information systems influences the quality of accounting information in terms of relevance, accuracy and completeness. The study aims to develop a theoretical framework and hypotheses to empirically test these relationships.
The association between hla drb alleles with pulmonary tuberculosis in babil ...Alexander Decker
This document summarizes a study that investigated the association between certain HLA-DRB alleles and susceptibility to pulmonary tuberculosis (PTB) in Iraq. The study found that the HLA-DRB1*04, DRB1*10 and DRB1*13 alleles were associated with increased susceptibility to PTB in Iraqi patients, while the HLA-DRB1*07 and DRB1*15 alleles were associated with protection against PTB. These results provide insights into the role of host genetics in susceptibility to tuberculosis in the Iraqi population. The findings were mostly consistent with prior studies in other populations, though some allele associations differed, suggesting geographic variation in these relationships.
The effect of corn oil in sperm parameters and levels of some hormone, elemen...Alexander Decker
This study investigated the effects of corn oil on sperm parameters, hormone levels, biochemical parameters, and trace elements in male rabbits. Fifteen male rabbits were divided into three groups: a control group given water and two experimental groups given 2 ml/day or 2.5 ml/day of corn oil. The results showed corn oil significantly increased sperm parameters but insignificantly affected hormone levels, biochemical parameters, and trace elements. Corn oil may improve semen quality in animals and humans by optimizing fatty acid levels important for sperm membrane structure and function.
The effect of gypsum plaster on the dry rate of emulsionAlexander Decker
This document summarizes a study that investigated the effect of gypsum plaster on the dry rate of emulsion paint. Gypsum plaster was added to emulsion paint and the resulting product had a pH and viscosity within standard ranges. The dry time was 70 minutes, shorter than standard products that take 90-110 minutes to dry. This suggests gypsum plaster can positively impact paint properties, especially by reducing dry time. The document provides background on paint composition and properties, as well as common causes of paint failure like improper surface treatment, dilution, and exposure to sunlight.
The effect of corporate income tax on financial performance of listed manufac...Alexander Decker
This document summarizes a research study that examined the effect of corporate income tax on the financial performance of listed manufacturing firms in Ghana over a seven year period from 2005 to 2012. The study used panel data from 10 listed manufacturing firms. The results revealed that there is a significant negative relationship between corporate income tax and financial performance. However, the study found a significant positive relationship between financial performance and the size, age, and growth of the firms. The study contributes to understanding how corporate income tax impacts the financial performance of manufacturing firms in Ghana.
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This study examined the effects of assessment model (written vs oral skills), cognitive style (field independent vs dependent), and their interaction on high school chemistry students' achievement, controlling for basic knowledge. The results showed that:
1) Students who were assessed via writing performed better than those assessed orally.
2) Students with field-independent cognitive styles performed better than those with field-dependent styles.
3) There was a significant interaction between assessment model and cognitive style affecting chemistry achievement.
The consequences of de hubbing for airports and tourism - a case studyAlexander Decker
- De-hubbing, which occurs when a hub carrier withdraws from an airport, negatively impacts the airport's growth potential and passenger traffic levels. It can also seriously harm the local tourism industry by reducing inbound visitors from markets no longer connected to the airport.
- Using Budapest airport as a case study, the recovery rate after de-hubbing depends on factors like the type of airline replacing lost routes, demand for inbound tourism, and capacity offered on key markets. Low-cost carriers taking over can support stronger recovery by providing more seats at lower fares.
- Sudden de-hubbing may increase inbound tourism in the short-term if airlines dump excess capacity on certain routes, but recovery is stronger
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This document discusses several key concepts related to health policy:
1. It identifies prerequisites for health such as peace, shelter, education, food, income, and environmental sustainability.
2. It outlines five areas for building healthy public policy: building healthy environments, strengthening communities, developing personal skills, reorienting healthcare services, and advocating for these changes.
3. It discusses prevention strategies starting from changing social and environmental risk factors and continuing support for at-risk groups. Prevention strategies are amenable to policy changes.
1) This document summarizes a capstone project examining geographic accessibility to healthcare in Kenya. It discusses factors that affect healthcare access, including availability, affordability, and geographic access.
2) In Kenya, poor infrastructure and lack of transportation contribute greatly to limited geographic access to the few existing healthcare options. Travel time to facilities is used to measure geographic accessibility.
3) Previous studies have found associations between increased distance to healthcare and higher health risks, particularly in developing countries. The capstone project aims to model healthcare accessibility in Kenya based on travel time and examine relationships with health outcomes.
Mutale et al. BMC Health Services Research 2013, 13291http.docxrosemarybdodson23141
Mutale et al. BMC Health Services Research 2013, 13:291
http://www.biomedcentral.com/1472-6963/13/291
RESEARCH ARTICLE Open Access
Systems thinking in practice: the current status of
the six WHO building blocks for health system
strengthening in three BHOMA intervention
districts of Zambia: a baseline qualitative study
Wilbroad Mutale1,2*, Virginia Bond3, Margaret Tembo Mwanamwenge3, Susan Mlewa3, Dina Balabanova4,
Neil Spicer4 and Helen Ayles2,3
Abstract
Background: The primary bottleneck to achieving the MDGs in low-income countries is health systems that are
too fragile to deliver the volume and quality of services to those in need. Strong and effective health systems are
increasingly considered a prerequisite to reducing the disease burden and to achieving the health MDGs. Zambia is
one of the countries that are lagging behind in achieving millennium development targets. Several barriers have
been identified as hindering the progress towards health related millennium development goals. Designing an
intervention that addresses these barriers was crucial and so the Better Health Outcomes through Mentorship
(BHOMA) project was designed to address the challenges in the Zambia’s MOH using a system wide approach. We
applied systems thinking approach to describe the baseline status of the Six WHO building blocks for health system
strengthening.
