National Health Insurance Program in Ghana - Research Proposal Example

Running Head: RESEARCH PROPOSAL Has the implementation of the national health insurance program in Ghana help reduce HIV AIDS which is prevalent in rural Ghana? Name of Client Name of University Name of Class Has the implementation of the national health insurance program in Ghana help reduce HIV AIDS which is prevalent in rural Ghana? Project Summary The African state of Ghana has a relatively low instance of HIV AIDS in comparison to other nations inside the continent. At a rate of 3.1% of people between the ages of 15 to 49 year olds, the disease is primarily considered a disease of female prostitutes within the country. Two thirds of the infected are women and the highest rates correspond with the areas with the highest number of sex workers (Patterson, 2005, p. 79). However, the perception of a lowered rate combined with the social status of those involved has led to a lowered interest by the government to address the issue. The government marginalizes sex workers as not of interest, therefore the disease is not given the due consideration in the newly democratized stated (Howley, 2010, p. 367). The prevention of HIV/AIDS through behavior modification has been a primary resource for addressing the disease (Howley 2010, p. 186). According to the International Monetary Fund (2006), HIV/AIDS issues are recognized as a threat to the “socioeconomic development of the country through its potential impact on human capital development, productivity, and social services delivery“(p. 109). In 2006 the following measures were taken in working towards prevention of the disease within the nation of Ghana: Advocacy sessions held with the regional House of Chiefs concerning the economic, sociocultural, and legal epidemic. A national Policy Guidelines on Orphans and Vulnerable Children (OVC) was developed and implemented as response to OVC. The media was supported to scale up targeted HIV/AIDS messages Voluntary counseling and treatment services were made available at 243 public and NGO sites, while 104 sites provided PMTCT services across the country. The Administration of Antiretroviral Therapy (ART) is progressing steadily. There are currently 46 sites which provide ART. The breakdown is as follows. 2 teaching hospitals 10 regional hospitals 14 district hospitals 5 private self-financing 2 uniformed service facilities (International Monetary Fund, 2006, p. 109) The following table shows the number of people who were benefiting from ART as of December of 2006. At that time, there were 50,942 people in need of services with only 7,338 benefiting from art which represents only 14.4% of those in need(International Monetary Fund, 2006, p. 109). Clients on Art as of December 2006 Male Female Total Adults 2,678 4,392 7,070 Pediatrics 151 117 268 Total 2,829 4,509 7,338 (International Monetary Fund, 2006, p. 109) Ghana has seen a decline in poverty from 39.5% in the 1998 to 1999 years to 28.5% in 2006 (African Development Bank., & OECD, 2008). In addition, there has been a concerted effort on the part pf the government to address the needs of their citizens in regard to health care. According to former President of Ghana, Jerry John Rawlings, Ghana suffers from a poor system of health care that is lead by a staff of insensitive and unprofessional medical personal and complicated by poor infrastructure and a lack of equipment. The staffs of hospitals are burdened by a lack of everything, thus leaving them jaded and without motivation (Modernghana.com 2010). In addition, the National Health Insurance Scheme that has been put into place is beleaguered by problems and is not providing the much needed services that the people need in order to have adequate health care. Statement of the Problem The National Health Insurance Scheme is the product of the administration led by John Kufuor. However, one of the exceptions to the insurance plan that was developed are the antiviral medications needed for HIV (Ghanaweb, 2010). Therefore, the treatment of HIV is left largely unattended. The drugs require financial commitments that many of the people who are at the highest risk cannot afford. While there is an emphasis on the use of educational programs in order to provide information for the use of prevention, there appears to be an undercurrent of neglect for those who have already contracted the virus (African Development Bank., & OECD, 2008). In addition to the perspective that HIV/AIDS is a problem that does not warrant policy consideration, the general attitude towards women must be taken into consideration as a part of the problem. Female circumcision, as an example is still a wide held practice within the nation (Shweder, Minow, & Markus, 2004, p. 221). The implementation of methods to preserve sexual virtue combined with the statistical relevancy of sex workers to the prevalence of HIV/AIDS suggests that there is a cultural distinction about the sexuality of women that affects the way that policy is implemented. Although in some countries HIV/AIDS is stigmatized