Background/aims Understanding patients' views on healthcare quality allows healthcare managers and policy makers to address any gaps and promote a patient-centred approach in healthcare delivery. A study was carried out to evaluate patients' perception of the quality of services in hospitals affiliated with the Christian Health Association of Ghana. Methods The SERVQUAL scale was used to survey 540 patients in 18 Christian Health Association of Ghana hospitals. Using STATA software package (version 13.0), mean scores of the patients' expectations and perceptions of service quality were computed. A t-test was performed to determine the significance levels of the difference between the mean scores for expectation and perception. Results The patients' expectations were not met. The five SERVQUAL dimensions showed statistically significant negative mean service quality gap scores. Conclusions Further investigations into the reasons that the patients responded in this way are warranted to help in stepping up patient-focused interventions to bridge the perceived service quality gaps identified.

without a time limit from inception to June 2019. Inclusion criteria were: studies published in English or Arabic, and conducted in Saudi Arabia. Results: thirty tow studies of 67 published studies met the inclusion criteria which conducted in Saudi Arabia. Observational cross-national was the manly methods used to investigate selfmedication practice in the selected studies. Seven of these Studies were conducted in Riyad. Non-steroidal anti-inflammatory drugs, antibiotic, vitamins are the most common medicines that involved in the self-medication practice in Saudi. Conclusions: Self-medication practice is common among patients in Saudi Arabia. Special attention should be given to educating the public and health care providers on which illnesses for which they can seek self-medication without the advice of a healthcare provider, and responsible governmental and nongovernmental organizations should work hard to ensure the rational use of medication

Background: Assessing the performance of health systems through quantitative and qualitative methods is recognized as an effective approach to strengthening national health systems. However, while many high-income countries have institutionalized health system performance assessment (HSPA) as an integral component of their respective health systems, few studies on HSPA have been documented in low and middle-income countries, including Ghana. This study aims at providing a comprehensive framework for periodic assessment of the performance of the entire health system in Ghana.Methods: The study will have four work packages. First, a structured review will be conducted to identify both international and national HSPA frameworks that could be applied to the Ghanaian context. Second, based on the structured review, an assessment framework tailored to the Ghanaian health system context will be developed. Third, the draft framework will be presented and discussed with experts and stakeholders for its appropriateness, feasibility and acceptability. Finally, the framework will be piloted to assess its effectiveness and suitability for full-scale implementation.Discussion: Currently, Ghana does not have a full-fledged HSPA tool that provides a holistic health sector-wide approach to assessing health system performance. Thus, developing this HSPA framework for the country will provide a tool for periodic and comprehensive assessment of the performance of the health system, which can be compared with that of other countries. Such a comparison will offer the opportunity for mutual learning and for exploring new options for formulating more effective national health policies. As this is expected to be the first attempt to develop a comprehensive HSPA framework in Ghana, this study will provide a basis for future discussions on how to further develop and implement HSPA programs in the country.

Objective: Differences exist in the composition and morbidity/mortality patterns of older persons. This analysis determined sex differences and rural-urban disparities in common chronic diseases and health risks among older persons in Ghana.Methods: This work was based on World Health Organization’s (WHO) multi-country Study on global AGEing and adult health (SAGE), conducted in six countries including Ghana. Nationally representative sample of 4725 persons ≥50 years was involved in this analysis. Data were obtained on eight self-reported chronic diseases and analysed by sex and location.Results: Women ≥50 years in rural-urban locations self-reported more ill-health than men of comparable age. Educational levels, household incomes and possession of health insurance were lower among rural residents. Alcohol and tobacco use were significantlyhigher in rural locations (61% vs. 55.3%) and (29.6% vs. 20.9%) respectively, while obesity was significantly higher among urban residents (17.5% vs. 4.5%). Sex differences in prevalence of chronic conditions were statistically significant for-Angina (F:M 1.8), Arthritis(F:M 1.7), Depression (F:M 2.9), Diabetes (F:M 1.3), Hypertension (F:M 1.8) and Stroke (F:M 1.2). Urbanrural disparities were significant for chronic lung disease (1% vs. 0.4%), diabetes (6.4% vs. 2.2%), hypertension (22.8% vs. 7.3%) and stroke (4% vs1.7%).Conclusions: Preventive health programmes and provision and targeting of social protection (improved access to health care and pensions) should consider sex and location of vulnerable older persons as the country implements the national aging policy.