Methods: A qualitative study was conducted looking at the status of the Six WHO building blocks for health
systems strengthening in three BHOMA districts. We conducted Focus group discussions with community members
and In-depth Interviews with key informants. Data was analyzed using Nvivo version 9.
Results: The study showed that building block specific weaknesses had cross cutting effect in other health system
building blocks which is an essential element of systems thinking. Challenges noted in service delivery were linked
to human resources, medical supplies, information flow, governance and finance building blocks either directly or
indirectly. Several barriers were identified as hindering access to health services by the local communities. These
included supply side barriers: Shortage of qualified health workers, bad staff attitude, poor relationships between
community and health staff, long waiting time, confidentiality and the gender of health workers. Demand side
barriers: Long distance to health facility, cost of transport and cultural practices. Participating communities seemed
to lack the capacity to hold health workers accountable for the drugs and services.
Conclusion: The study has shown that building block specific weaknesses had cross cutting effect in other health
system building blocks. These linkages emphasised the need to use system wide approaches in assessing the
performance of health system strengthening interventions.
* Correspondence: [email protected]
1Department of Community Medicine, University of Zambia School of
Medicine, Lusaka, Zambia
2Clinical Research Department, Facu.
Implementation science studies strategies for adapting and applying evidence-based interventions in real-world settings like schools, workplaces and healthcare facilities to improve population health. This field develops theories of implementation and evaluates measures of implementation success. Methods include stakeholder engagement, effectiveness studies, research synthesis and modeling to identify strategies for integrating evidence-based interventions into programs and policies. For implementation science to reach its full potential, the research paradigm needs to shift toward greater stakeholder input and reporting on external validity to improve relevance and guide decision makers.
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This is an outline paper which summarises work done for the Association of Directors of Public Health on the Public Health contribution to health and social care integration
Evidence & Implementation of Strategies to Strengthen Health ServicesIDS
This presentation was given by Peters to the International Health Economics Association Conference 2009 in Beijing. It is research conducted as part of the Future Health Systems Research Programme Consortium www.futurehealthsystems.org.
The document discusses mHealth programs and initiatives in low and middle income countries. It summarizes reviews and studies that find mHealth evidence is limited by small pilot programs rather than large-scale implementations and health outcome studies. There is a need for standardized indicators, integrated solutions, and policies that facilitate collaboration and scale-up of effective mHealth programs.
This study focused on the practice of health communication on family planning at Amhara
National Regional state, East Gojjam Zone specifically Gozamen woreda, on whether the communication
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what kind of communication strategies
A realist synthesis to develop an explanatory model of how policy instruments...Araz Taeihagh
Abstract
Background
Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes.
Methods
A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories.
Findings
From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types.
Conclusions
This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes.
This summary provides an overview of a systematic review of 34 HIV/AIDS mass communication campaigns from 1998 to 2007:
1) The review found that campaigns increasingly employed strategies recommended for effective design such as targeted audiences developed through segmentation, behavior-focused themes, use of behavioral theory, high message exposure, stronger research designs, and inclusion of behavior measures.
2) An examination of 10 campaigns using more rigorous designs found that the majority (8 of 10) demonstrated effects on behavior change or intentions.
3) However, most campaigns still used weak pre-experimental evaluation designs, indicating room for improved evaluation practices.
Delivering community-led integrated HIV and sexual and reproductive health services for sex workers: A mixed methods evaluation of the DIFFER study in Mysore, South India
This document provides an overview of a research project conducted by a civil society consortium to examine the interactions between global health initiatives (GHIs) and national health systems. The consortium conducted research in Kenya, Malawi, Uganda, and Zambia through interviews and focus groups. The research aimed to understand the roles of civil society in maximizing positive synergies between GHIs and health systems. The consortium found that civil society plays an important role across various components of health systems, but often lacks capacity. Strengthening community systems is key to empowering civil society to advocate for community needs and provide oversight of GHIs and health services.
Strengthening health systems in Sub-Saharan Africa requires health policy and systems research and analysis (HPSR+A). HPSR+A takes a multidisciplinary approach to understand how health systems function and how to improve them. It also examines how to influence health policies and implement policies effectively to strengthen systems. Some priorities for HPSR+A include conducting mixed-method longitudinal studies, using theory, and thinking outside disease-specific approaches to consider the broader health system issues. Several HPSR+A studies provided examples of how health systems can be strengthened by taking a systems perspective rather than just focusing on individual programs or diseases.
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Can community action improve equity for maternal health and how does it do soHFG Project
Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health.