by an association to homosexuality, the stigma in Ghana is the association with women. This suggests that the needs of these women are not considered a priority within the country. Justification and Use of the Results The justification of this study is based on the increase of knowledge about the topic in order to provide a framework for policy makers to promote change. In understanding the needs within Ghana and what is neglected within those needs, policy makers can address these issues and promote change within the government. The justification of this study is based on the belief that in order to promote change, it is within an awareness of the problem that policies and services can be implemented. The disparity that appears to exist between the policies of public health care and the denial of coverage for antiviral medications provides an opportunity to study the situation from a socioeconomic perspective, a cultural perspective, and a public health care perspective. In addition, a perspective from the point of view of the field of women’s studies can also be adapted. Therefore, the work has a great potential for applications across a variety of disciplines. Researchers and policy makers can utilize the work in order to support their needs and decision making practices. Theoretical Framework This study will be based on a theory of functionalism. According to Ferrante-Wallace (2005), a functionalist will define society as “a system of interrelated, interdependent parts” (p. 34). Through the vantage point of the functionalist, this research will determine ways in which a broken system can be repaired in order to provide a system for those with HIV/AIDS to better function within society and to live longer lives within the nation of Ghana. Because the functionalist will see that the many parts of society are needed in order to create a whole, the cultural point of view will be challenged as well as the policies that oppress those afflicted with HIV and AIDS. As well, the point of view that is shared culturally within the country towards women will be examined as the disease has been determined to be primarily a female problem within the country. According to Abbot, Wallace and Tyler, there is no distinct theoretical framework for feminist objectives, but that all frameworks can be developed from a feminist point of view. Therefore, utilizing the functional theoretical perspective, and combining it with the cultural aspects of the nation in regard to the way in which women and women’s issues are addressed and considered will provide an understanding of the causes behind the lack of support for HIV/AIDS victims. Research Objectives In doing a quantitative study of this type it will be important to identify and establish clear research questions that can be answered through a thorough examination of the data. The objectives of this research will be to answer the following questions: 1. Why are HIV/AIDS patients not covered for antiviral medications under the National Health Insurance Scheme in Ghana? 2. What is the current most common experience for those afflicted with HIV/AIDS in Ghana? 3. What would be the costs of covering an individual for antiviral medications per year and what are the average overall medical costs per year for a patient with HIV/AIDS? 4. What are the resources available to HIV/AIDS patients in Ghana and what availability is appreciated by most patients? 5. What would make the most significant change for those suffering with HIV/AIDS in Ghana? 6. How has the implementation of the current programs and services affected the prevalence of HIV/AIDS in Ghana? 7. What are the current statistics regarding the implementation of those programs in comparison to the time period before those programs were instituted? A thorough examination of these issues will provide a framework for discussion and recommendation to policy makers. Methodology The research for this study will first be explored through a comprehensive examination of the relevant literature. Current information that has been explored previous to this work will be examined for its relevancy and importance to the topic of HIV/AIDS treatment in Ghana. Statistics that are currently available will be evaluated for their relevancy and used to determine an answer to the issue at hand. The research will be done via the internet through a search of databases, online journals, and related articles. In addition, historical information will be researched using books that are relevant and current. Government resources will be utilized to provide accurate and accepted information from the country of Ghana as well as the information that can be attained from worldwide agencies. The entire study will be comprised of a mixed methodology of both quantitative and qualitative aspects of the issue. Because of the human element and the cultural differences that exist within the region, an understanding of how the phenomenon affects the citizens of Ghana will add a qualitative experiential element to the quantitative statistical analysis. A quantitative research