Enhancing utilization of the findings from the youth reproductive health project in Senegal

Abstract

In 1999, FRONTIERS began a three-year collaboration with the World Health Organization (WHO), the Senegalese ministries of Education (MOE), of Youth (MOY), and Family and Social Affairs (MOFSA), the Center for Research and Training (CEFOREP) and the Population Training Group (GEEP) to test the feasibility, effectiveness and cost of school-, clinic-, and community-based interventions to improve the reproductive health of youth aged 10-19 years. The Operations Research (OR) study focused on providing information appropriate to the cultural context of Senegalese adolescents on a variety of reproductive health issues including: knowledge of the human body; puberty; sexuality; gender roles; different cultural, familial, and peer values regarding sexual and reproductive behavior; contraception; responsible parenthood; STIs and AIDS; and sources of help and services. The study tested different ways of providing information. At the community through outreach, an "edutainment" format was adopted; this comprised interactive participation of beneficiaries involving both education and entertainment. In schools, extra curricular activities and events such as music festivals were used as the forum. In clinics, a combination of edutainment and standard approaches of providing information were used.

Refusal to enrol in Ghana’s National Health Insurance Scheme: is affordability the problem?

“…Enrolling all household members in the NHIS is also not expected to exert a heavy burden on the majority of households as they would be expected to spend 5.9% of their non-food expenditures or only 2.0% of total expenditure on health insurance. This is close to the 5.0% and 1.2% reported by Diop [ 32 ] in the study in Senegal. A recent study [ 51 ] in Ghana suggests that about 30% of the 65% of the NHIS members who are exempted from paying premiums could indeed afford to contribute.…”

“…What constitutes affordable premium however lacks a clear economic definition, though attempts have been made to estimate it in the developed world [ 27 - 29 ]. In the few studies in Africa which have looked at the premium as a barrier to enrolment or retention in health insurance schemes, attempts have not been made to estimate what constitutes affordable insurance contributions [ 13 , 14 , 30 , 31 ], though few have analysed household capacity to pay the insurance premium [ 32 , 33 ]. These studies have reported mixed results on whether affordability is the main barrier to enrolment.…”

“…For instance, in a review of the impact of mutual health organisations in West Africa, Chankova et al [ 34 ] report that premium payments can be unaffordable to many households even when small and can therefore become a major barrier to enrolment. Diop [ 32 ] however observed that the majority of households surveyed in the Thies region of Senegal had the ability to pay insurance contributions as the incidence of insurance contribution was about 1.2% of total household expenditures and about 5% of non-food expenditures. Findings from another study in Burkina Faso suggested that the low demand for community-based insurance may be due to institutional rigidities rather than to poverty per se [ 13 ].…”

Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana

“…However, this aim of containing adverse selection in the NHIS has not been fully achieved because although by design the NHIS is mandatory for all people living in Ghana, in practice it is voluntary because there is no legal enforcement, making it possible for low risk individuals to opt out living high risk individuals mostly from the exemption groups in the insurance pool. Other studies from community-based health insurance schemes in Africa by Atim [ 39 ] and Diop [ 40 ] also pointed to similar conclusions.…”

Effects of parents training on parents’ knowledge and attitudes about adolescent sexuality in Accra Metropolis, Ghana

“…Differences in religious and cultural norms may account for the differences in knowledge about sexuality topics from country to country. For example in Dakar, Senegal, religious leaders believed that parents should discuss reproductive health issues openly with their children, but parents lack the knowledge to do so with confidence [ 26 ]. On the contrary, talking about sex and sexual activities with adolescents in Ghana is perceived as a cultural taboo.…”