F e a t u r eGetting on Target with CommunityHealth Advi.docxmydrynan
The GOTCHA project aimed to address health disparities in rural Mississippi through a community-based participatory research (CBPR) approach using community health advisors (CHAs). An interdisciplinary team developed an innovative CHA training curriculum in response to identified needs from community discussions. The training included a 35-hour core skills component to equip CHAs with comprehensive outreach skills, followed by disease-specific modules. The training employed popular education techniques grounded in adult learning theory to raise consciousness and empower community members for social change. The goal was to transform community health through grassroots efforts led by indigenous CHAs.
Running Head RESEACH PAPER1SOCIAL MARKETING CAMPAIGNS45.docxtoltonkendal
Running Head: RESEACH PAPER 1
SOCIAL MARKETING CAMPAIGNS 4
5
Plan to Address Health Issue
Name
Institutional Affiliation
Date
Introduction
Evidence-based practice refers to the integration of clinical expertise, research evidence, and application of patient values during the process of making decisions for the care of clients and patients. The practices have been tested and studied comprehensively to ensure that they are conscientious and explicit for the provision of the best care to the patients (Baker & Tickle-Degnen 2014). In the case of the two previously exposed campaigns, project action and teens stopping AIDS in Sacramento there is need to assess the strategies put forward and evaluate whether they are in line with evidence-based practice.
A comparison and contrast of the campaign strategies with evidence-based practice
The strategies which were employed by the two campaigns have some similarity as well as differences in different perspectives. The campaign strategies were divided into phases which are similar to the evidence-based practice. For example, in teens stopping Aids campaign, the first phase is to describe the problem which had led to the conduction of the campaign (Fisher et al., 2014). Similarly, in evidence-based practice, the first thing which is done is to ask a question which provides the problem of the patient or client. Other similar phases include evaluation, planning, and selection of the best interventions.
On the other hand, there is some difference between the campaign's strategies and evidence based care. The two campaigns are employing a group of people who are involved in decision making who represent many groups in the population of interest. However, the nurse for example in evidence-based care is the one who uses their expertise and refers to the documented scientific evidence and then decide what is best for the patient but of course in collaboration with the patients who are being cared for (Rundle, 2014).
Adoption, implementation, and maintenance of the strategies proposed
Prevention of Aids transmission is not a simple task and therefore comprehensive and suitable strategies needed to be adopted, implemented and ensure that they remain active and in use in preventing further cases of infection. The primary focus strategy of the two campaigns was behavioral change. This aspect is supreme in determining whether the policies proposed will be adopted, implemented and maintained in the community or not (Kalichman, 2014).
Through heavy campaigning, the aim was to provide information about the disease, reduce stigma, enhance the accessibility of services, delaying the first onset of sex, reducing the number of sexual partners among others all of which are part of the behavior that needed to be changed. Other than that, provision of comprehensive information was vital to ensuring that the strategies were adopted and maintained by the community (Cordner, 2014). This was done by making ...
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The challenge of communicating change a case study of ghana’s community-based health planning and services (chps) policy
1. Public Policy and Administration Research
ISSN 2224-5731(Paper) ISSN 2225-0972(Online)
Vol.3, No.10, 2013
www.iiste.org
The Challenge of Communicating Change: A Case Study of
Ghana’s Community-based Health Planning and Services (CHPS)
Policy
Niagia F. Santuah, MGL, MA
Population Council, 14B Ridge Road, Roman Ridge, P.O. Box CT 4906, Accra, Ghana
Email: nsantuah@yahoo.com
Abstract
In settings where health reform has been launched, the momentum for organisational change is slow because
information used for management decisions assumes a top-down character at the expense of lateral and bottomup models that seem more appropriate. While no one communication approach is sufficient, this study
investigated the effect of exposure to six communication mechanisms under Ghana’s pro-poor Communitybased Health Planning and Services (CHPS) policy. Findings show that districts’ exposure to the various
information sources directly correlates with progress made in the implementation of CHPS.
Keywords: innovation, laggards, moderates
1. Introduction
Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully
in one location, they often disseminate slowly – if at all. This is partly because conditions under a pilot study are
markedly different from those experienced during scale up of results of the pilot. One other issue has to do with
how the results are communicated that puts managers at ease about the feasibility of scale up outside
experimental conditions. Communication is increasingly recognized, communication is seen, at least
conceptually, as fundamentally a two-way rather than one-way; bottom-up as opposed to the top-down hierarchic
approach; interactive and participatory rather than linear.
Increasingly, the need for "bottom-up" and “lateral” communication is particularly crucial to health reform
initiatives that build strategies on findings from operations research into large-scale organizational reform
programmes. One question always comes up: How can the “top-down” and “bottom-up” communications be
combined with peer exchange mechanisms that prioritize learning-by-doing?
An experimental project in northern Ghana has provided a platform for testing the relative efficiency of a
combination of the “top-down”, “bottom-up” and “horizontal” or “lateral” communication mechanisms. This
adds a new impetus to the ever-revolving nature of communications, thus successfully shifting away from a
"one-to-many" model of communications to a "many-to-many" model (Tiffany Shlain, 2006).
