"Having done my field research in my home country Ghana, I had first-hand knowledge of health related issues."

January 18, 2010.  

Interview with Dr. Edward Nketiah-Amponsah, an economist from Ghana, who did his PhD research at ZEF on the public health system in his home country.

Edward Nketiah-Amponsah did his PhD research at ZEF's Department of Economic & Technological Change from October 2006 until January 2010. The topic of his doctoral research was: Economic analysis of under-five morbidity, mortality and health seeking behaviour - evidence from Ghana. He received his doctoral degree from the Faculty of Agriculture, University of Bonn. His supervisors were: Prof. Dr. Ulrich Hiemenz (main supervisor), Director at ZEF, Prof. Dr. Isabel Günther (2nd Supervsior) of Swiss Federal Institute of Technology (ETH), Zürich and Prof. Dr. Monika Hartmann (3rd Supervisor) of the Institute of Food and Resource Economics, University of Bonn.

Dear Edward, with what expectations and motivation did you come to ZEF?

I came to ZEF because I had heard of ZEF's strength in applied and development related research. Hitherto, I had heard about experiences from ZEF alumni at the University of Ghana and was convinced that ZEF would contribute to advancing my academic career. Also, prior to my enrolment at ZEF, I was considering other offers but the award of a DAAD scholarship made the final decision easier for me since getting funding for PhD studies is not easy. With a DAAD scholarship, I was assured of a stress-free PhD research, at least on financial grounds.

What are the main benefits of having done your PhD study in the framework of ZEF's doctoral program?

I think the multicultural and interdisciplinary nature of ZEF's PhD program provides an international environment for conducting PhD research. It also enhances networking even after graduation since it is easy to keep in touch with colleagues from other parts of the world through the alumni network. The idea of inter-cultural seminar also helps to enhance harmonization and appreciation of students from different cultural and racial background. The strength of ZEF's PhD program could also be seen in its problem solving approach. By undertaking applied research in the area of development economics among others, we contribute to the development debate from an experiential point of view. Having undertaken the field research in my home country Ghana; I had first-hand knowledge of health related issues which have since challenged my thinking for further research. In addition, ZEF provides adequate office space and research logistics which are essential for conducting scientific research.

On the other hand, I would like to mention that, if one does not come to ZEF with a well-developed proposal, completing on schedule could be problematic. Although, PhD programs in Germany are mainly research oriented, I am inclined to believe that students could benefit from a prolonged coursework. This is because very interesting and innovative research could be borne out of the coursework.

What was the main outcome of your PhD research?

My research is in the area of Health Economics. The study was premised on the rationale that Ghana's under-five mortality rate is high and that there is a need to examine the factors that hinder to help to inform policy. The study argued that access to appropriate health care can help reduce the high mortality rate. It has been observed that approximately 47% of mothers or care givers resort to inappropriate health care as the first remedy during childhood morbidity and only make use of appropriate health facilities when their children's health condition is already deteriorated. An important health policy which serves as a catalyst in the demand for appropriate health care is access to health insurance. Thus if women in the reproductive age could have access to health insurance, it will promote the utilization of appropriate health care and reduce fatal outcomes.

My dissertation came out with a number of results. Although some of the results are not entirely new, they contribute to the debate on health care in developing countries. I found that low-cost but effective biomedical interventions such as the utilization of antenatal care services, childhood vaccinations and insecticide treated bed nets (ITNs) are robust in reducing the hazard of under-five mortality in developing countries. Although my thesis emphasizes supply side variables such as availability of road infrastructure and health workers, I found the biomedical variables to be more important in curbing under-five mortality relative to supply-side variables. Although, increased household income has the tendency to reduce under-five mortality, its impact is only felt when it is translated into the purchasing and utilization of health inputs such as antenatal care, vaccinations and insecticide treated bed nets among others. The current levels of Ghana's road infrastructure and health workers are woefully inadequate in causing significant reductions in under-five mortality, a situation that undermines Ghana's prospect of achieving the health related MDGs.

It was also evident that road infrastructure and availability of hospital beds influence the choice of a health care provider. However, subscribers of alternative health care providers such as Traditional medicine and Pharmacy/Over-the-counter drugs do not respond to supply-side variables. This might be attributable to the low- level of investment required for the establishment of these alternative providers vis-à-vis allopathic private and public health providers.


It is also worth mentioning that distance is a disincentive to the utilization of appropriate health care since it denotes opportunity costs. However, subscribers of private health care disregard longer distances to demand private health care because of the perceived quality. Yet, consumers who are unable to subscribe to private health care resort to self-treatment. As a follow up result, consumers of private health providers are 12 percentage points more satisfied than their counterparts who utilize public health care.

