I am in Accra this summer working for the Women's Health Study of Accra (WHSA). This is a study funded by the United States' National Institutes of Health and consists of 2 waves of household interviews and 1 wave of comprehensive clinical exams. The first wave and the comprehensive clinical exam were completed in 2003 when slightly under 3,000 women from the Accra metropolitan area were interviewed and half of them then taken to Korle Bu teaching hospital where they had blood tests and physical exams. The first wave led to intriguing clinical findings including high rates of hypertension, obesity, and diabetes mellitus -- typically "western" diseases. Though food security, malaria, cholera, and high rates of maternal and infant mortality are still a concern in Accra and throughout Ghana, the "epidemiological transition" (the move from communicable to non communicable diseases as the leading cause of disability and disease burden) is well under-way in Accra. Because Ghana has one of the most stable West African governments and one of the most progressive legislatures, Accra is looked upon by her African neighbors as the way of the future. How health care, health policy, and health in Accra progress is of extreme importance.
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This said, given several questions raised by the first wave of the WHSA and a curiosity about the impact of several new policies implemented during the last 5 years, a second wave of the WHSA was conducted in 2008. Wave 2 of the WHSA involved locating the same women interviewed 5 years previously and re-interviewing them with a similar survey instrument to aid in comparability but also to ask about topics not included on the previous survey. These topics
include areas such as national health insurance and health service usage and mental health needs. Though locating the women for interview was quite a task (many of the "addresses" for women read as follows: "Walk towards the yellow house, turn right at the big tree, third hut on left." Despite the difficulty, the office staff managed to re-locate 2/3 of the original women. Those who could not be found were replaced with women of similar age, geographic location and socio-economic status.
The data collection and entry for the second wave of the study is just now finishing. So here's my job:
I am in Accra this summer to begin the basic descriptive statistical analysis of the findings from the 2nd Wave of the WHSA. Additionally, I am conducting a stakeholder analysis and identifying the priorities of organizations and agencies working in Accra responsible for health policy and programming. Once I have discerned the priorities of these influential parties, I am preparing a series of topical briefings from our data with the intent of aiding in evidence based policy and programming in areas concerning women's health and urban health that are of current political and programmatic significance. The goal behind my work is to make our data accessible and available. Publications will certainly result from our data, but it will take years for them to be published, and our data will be made publically available in raw form, but not all agencies have the capacity to process the data. My job is to address this information gap.
After two weeks of work, the task is still overwhelming and challenging. But I am passionate about evidence based policy and programming and am passionate about helping to facilitate the process, particularly as this seems to be the only morally responsible way to conduct public health research.
Though my task is challenging, it is quite fascinating to have the authority and the opportunity to meet with some of the biggest health stakeholders in Accra. In the past week I've had the chance to meet with: the director of the Population Council in Ghana, one of the key drivers behind the current National Health Insurance Scheme Reform, the regional and metropolitan directors of Ghana Health Services, faculty at the University of Ghana, physicians at a public hospital, and many more. In the upcoming weeks I hope to have meetings with representatives from the WHO, USAID, UNICEF, the Ghanaian Ministry of Health, UNDP and more. This is an amazing opportunity to learn about how these organizations function in their country offices and to gain exposure to job opportunities in my field. My hope for this summer is not only that I produce products of use to Ghanaians, but that I gain insights into my own career aspirations.
To complete my work, my daily tasks include lots of phone calls, some statistical analysis, some research, and meetings. At some point I will need to begin writing, but a fair amount more analysis needs to happen before then! The WHSA has an office in Adabraka Official Town and is staffed entirely by Ghanaians. Even though I could do some of my work from my home in Teshie, the office is such a wonderful environment that I look forward to going in. Becky, the office manager, is the sweetest girl you will ever meet. Richard, Maame, Comfort, Silvia, and all of the other staff are incredible people who will make you laugh and try and convince you that you work too much.
One of my biggest challenges in working here in Ghana is relaxing my intense work ethic to come closer to the relaxed Ghanaian pace. Work days here often end quite early (2:30/3:00), and I find myself pressured to leave my work. There have been a few evenings with me working in the office long past when all the other staff have left, and I think I may need to get in the habit of doing this, even if it isn't the Ghanaian way, to ensure that my work gets completed in the short period of time that I am here. Or if not completed, at least to a point where it can be finished in the USA.
I hope this answered some of the questions about what I do and why I am here without being too academic or rambling. If you would like to know more about the study, or my work, I could talk about it all day, so feel free to ask!
For your knowledge:
Population Council, Ghana: http://www.popcouncil.org/africa/ghana.html
UNICEF, Ghana: http://www.unicef.org/infobycountry/ghana.html
UNDP, Ghana: http://www.undp-gha.org/
WHO, Ghana: http://www.who.int/countries/gha/en/
Ghana, Ministry of Health: http://www.moh-ghana.org/moh/default.asp
Ghana Health Services: http://www.ghanahealthservice.org/
I almost forgot... Samantha, the other Harvard student in Accra with me, is working for the same study as I am but doing a different task. Sam's job for the summer is to organize a verbal autopsy project. There were 177 women who were recorded as having died between the first and second waves of the survey though we have no information as to why. Sam's task is answering just that question. There are fieldworkers going out to locate the families of these women (using the only information we have--the last address of the woman, from 2003) and interview them with a verbal autopsy (a questionairre that attempts to discern cause of death). These interviews will then be reviewed by 2 physicians who will attempt to determine from the information provided the cause of death. If they both agree on a cause, this will be compared with hospital records and the death certificates. In Ghana there is no reliable information on the major causes of death, because physicians will record causes of death as "old age" or "exhaustion." Of the 177 women who died, their ages are fairly evenly distributed across all age groups.
Because we're in the same department at Harvard, we are helping each other out on our projects. This means Sam gets to come along on some of my meetings, and I get to go out on some of the interviews from her study. I quite enjoy this collaboration and enjoy having Sam's company!
Great post. Enjoy the rest of your Ghana stay
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