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The study aimed to investigate the impact on health care seeking behaviour of the cost-sharing policies introduced in Ghana between 1985 and 1992. Qualitative research techniques were used to investigate the behaviour of patients after the introduction of these policies. Focus group discussions of cohorts of the population and in-depth interviews of health workers and selected opinion leaders were used to collect data from rural and urban health care facilities in three districts of Ghana. The study findings indicate that the cost recovery policies have led to an increase in self-medication and other behaviours aimed at cost-saving. At the same time, there is a perception of an improvement in the drug supply situation and general health delivery in government facilities. The study advocated enhanced training of drug peddlers and attendants at drug stores, especially in rural areas. User fee exemption criteria need to be worked out properly and implemented so that the very needy are not precluded from seeking health care at hospitals and clinics.

Norm enforcement may be important for resolving conflicts and promoting cooperation. However, little is known about how preferred responses to norm violations vary across cultures and across domains. In a preregistered study of 57 countries (using convenience samples of 22,863 students and non-students), we measured perceptions of the appropriateness of various responses to a violation of a cooperative norm and to atypical social behaviors. Our findings highlight both cultural universals and cultural variation. We find a universal negative relation between appropriateness ratings of norm violations and appropriateness ratings of responses in the form of confrontation, social ostracism and gossip. Moreover, we find the country variation in the appropriateness of sanctions to be consistent across different norm violations but not across different sanctions. Specifically, in those countries where use of physical confrontation and social ostracism is rated as less appropriate, gossip is rated as more appropriate.

We developed a test battery for use among children in Bangladesh, Ghana, and Tanzania, assessing general intelligence, executive functioning, and school achievement. The instruments were drawn from previously published materials and tests. The instruments were adapted and translated in a systematic way to meet the needs of the three assessment contexts. The instruments were administered by a total of 43 trained assessors to 786 children in Bangladesh, Ghana, and Tanzania with a mean age of about 13 years (range: 7-18 years). The battery provides a psychometrically solid basis for evaluating intervention studies in multiple settings. Within-group variation was adequate in each group. The expected positive correlations between test performance and age were found and reliability indices yielded adequate values. A confirmatory factor analysis (not including the literacy and numeracy tests) showed a good fit for a model, merging the intelligence and executive tests in a single factor labeled general intelligence. Measurement weights invariance was found, supporting conceptual equivalence across the three country groups, but not supporting full score comparability across the three countries.

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