Launched by the Ghana Health Service in 1994 as a pilot project, and expanded in 1996 to a factorial trial, the
Community Health and Family Planning Project (CHFP), explored the effects of two sets of strategies for
mobilizing existing resources for health service delivery. i) traditional mechanisms for community organization
and mobilization and ii) underutilized resources of the health service system, such as community health nurses,
who were based in inaccessible clinics rather than communities. Two domains of the resource mobilization were
tested independently, jointly, or not at all, comprising a four-celled factorial trial that was evaluated with fertility
and mortality endpoints. The overall aim of the experiment was to determine the most appropriate means of
bringing health to the doorsteps of poor people in hard-to-reach locations.
1.1 Results
Three years into the experiment, results came into sharp focus. The experiment had an immediate impact on
knowledge of contraception and a major impact on health service coverage and utilization. Contraceptive use
shot up from 3% to 20% in the area where the nurse works in the context of active community support;
childhood immunization coverage also increased from 30% to over 83%. Infant mortality rates declined from
141 to 96 per 1000 live births (Fred N. Binka et al., 1995). Total fertility rate (FTR) declined 15%, the equivalent
of one birth per woman (TFR from 6 t0 5 children), representing the largest fertility effect ever demonstrated in
Africa through programmatic intervention.
The Navrongo experiment thus demonstrated, convincingly, that community mobilization combined with
community-based deployment of the nurse represents the most effective innovative intervention to enhance
service coverage and utilization (Fred N. Binka et al, 1998).
1.2 Scale-up challenges
Initial deliberations on the potential use of results of The Navrongo experiment focused on the possibility of
extending operations to the three northern regions where the health indicators, cultural institutions, and
ecological zone were similar to Navrongo. However, this option was redirected by the Ministry of Health in
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favour of an approach that would foster the diffusion of operational change throughout Ghana simultaneously.
The Ghana government in October 1999, adopted the Navrongo innovation as the basis for organizing
community-based health service operations. Known as Community-based Health Planning and Services (CHPS),
the new policy initiative became an integral component of the government’s national poverty reduction strategy
(Opt cit).
Enthusiasm for starting community-based care based on the Navrongo model quickly outpaced the capacity of
the health system to cope. Districts were ready to launch CHPS but had no idea how to proceed (James F.
Phillips et al, 2006). Since 2000, efforts to replicate and scale up CHPS have been implemented throughout the
country. As of 2004 reports by the CHPS Secretariat indicated that 106 of the 110 districts nationwide had
launched preliminary activities for implementing CHPS although only about 3 percent of the population receives
the services of a resident nurse. An overwhelming number of districts are unable to proceed beyond the planning
stage.
In 2005, a baseline survey conducted in 28 selected districts in the seven southern regions of Ghana by the CHPS
Technical Assistance project revealed that, although 22 percent of the population in the 28 districts is covered by
the CHPS “planning milestone,” 13.2 percent of the population lives in functional CHPS zones, i.e., zones where
community health officers are posted and providing services (Population Council, 2006).
1.3 Bridging the implementation gap
The implementation gap is attributed to lack of actionable information. Here communication was seen as playing
a unique role in fostering the diffusion of the Navrongo health innovation based on solid scientific evidence
about what has worked in decentralizing access to basic health services for the poor.
As Barnes, Grace (2007:73) points out, innovations should be predicated on proper identification of the
healthcare needs of the people so that polices can be well tailored to meet the needs of the health service users.
Since CHPS became a national policy, enthusiasm for community based care has grown but this did not
automatically lead to increased health service utilisation (James F. Phillips et al (2006). The wide geographical
disparity in the implementation of CHPS is attributed to many factors including insufficient information. Health
managers have expressed concern that once CHPS is launched, the requisite information for accelerating the
pace of organisational change is either lacking, inadequate or diffused through inappropriate channels, all of
which hinder rather than help the adoption process. This constitutes a setback to the diffusions model (Rogers
Everett M, 1962) which represents the conceptual framework for the diffusion and adoption of innovations.
Indeed critics such as Florangel Rosario Braid (2006:186-190) have criticised Rogers’ diffusion model as being
inappropriate for developing countries, and called for an abandonment of the “vertical” approach to diffusion in
favour of more “horizontal” methodologies emphasizing access, dialogue and participation.
Rogers himself acknowledged the deficiencies of his diffusions model which itself may be the biggest barrier to
the adoption of innovations. He began advocating for the principles of “bottom-up” participatory planning as
against earlier editions of his work that focused on the “top-down” diffusion of technology (Rogers Everett M,
1962; Rogers, Everett M. and F. Floyd Shoemaker (1971). In later editions (Rogers Everett M, 1983, 1995, 2003)
he emphasized the role of communications for social change in the development process.
According to Adam Rogers (2005), communications for social change or Development Communication, as he
called it, is “the planned use of communication in any effort to improve the lives of the poor, be it through
engaging them more fully in decision-making processes, or getting them to adopt new practices that will make
their lives easier, healthier and more secure”.
Whereas mass media channels are more effective in creating knowledge of innovations, interpersonal channels
are more effective in forming and changing attitudes toward a new idea, and thus influencing the decision to
adopt or reject a new idea (Rogers Everett M, 1995:409).
Gray-Felder, D. and Deane, J. (1999) recommend a process of dialogue through which people realize “who they
are, what they want and how they can get it”. The researchers emphasize that the true power of communication
is to give people the confidence and conviction to own the process and the content of communication in their
communities. This is the thinking behind the mixture of different (top-down, lateral and bottom-up)
communication mechanisms developed to facilitate the CHPS implementation process.