Other findings from the study were that availability of health workers, income, access to media and religious denomination influence the propensity to undertake health insurance among women in the fertility bracket. At the household level however, distance, insurance premium, presence of children aged under-five inter-alia are the most significant predictors for the proportion of household members insured. These findings are by no means exhaustive but give an overview of the results from the study.

Did you formulate any policy recommendations?

Yes, I formulated some policy recommendations. Some of the recommendations are reminiscent of a situation of déjà vu, since previous recommendations akin to mine have not been implemented. Here is a selection of my recommendations:

  • A careful examination of health policies in Ghana shows that, there is lack of synergy between road infrastructure and improvement in health care or yet still better health outcomes. It is about time that public health policies incorporated improvement in road infrastructure as a key health policy. Since the transport sector is primarily privately operated, transport owners will hardly ply bad roads in that it results in longer travel times and higher vehicular operation cost. The effect of which is to severe the barrier to health care in the remotest parts of the country. Once such synergy is recognised, the government will give priority to maintenance, improvement of existing road infrastructure and the construction of new routes.
  • Public health policies should focus on low-cost but effective interventions such as the utilization of antenatal care services, childhood vaccinations and the utilization of insecticide treated bednet in the quest to achieve significant reductions in under-five mortality. To this end, pragmatic efforts should be exerted to increase nationwide immunization coverage.
  • Although public health care is highly subsidized, it is imperative that policy makers make frantic efforts to adequately equip public health facilities to provide quality health care. Often public health facilities are characterized by lack of essential logistics such as X-ray Machines, hospital beds and drugs inter alia. This anomaly needs to be addressed in order to increase the demand for public health at the expense of self treatment and faith healing.
  • Innovative ways of financing health care through health tourism could be explored. With a consistent policy to develop health infrastructure and logistics over time, Ghana could become a haven for health tourism in the ECOWAS sub-region, which is otherwise characterized by poor health facilities and political instability. With well equipped health facilities coupled with stable political environment, Ghana can provide health care to its neighbours to generate foreign exchange which could be reinvested in the health care system and to subsidize domestic cost of health care for the needy and vulnerable such as women and children aged under-five years.
  • To help implement to the fullest, the free medical care policy for children aged under-five, the aged and expecting mothers irrespective of insurance status, accruals from debt relief following Ghana's subscription to the Enhanced Highly Indebted Poor Countries initiative could be channelled into financing some of the burden of the scheme. Proper mechanisms such as birth registration and certification should be encouraged to help identify the target population; to save the policy from blatant abuse.

Where did you do your field research? What were your most remarkable experiences during your field research?

I conducted the field research in three Districts in Ghana (Lawra, Ejisu-Juabeng-now a Municipality and Dangme West). Concerning remarkable experience, two issues come to my mind: The first concerns a motor-bike accident I experienced, albeit not that serious. In fact, it was my first ride on the bike. This happened when my research assistants and I needed to commute between Lawra and Nandom, the two major towns in the Lawra District to interview some sampled households. The second relates to a near termination of my field survey by the Ghana's Health Service's Ethical Review Committee for conducting research on human subjects without prior approval or ethical clearance. Apparently, being an economist who had just ventured into health related research, I was not aware that such a clearance was needed. However, I applied to the committee thereafter and was given the needed clearance

What kind of position do you have now / are you going to have after graduation?

I hold a position as a lecturer and researcher at the Department of Economics, University of Ghana.

In what way do you profit in your current position from your education at ZEF?

It is a prerequisite to have a PhD degree in the relevant discipline before one can hold a lectureship position at the University of Ghana. I was given three years of leave to obtain my doctoral degree at ZEF to fulfil this obligation; otherwise my contract would not have been renewed since I entered the University of Ghana with a master's degree. Thus, I have received the PhD degree at the most opportune time. In addition, I now have the chance of being promoted, if I manage to produce some few journal articles in addition to what I have already published.

Besides, I am currently on a DAAD sponsored internship with the United Nations World Food Programme in Rome, Italy, until May 31, 2010. But without having done my PhD studies at ZEF, I would never have gotten this opportunity. I will return to the University of Ghana in June 2010.

Is there anything you want to say or add?

I would like to take this opportunity to thank the entire ZEF team and the DAAD for giving me the opportunity to study at ZEF. I am also grateful to my home institution, the University of Ghana, for granting me study leave to pursue my PhD studies at ZEF.



Alma van der Veen