study will be undertaken using a nonequivalent control group methodology. Health care policies in Ghana will be compared to those in democratic South Africa and additionally compared to those in Canada, utilizing their public health care system as an example from which to provide comparison. A participant group of 300 from Ghana will provide insight that is more extensive to that which is collected from both South Africa and Canada. The results of the control groups will be to determine how the policies in Ghana compare and can be improved, as well as any increased success that can be appreciated from the nation. The control groups will be participant groups of 150 each in order to provide a comprehensive overview of the information that is available. The questionnaire that will be utilized in Ghana will have several sections, including an ASI in order to determine the general welfare of the participant in regard to drug abuse, alcohol abuse, legal issues, and the general welfare of the participant. In addition, a medical questionnaire will provide a comprehensive look at the general state of health that is experienced with those suffering from the virus and its effects. The information will be determined using a five point scale in order to have statistical information that can be analyzed. In addition to the quantitative research, the study may find that using a few case studies that are developed through a phenomenological approach to qualitative research will be useful. Using information that is based on experiences might give the research a more refined approach to the issue and provide basis for better understanding the quantitative variables that are achieved through the five point scale quantitative approach. A selection of 15 respondents will be given an additional questionnaire that will allow for statements to be made about the overall experiences that have been realized both before the implementation of the National Health Care Scheme and after its development. Three to five cast studies will be developed from this 5 respondents in order to provide some perspective within the work. The limitations of this research will be in that the study of this topic will not be possible from within the country of Ghana. The researcher will not be able to go to the nation and see first hand how the victims of HIV/AIDS. In addition, a language barrier may be a problem in Ghana in creating respondents for the questionnaires. While the official language of Ghana is English, based on the former colonization of the country by the United Kingdom, there are no less than, and possibly more than 79 languages within the nation (International Monetary Fund 2006). Therefore, there will be a need to utilize gatekeepers to facilitate the research. These gatekeepers will be comprised of medical personnel, agency officials, and volunteer workers from global agencies. Plan for Analysis of Results The information from the five point score questionnaire will be analyzed through SPSS software in order to construct variances and differentiations that are relevant to the research questions through a quantitative point of view. The work will be utilized to form conclusions based on the statistical results from this analysis. In addition, the case studies will be analyzed through a qualitative perspective for commonalities of experiences in order to better understand the phenomenon of the services experienced before the implementation of the health plan and those that came after the implementation of the health plan. Timetable Budget In order to fund the research study, grants will be applied for and funds searched out to create a viable budget. With 500 respondents paid $20.00 per participant, the costs of the research will reach $10,000 just to pay the participants. The gatekeepers will be compensated by $50.00 per gatekeeper. It is estimated that 10 gatekeepers will be needed to provide help with finding respondents and collecting the answers to the questionnaires. In addition to these costs, a budget of $100 will be assessed for office supplies and another $200 for long distance phone calls. The total ideal cost of the project will be $10,700. In the event that there is no financial support available for the project at this level, the budget will be adjusted accordingly. References Abbot, Pamela, Claire Wallace & Melissa Tyler. (2005). An introduction to sociology: A feminist perspective. New York: Routledge. African Development Bank., & OECD. (2008). African economic outlook: 2007/2008. Paris, France: African Development Bank. Ferrante-Wallace, J. (2005). Sociology: A global perspective. Belmont, Calif: Thomson/Wadsworth. Ghanaweb. Health Insurance in Ghana. 30 July 2010. Ghanaweb 2010. Web. Howley, K. (2010). Understanding community media. Los Angeles: SAGE. International Monetary Fund. (2006). Ghana: Poverty reduction strategy paper - 2006 annual progress report. Washington D.C.: International Monetary fund. Modernghana. Fixing our Broken Health Care System. 31 July 2010. Ghana Resource Center. 