Bridging the implementation gap in the CHPS process and providing impetus for speeding up the process of
organizational change, six communication mechanisms were instituted. Navrongo, in addition to its core
mandate of conducting research on health and policy issues, was to continue playing its key role in disseminating
lessons from its research by orienting visiting teams to The Navrongo experiment. The six communication
mechanisms are explained below.
1.3.1. The CHPS Implementation Guides
The CHPS Implementation Guides, developed by the Johns Hopkins Centre for Communication Programmes,
contain a roadmap to CHPS implementation. The approach captures the CHPS process in six implementation
milestones; Planning, Community Entry, Community Health Compound, Community Health Officer, Essential
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Logistics, and Volunteers. These have been broken down into 15 steps and 20 activities with detailed
explanation about what is expected at every stage of the process (PPMED/GHS (2002). Though the milestones
are distinct they are by no means discreet. However, Richard Killian and others (2002) observed that “the most
frequently named criteria for selection of communities for CHPS implementation were remoteness,
inaccessibility, and distance from a Health Centre and deprived (sic) ... community preparedness was
infrequently mentioned”. Their assertion that “it would take effective coordination and leadership for CHPS to
achieve its objectives, the many challenges notwithstanding,” will come under investigation as part of the study.
1.3.2. The What works? What fails?
The Navrongo Health Research Centre created the What works? What fails? series as a bottom-up
communications approach to assist health workers adapt innovative service strategies to local circumstances and
needs. The What works? What fails? series provides a mechanism for participants of the Community Health and
Family Planning (CHFP) project or the Navrongo Experiment to communicate their experiences and insights to
District Health Management Teams throughout Ghana. These newsletters also enable CHFP skills to be shared
more broadly elsewhere around the world to show what has worked and what has failed in an experiment to
make primary health care more accessible to rural people. What works? What fails? based its approach on the
principle that communities, service providers and managers develop ownership when they participate in the
development and improvement of systems and processes for service delivery.
A typical What works What fails? is a 1,200-word, two-page, easy-to-read leaflet. Every newsletter stands
independently and reflects information about the experiment and the processes and roles of the various
stakeholders. Various strategies used in the documentation include personal testimonies and in-depth interviews
with principal investigators, field coordinators, research scientists, paramount chiefs, community opinion leaders,
ordinary community members, clan and lineage heads, health committee members, health volunteers,
community health officers. Some notes are also based on review and simplification of published scientific
papers on the CHFP.
In all, 89 title notes have been written, printed and circulated over a period of three years. Notes are distributed
first to paramount chiefs in the district, Community Health Officers, and health volunteers. Notes are then snailmailed to all districts countrywide using a distribution list which includes Nurses Training Institutions,
universities, some national and international NGOs, libraries and diplomatic missions.
1.3.4. The National Health Forum
The National Health Forum on CHPS was created in 2000 as the crucible for national discourse and consensus
building on how to fast track the national CHPS programme. A typical Forum brings together between 150-200
people made up of health managers, policy makers, programme implementers as well as development partners
and potential donors who share knowledge and experiences on issues related to implementation of CHPS as a
national programme.
The Forum 2000 gave participants an insight into the new health service delivery regimen by clarifying the
concept and definition of CHPS. It reached a broad consensus that implementing CHPS represents a complete
paradigm shift in service provision and will depend on innovation and regular sharing of experiences from the
field – a process of learning-by-doing – to speed up the process.
The Forum 2004 under the theme, “Community Partnership for Health development” built on the maiden one
and reached a clearer understanding of CHPS implementation mechanism and coordination. It also reviewed the
CHPS Operational Policy and the CHPS Implementation Strategy which set the contours of a roadmap for
rolling out CHPS within the 5yr Programme of Work. The Forum evolved strategies for marshalling resources
for CHPS implementation, and agreed that implementing CHPS requires the concerted efforts by all stakeholders
and not simply the Ghana Health Service alone.
1.3.5. The Peer Advocacy Programme
To free resources from both governmental and non-governmental sources, the CHPS technical assistance
(CHPS-TA) project supported by the USAID, implemented a peer advocacy programme on CHPS with political
authorities at the district level. The programme used the interpersonal and learning-by-doing communication
approach in which high-performing districts are paired with those wishing to learn firsthand how to launch and
sustain a CHPS programme. This initiative was based on the conviction that districts that are the most advanced
in CHPS have considerable experience in addressing practical challenges in implementation and can help others
speed up the process. During the exchange, visiting teams share experiences with their counterparts and visit a
functional CHPS zone to interact with the CHO and health volunteers. The visiting teams also attended a
community durbar where they learned more about the benefits of CHPS and hear testimonies about community
contributions to getting started. The program proved that peer exchange is an effective organizational diffusion
methodology that facilitates lateral communication and adoption of innovations. District-to-district peer
advocacy learning exchanges improved understanding of the CHPS concept, accelerated its launch, galvanized
local level political support, and leveraged resources for its implementation.
