Background We determined the availability and pricing of laboratory testing in the Northern Region of Ghana to identify current gaps with respect to the WHO's Essential Diagnostics List (EDL). Methods A representative sample of facilities offering diagnostic testing within the Northern Region was geographically mapped and evaluated, with random sampling stratified by population density. Data were collected on testing menus, volumes, turn-around times, and out-of-pocket test prices. A total of 27 health centers and 39 clinical laboratories were surveyed between June and August 2019. Results Health centers offered a median of 2 of 20 tests recommended by the WHO for facilities without laboratories. The most common tests offered included point-of-care tests for malaria, HIV, and pregnancy. Clinical laboratories offered a median of 11 of 72 tests on the EDL. These facilities most commonly provided testing for malaria, HIV, pregnancy, HBsAg, urinalysis, HCV Ab, syphilis, glucose, and CBC. Urban laboratories had a total of 36 EDL tests available while rural laboratories had 12. Test prices were higher in private compared to public laboratories. National Health Insurance reimbursements were lower than out-of-pocket prices (38%), and when controlling for test price, test availability was negatively associated with this gap in reimbursement. Conclusions Availability of diagnostic testing in Ghana’s Northern Region is severely limited compared to the WHO's EDL. The disparity is pronounced in rural facilities. Reimbursement rates should be reset to more closely match out-of-pocket test prices in order to achieve the Universal Health Coverage target of the Sustainable Development Goals.

BackgroundThirty per cent of all women experience intimate partner violence (IPV) in their lifetime. The aim of this study was to examine the association between the WHO’s novel R.E.S.P.E.C.T framework and IPV among women in Kenya.MethodsWe used the 2014 Kenya Demographic and Health Survey (KDHS). Only women selected for the domestic violence module and who were married/living with their partner were eligible for this study (n=3737). We created a summary score for the strategies denoted by R.E.S.P.T based on availability of questions addressing these strategies in the KDHS, and a total score that summed responses across all strategies. Each letter was assessed with Cronbach’s alpha. Multiple logistic regression models were used to investigate the relationship between R.E.S.P.T scores and IPV.ResultsAll strategies except for E lowered the odds of IPV. Decision-making (R) was negatively associated with experiencing IPV (OR=0.62 (0.53 to 0.72)). Land and property ownership (E) were positively associated with experiencing IPV (OR=1.25 (1.08 to 1.43)). Access to healthcare (S) was negatively associated with experiencing IPV (OR=0.55 (0.48 to 0.63)). Higher levels of wealth (P) were negatively associated with experiencing IPV (OR=0.47 (0.37 to 0.62)). Not justifying wife-beating in any scenario (T) was negatively associated with experiencing IPV (OR=0.39 (0.29 to 0.53)). After adjusting for demographics, a 1-unit increase in total R.E.S.P.T score was negatively associated with experiencing IPV (AOR=0.63 (0.57 to 0.70)) with a similar finding for IPV in the past 12 months (AOR=0.59 (0.53 to 0.66)). Younger women, higher education and Muslim religion were associated with decreased odds of experiencing IPV while living in a rural location and working were associated with increased odds of experiencing IPV.ConclusionsOur study provides initial evidence that by using the multistrategy R.E.S.P.E.C.T framework, countries can dramatically lower the odds of women experiencing IPV. IPV prevention strategies must have a wide approach. The DHS can be used as a tool to monitor implementation and efficacy of this novel strategy.

Background Thirty percent of all women experience intimate partner violence (IPV) in their lifetime. The aim of this study was to examine the association between the World Health Organization’s (WHO) novel R.E.S.P.E.C.T framework for intervention and IPV prevalence among women in Kenya. Methods We used the 2014 Kenya Demographic and Health Survey (KDHS). Only women selected for the domestic violence module and who were married/living with their partner were eligible for this study (n=3,737). We created a summary score for each strategy denoted by R.E.S.P.T based on availability of questions addressing these strategies in the KDHS, and a total score that summed responses across all strategies. Each letter was assessed with Cronbach’s Alpha. Multiple logistic regression models were used to investigate the relationship between R.E.S.P.T scores and IPV.Results All strategies except for E lowered the odds of IPV. Decision-making (R) was negatively associated with experiencing IPV (OR = 0.62 [0.53-0.72]). Land and property ownership (E) were positively associated with experiencing IPV (OR = 1.25 [1.08-1.43]). Access to health care (S) was negatively associated with experiencing IPV (OR = 0.55 [0.48-0.63]). Higher levels of wealth (P) were negatively associated with experiencing IPV (OR = 0.47 [0.37-0.62]). Not justifying wife-beating in any scenario (T) was negatively associated with experiencing IPV (OR = 0.39 [0.29-0.53]). After adjusting for demographics, a 1-unit increase in total R.E.S.P.T score was negatively associated with experiencing IPV (AOR= 0.63 [0.57-0.70]) with a similar finding for IPV in the past 12 months (AOR = 0.59 [0.53-0.66]). Younger age, higher education, and Muslim religion were associated with decreased odds of experiencing IPV while living in a rural location and working were associated with increased odds of experiencing IPV.Conclusions Our study provides initial evidence that by implementing the multi-strategy R.E.S.P.E.C.T framework, countries can dramatically lower the odds of women experiencing IPV. The DHS can be used as a tool to monitor implementation and efficacy of this novel strategy.