17 March 2010. Web. Patterson, A. S. (2005). The African State and the AIDS crisis. Global health. Ashgate [u.a.: Ashgate. Shweder, R. A., Minow, M., & Markus, H. R. (2004). Engaging cultural differences: The multicultural challenge in liberal democracies. New York: Russell Sage Foundation. White, T. L., & McBurney, D. (2010). Research methods. Belmont, CA: Wadsworth Cengage Learning. Appendix A. Kentucky Drug Court ASI Adapted for Ghana HIV/AIDS Patients Date of Assessment __ __/__ __/__ __ __ __ Time assessment begun __ __: __ __ 1=a.m. 2= p.m. Interviewer: Drug Court Site: Section 1: Locator Information The first section asks about your contact information. 1. Client name_________________________, ______________________ ______ Last name First name MI 2. What is your current address? ____________________________________________ Street address 3. How long have you lived at this address? ________Years 4. Is your current residence owned by you or your family? 0=NO 1=YES 5. What is your best mailing address? ________________________________________ Street address 6a. What is the best phone number to reach you? (______) _____________________ 6a1. Who else might answer that phone? Full name: _________________________ Relationship________________ Full name: _________________________ Relationship________________ 6b. Is there another number that you may be reached at? (______) _________________ 6b1. Who else might answer that phone? Full name: _________________________ Relationship________________ Full name: _________________________ Relationship_________________ 7. Do you currently work or know where you plan to work in the near future? 0=NO If NO, Skip to Question # 10 1=YES 8. What is the name of the place you work or plan to work?______________________ 8a. What is your work phone number? (______)___________ 9. Work address ____________________________________________________ Street address ____________________________________________________ City, State, Zip code 10. Please tell me the name of your mother or grandmother or other close relative that usually knows where you are or that you maintain regular contact with: A) Full name: ________________________________________________________ First Middle Last Address: _________________________________________________________ Street City ST Zip Phone: (_______)_____________ Relationship ___________________ 11. Do you have any other relatives or friends who usually know how to reach you? A) Full name: ________________________________________________________ First Middle Last Address: _________________________________________________________ Street City ST Zip Phone: (_______)_____________ Relationship ___________________ 12. Interviewer comments on client contact information: Section 2: Demographic Information This section asks about your demographic information and about your child(ren) if you have any. 1. What is your birth date? __ __/__ __/__ __ __ __ MM DD YYYY 2. What is your Social Security Number? (Interviewer, if possible verify this number with a social security card. This number needs to be accurate!) 3. Are you: 1=Male 2=Female 4. In what country were you born? 1=US If BORN IN U.S., Skip to Question # 5 2=Non-US born 4a. If not born in the U.S., how many years have you lived in the U.S.? years 5. What country was your mother born? 1=US 2=Non-US born 6. What country was your father born? 1=US 2=Non-US born 7. Are you Hispanic or Latino? 0=NO 1=YES 8. What race do you consider yourself to be? 9. What language do you usually speak? 10. Do you have a particular religion you follow? 1=Protestant 2=Catholic 3=Jewish 4=Islamic 5=Other 6=None 11. Have you been in a controlled environment in the past 30 days like a hospital or jail (not a shelter)? 0=NO If NO, Skip to Question # 12 1=YES 11a. If yes, please tell me which controlled environment(s) you have been in and how many days you have spent in that environment in the previous 30 days: Which controlled environment(S) 0=No 1=yes # Days Jail 0 1 Alcohol or Drug Treatment 0 1 Medical Treatment 0 1 Psychiatric Treatment 0 1 Other (specify): 0 1 12a. If Female ask “How many times have you been pregnant?” _________times If 0, Skip to Question # 19 12b. If Male ask “How many pregnancies have you been responsible for?” ______pregnancies If 0, Skip to Question # 19 13. How many of those pregnancies resulted in a live birth? ______pregnancies If 0, Skip to Question # 19 14. How old were you when the first baby was born? _________years old 15. How many children do you have? __________children 16. Starting with the youngest child, please answer the following: A. What is the gender of this child? (Circle one) 1=Male 2=Female B. What is the birth date of this child? (record date of birth) C. Who does this child live with? (record number corresponding to answer) 0=Respondent 1=Other parent 2=Other family member 3=Friend 4= Step parent 5=Foster care 6=Adopted 7=Institution 8=Deceased 9=Lost custody 10=Other 11=Not applicable D. What is the legal custody status of this child? (record number corresponding to answer) 1=Joint—Mother primary 2=Joint—Father primary 