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The CHPS-TA Final Project Report (Population Council, 2009) indicated that the number of District Assemblies
supporting CHPS rose from 8 at baseline in 2005 to 15 by midterm in 2007 and 29 by the end of the project in
2009. It noted that before the advocacy programme, the total contribution to CHPS in the 30 project districts was
GH¢11,700 approximately (US$8,000). However, within a year after the first advocacy event, support for CHPS
increased by almost 700 percent to GH¢88,000 or US$61,000. The number of Functional CHPS Zones in the 30
districts equally increased (Population Council, 2008).
1.3.6. The CHPS News
Various stakeholders such as policy makers, health managers, regional and district directors of health services,
development partners, the media, District Assemblies, NGOs, the general public, and members of the scientific
community needed to access and share appropriate information relative to CHPS. CHPS-TA introduced the
CHPS NEWS newsletter as a bottom-up and lateral communication tool for exchanging experiences in CHPS
and sharing best practices and innovations in the implementation process. In all, 72,000 issues of twelve editions
of the newsletter were distributed to all relevant stakeholders associated with the implementation of the CHPS
initiative across the country, which includes regions and districts that are not covered by CHPS-TA. Monitoring
reports showed that the newsletter reached its target audience; twenty-six districts out of 30 reported they had
received at least two editions of the newsletter (Population Council, 2009).
1.3.7 The CHPS Video
In recognition of audio-visuals as formidable communication tools, the CHPS newsletter was complemented by
a 30-minute (with a 15-minute version) CHPS video documentary entitled “Close-to-Client”. The documentary
was produced and aired twice weekly during primetime on national television networks. The CHPS video was
conceived basically as an advocacy tool to engender policy reform, galvanize political support and leverage
resources from public and private entities for CHPS implementation. Members of Parliament, District
Assemblies, Non-governmental organisations, and development partners constitute the primary audience. Over
240 copies of the video were subsequently distributed to relevant stakeholders across the country.
The effect of these communications mechanisms on clarifying key concepts for rolling out CHPS remains a
subject of intense debate. Nyonator Frank et al (2005) has noted that many districts still lack a clear
understanding of the CHPS concept. “Without a firm grasp of the concept of CHPS,” concludes Nyonator, “fears
about starting CHPS remain largely justified”. The extent of exposure of districts to these major sources of
authentic news and information about CHPS gives a fair indication about the level of preparedness of districts to
roll out the health innovation.
2. Methodology
A cross-sectional survey was conducted using structured questionnaires to conduct interviews with health
managers, frontline cadres and health volunteers in CHPS process.
2.1 Aim
The overall aim of the study is to assess the level of exposure of health managers, frontline cadres and health
volunteers to the six communication mechanisms and its effect on the implementation of CHPS.
2.2 Sampling
An exploratory study was conducted to clarify key concepts. All Functional CHPS Zones (FCZs) in all 30
districts under the CHPS Technical Assistance (CHPS-TA) project as contained in the “2008 CHPS-TA
Assessment Report of CHPS Implementation” (Population Council, 2008:4) constituted the study population.
The number of FCZs was used as a proxy indicator of progress in CHPS. Using this criterion, districts were
classified as “Innovators” (doing exceedingly well), “Moderates” (doing fairly well) or “Laggards” (performing
below expectation). Only four districts qualified as “Innovators”. Six districts each from the “Moderates” and
“Laggards” were randomly selected. Three more “Laggard” districts from the Central region, which had 40% of
the districts (12 out of the 30), were included to give the region a fairer representation and Laggard districts a
better chance of being heard. Thus the total number of districts for the study was 18. Three Functional CHPS
Zones were randomly selected from each selected district, thus 54 FCZs. Two volunteers were also randomly
selected from two different communities in each Functional CHPS Zone, thus 108 volunteers.
2.3 Data collection and analyses
Questionnaires were pretested from June 28 to 30, 2009 whilst actual data collection was conducted from July
11to 31, 2009. The study is non-invasive and did not cause any physical harm. Permission was obtained from
the District Health Administration before interviews were conducted. The purpose of the study was first
explained to respondents by trained data collectors and respondents’ verbal consent obtained before the
interviews. Where the target respondents were not available, those next in command were interviewed. Since
these are role responsibilities, the representatives are considered competent enough to answer the questionnaires
and their views are held as valid. Respondents were assured of confidentiality of their identity in the study. Data
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entry was done simultaneously as questionnaires came from the field. Data was entered and edited in EpiData
3.1 and transferred to SPSS 16.0 for analysis. All data was entered twice thereby subjected to 100% verification.
2.4 Limitations of study
Only districts supported by the CHPS-TA project were sampled for the study. Since all these districts are in
southern Ghana, the views expressed may not necessarily mirror the general picture of CHPS implementation in
the entire country. The reasoning being that northern Ghana and southern Ghana are different in terms of
geography, settlement patterns and economy. CHOs had to be relied upon for the selection of volunteers since it
was practically impossible for the researcher to do so without such assistance. In the process, CHOs may have
selected communities and volunteers of their preference and not necessarily randomly, thus introducing some
bias into the sampling procedures which the researcher himself sought to avoid. This may have affected, though
insignificantly, the outcome of this research work.
3. Findings
Seventeen District Directors of Health Services out of 18 were interviewed, representing 94% response rate. Of
the 54 CHOs expected, 49 or 91% were interviewed whilst for volunteers, 96 out of 108, representing 89%, were
interviewed.
3.1 The CHPS Implementation Guides
An overwhelming majority (94%) of District Directors of Health Services (DDHS) have seen the CHPS
Implementation Guides. All DDHS from Innovator and Laggard districts have seen the Guides as compared to
80% for Moderates. Twenty-two percent CHOs have seen the CHPS Implementation Guides. Of this number,
55.6% are from Moderate districts, none (0%) from Innovator districts and a quarter from Laggard districts.
Among District Directors 70.6% knew the Six CHPS Implementation Milestones, 29.4% did not. All District
Directors from Innovator districts knew the Six Milestones as compared to 60% for Moderates and 67% for
Laggards.
When asked to choose the three most critical Milestones, District Directors from Innovator, Moderate and
Laggard districts chose “Planning” and “Community Health Officer (CHO)” as the first two. However, whereas
Innovators chose “Community Entry” as their third most critical Milestone, Moderates chose “Logistics” and
Laggards chose “Community Health Compound”. Thus districts prioritize the Six CHPS Implementation
Milestones differently depending on their level of CHPS implementation. Among CHOs, 33.3% from Innovator
districts knew the Six CHPS Implementation Milestones as compared to 41.2% for Moderates and 63.2% for
Laggards. Whereas knowledge of the Six CHPS Milestones among District Directors increased with progress in
CHPS, it decreased among Community Health Officers. This partially supports the view held by Phillips JP et al
(2003) that where CHPS is working people are less concerned about steps and milestones – they just focus on
practical ways of getting things done.
When asked to chose the three most critical of the Six Milestones, all Community Health Officers in Innovator,
Moderate and Laggard districts unanimously chose “Planning”, “Community Health Officer” and “Logistics”.
This is not surprising; as the frontline staff in CHPS service delivery, Community Health Officers are the first to
face the practicalities of CHO deployment which is equipment for service delivery.
3.2 The What works? What fails?
Nearly a quarter (23.5%) of District Directors have seen the What works? What fails? series. No Innovator, 20%
of Moderates and 33.3% of Laggards have seen the What works? What fails? series. Only 4% of Community
Health Officers have seen the What works? What fails? series whilst an overwhelming majority have not. Thus
those lagging behind in CHPS are those most likely to have seen the What works? What fails? series.
3.3 The National Health Forum
Nearly two-thirds (59%) of District Directors have attended the National Health Forum on CHPS, whilst for
Community Health Officers, only one in ten (11%) has attended it. Whereas 66.7% of District Directors who
have attended the Forum are from Innovator districts, two-thirds are from Moderate districts and 55.6% from
Laggard districts. Thus the more advanced the district is in the implementation of CHPS the more likely it is for
District Directors to have attended the National Health Forum.
3.4 The Peer Advocacy Programme
Four out of five District Directors in Moderate and 77.8% in Laggard districts have attended an advocacy
programme with District Assemblies as compared to 66.7% for Innovators. This finding was to be expected
because the advocacy programme is meant to pair districts lagging behind with those making the most progress
in CHPS to foster peer learning. Innovator districts were not likely to have been invited to be part of the learning
exchanges except if they were hosts.
3.5 The CHPS NEWS
Nearly one out of ten (88%) District Directors have seen the CHPS NEWS newsletter. All District Directors from
Moderate districts, 88.9% of Laggards and 66.7 % of Innovators have seen the CHPS newsletter. Close to two-
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thirds (36%) of CHOs have seen the CHPS newsletter as compared to 19% of Health Volunteers who have seen
it. Of the almost one fifth of volunteers who have seen the CHPS newsletter, 38.9% are from Innovator districts,
31.4% from Moderate districts and 13.9% from Laggard districts. As with District Directors of Health Services
and Community Health Officers, Community Health volunteers in districts advanced in the implementation of
CHPS are those most likely to have seen the CHPS newsletter. Thus the CHPS newsletter which shares best
practices in CHPS has been more popular with Innovators than Moderates and Laggards.
3.6 The CHPS Video
With respect to the CHPS Video, 88.2% of District Directors as compared to 71% of Community Health Officers
and over a quarter (26%) of Health Volunteers have seen it on national television. All District Directors from
Innovator districts, 80% of Moderates and 89% of Laggards have seen the CHPS Video on television. With
regard to Health Volunteers, 38.9%, 11.4% and 16.7% in Innovator, Moderate and Laggard districts respectively,
have seen the CHPS Video Documentary on television. Many more districts are likely to have seen the video
but not necessarily on television since copies were distributed to all districts.
3.7 Other sources
Other sources for diffusing CHPS information included workshops, radio, newspapers, peers, durbars, television,
and the Internet. When asked which of these has been the most useful channel for diffusing CHPS information,
81.8% of District Directors mentioned “workshops” as against 18.2% who cited Television. All District
Directors in Innovator and Moderate districts as compared to a third of those in Laggard districts chose
“workshops”.
Thirty-seven percent of Community Health Officers consider “workshops” as the most useful channel for
diffusing CHPS information. Nearly a quarter (24%) chose “television”, 5% chose radio and 2% chose
“newspapers”. Learning exchanges, books, colleagues and staff meetings make up ‘other sources’.
When asked which source has been the most useful for diffusing CHPS information, 64% of Community Health
Volunteers mentioned “workshops”. Over one-tenth (11%) chose “television”, 6% chose “radio” and 2% chose
“colleagues”. Seventeen percent mentioned ‘other sources’ which include durbars, information, and education
and communication materials. “Newspapers” did not feature as a useful source for diffusing CHPS information
for Community Health Volunteers. This may largely be because most Community Health Volunteers are nonliterate.
4. Conclusion
The analyses show that districts at the various stages of the CHPS process (Innovators, Moderates and Laggards),
have been exposed differently to the various communication mechanisms designed to guide implementation.
However, districts doing very well in CHPS are those most likely to have been exposed to the communications
channels.
Inadequate knowledge of the Six CHPS Implementation Milestones is widespread, and this largely explains why
districts making little progress in CHPS are stuck at the planning stage, unable to move forward. Both health
managers and frontline staff in all three categories of districts under this study, rightly see “Planning” and the
“Community Health Officer” as the two most important Milestones in the CHPS process. This, among others,
indicates that districts may not be implementing CHPS according to prescribed procedures.
The Community Health Compound is the most capital intensive of the Milestones. By prioritizing construction
of a Community Health Compound, districts lagging far behind in CHPS have shot themselves in the foot by
choosing a Milestone that is the most difficult to achieve. This largely explains why progress in CHPS among
Laggards is much slower.
Good information is still considered to be the best medicine. It is more likely that a new idea or practice will be
adopted if the receiver is involved in a dialogue and discussion about his or her own needs, alternative courses of
action, and acquisition of resources to accomplish development goals. All the communication mechanisms may
have been successful in building consensus and clarifying roles and responsibilities in the CHPS process but
what people need is practical knowledge defined as actionable information for decision making that enables
health mangers implement the CHPS innovation. A participatory, interactive and interpersonal means of sharing
information about CHPS – such as during workshop settings – seems more useful to health managers,
community health officers and community health volunteers than the current communication mechanisms, and
much worse the traditional communication channels such as radio, television and newspapers.
References
1. Adam Rogers (2005). The state of communications in international development and its relevance to the
work of the United Nations
2. Awoonor-Williams, J.K. (2004). Bridging the Gap Between Evidence-based Innovation and National
Health-sector Reform in Ghana. Population Policy Research Division Working Paper No. 191.
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Barnes, Grace (2007:1-9, 65-73). The Impact of Health Sector Reforms on Service Users (unpublished
Graduate Thesis)
Population Council (2006). CHPS Technical Assistance Project. Baseline Survey of CHPS Implementation
in 28 Districts of 7 Regions in Ghana
Population Council (2008). CHPS Technical Assistance Project. Mid-term Survey on the Status of CHPS
Implementation in 30 Districts of 7 Regions in Ghana, page 4.
Fred N. Binka, Alex Nazzar & James F. Phillips (1995). The Navrongo Community Health and Family
Planning Project. Studies In Family Planning; 26,3: 121-139
Fred N. Binka et al., (1998). The Navrongo Community Health and Family Planning Project: Lessons
learned 1994-1998
Gray-Felder, D., & Deane, J. (1999). “Communication for Social Change” (A Position Paper and
Conference Report). New York: Rockefeller Foundation
Florangel Rosario Braid (2006:186-190) ‘User-Friendly Communications Strategy’ in Alfonso Gumucio
Dagron, Thomas Tufte (eds). Communication for Social Change Anthology: Historical and Contemporary
Readings. Communication for Social Change Consortium Inc. South Orange, New Jersey
Richard Killian, William Sampson &, Alexandre Muhawenimana (2002). Community-based Health
Planning and Services (CHPS): Lead District Readiness Assessment, Technical Report # 32
Nyonator Frank et al (2005). Scaling up Service Delivery Innovation. Health Policy and Planning 20 (1),
25–34 Q Oxford University Press
James F. Phillips et al (2006:84:949-955.). Accelerating reproductive and child health programme impact
with community-based services - The Navrongo experiment in Ghana. Bulletin of the World Health
Organization
PPMED/GHS (2002). The Community-based Health Planning and Services (CHPS) Initiative. The
Concepts and Plans for Implementation. Page 3
Rogers, Everett M. (1995). Diffusion of Innovations, 4th edition. New York: Free Press.
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Tiffany Shlain (2006). Speech delivered to Oklahoma Educators and Techies in February 2006 by Tiffany
Shlain, a leading Internet expert who spoke in Oklahoma City. Online. (March 27, 2013)
Table 1. Regions and districts where interviews were conducted
DISTRICT
REGION
EASTERN
Birim North
EASTERN
Afram Plains
WESTERN
Bia
WESTERN
Ahanta West
WESTERN
Bibiani Anhwianso Bekwai
VOLTA
Nkwanta
VOLTA
Akatsi
VOLTA
Kadjebi
BRONG-AHAFO
Sene
BRONG-AHAFO
Asutifi South
GREATER. ACCRA
Dangme West
CENTRAL
Komenda Edina Eguafo Abirem
ASHANTI
Bosomtwi Atwima.Kwanhwoma
CENTRAL
Asikuma-Odoben-Brakwa
CENTRAL
Assin South
CENTRAL
Cape Coast Metro
CENTRAL
Assin North
CENTRAL
Ajumako-Enaym-Esiam
61
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