3=Joint—Equal 4=Sole mother 5=Sole father 6=Other family 7=Friend 8=Ward of the state 9=Child is an adult 10=Other E. How many days per month, on average, do you see this child? (record number of days) F. Do you pay child support for this child? (record number corresponding to answer) 1=YES, court ordered 2=YES, not court ordered 3=NO, court ordered 4=NO, not court ordered 5=NOT APPLICABLE Start w/ youngest children a childs Gender b Childs dob mm/DD/YYYY c Who does child Live with? d Legal custody Status? e visits w/ client #days/MONTH? f Does client pay child SUPPORT? Child1 1 2 Child2 1 2 Child3 1 2 Child4 1 2 Child5 1 2 Child6 1 2 Child7 1 2 Child8 1 2 Child9 1 2 Child10 1 2 17. How much child support are you ordered to pay per month? $______________ 18. How much child support are you actually paying per month? $______________ 19. Are there other children living with you now that you take care of? 0=NO If NO, Skip to Question # 20 1=YES 19a. If yes, list their gender and birth date: Dependants Gender 1=male 2=female dob mm/DD/YYYY Dependant1 1 2 Dependant2 1 2 Dependant3 1 2 20. Interviewer comments on client demographic and child(ren) information: Section 3: Medical Health Information The following questions ask about your medical health history. 1. How many times in your life have you been hospitalized for medical problems? (Include ODs and DTs; Exclude birth of a child) _______times If 0, Skip to Question # 3 2. How long ago was your last hospitalization for a physical problem? (Exclude birth of a child) 1=less than six months 2=6-12 months ago 3=1-2 years ago 4=2-3 years ago 5=more than 3 years 3. Do you have any chronic medical problems that continue to interfere with your life? 0=NO 1=YES; If yes, what? _______________________ (If there are multiple answers please separate by commas) 4. Have you ever had any of the following health problems? health problems 0=No 1=yes Hepatitis (B, C) 0 1 Chlamydia (NGU) 0 1 Syphillis 0 1 Gonorrhea (GC, clap, dose) 0 1 Pelvic Inflammatory Disease (PID) 0 1 Genital Warts (HPV, venereal warts) 0 1 HIV+ 0 1 AIDS 0 1 5. Have you ever had a fit or seizure? 0=NO 1=YES 6. Are you taking any prescribed medication on a regular basis for a physical problem? 0=NO 1=YES; If yes, what? (If there are multiple answers please separate by commas) 7. Do you receive a pension for a physical disability? (Exclude psychiatric disability) 0=NO 1=YES; If yes, what? (If there are multiple answers please separate by commas) 8. Do you smoke cigarettes? 0=NO If NO, Skip to Question # 10 1=YES 9. On average, about how many cigarettes did you smoke a day in the last 30 days, or the last 30 days on the street? _________ cigarettes 10. Do you sleep past 11 a.m. most days? 0=NO 1=YES; If yes, is this because of your working hours? 0=NO 1=YES 11. How many months, in the past year, have you been covered by any type of health insurance, including Medicaid/Medicare? _______________months If 0, Skip to Question # 13 12. Which of the following best describes the type(s) of health insurance or health programs you are/were covered by? 13. How many days have you experienced medical problems in the past 30? (Not pregnancy related) ______ days 14. How troubled or bothered have you been by medical problems in the past 30 days? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 15. How important to you now is treatment for your medical problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely Interviewer Ratings for Medical Health Information 16. How would you (interviewer) rate the client’s need for medical treatment (circle one number next to your response ) 0 – 1 =No real problem 2 – 3 =Slight problem 4 – 5 =Moderate problem 6 – 7 =Considerable problem 8 – 9 =Extreme problem 17. Interviewer comments on medical health information: Section 4: Education and Employment Information The following questions ask about your education and employment history. 1. How many years of education have you completed? _______ years 2. How many months of training or technical education have you completed? ___________ months 3. Do you have a profession, trade, or skill? 0=NO 1=YES: If yes, what? (If there are multiple answers please separate by commas) 4. Do you have a valid driver’s license? 0=NO; If No, Why Not? 5. Do you have an automobile available for use? 0=NO 1=YES 6. Are you currently employed? 0=NO Go to Question # 7a 1=YES Go to Question # 7b 7a. How long was your last job? _________ years ________months 7b. How long have you worked at your current job? _________ years ________months 8. Is (was) this job: 1=Full time 2=Part-time 3= Other 9. What type of job is (was) it? 01 Professional and technical (accountant, architect, engineer, lawyer or judge, scientist, doctor, registered nurse, teacher, social worker, writer, entertainer, draftsperson) 02 Manager and administrator (office manager, sales manager, school administrator, government official, small business owner) 03 Sales (sales representative, insurance agent, real estate broker, bond sales person, sales clerk or other sales people, cashier) 04 Clerical or office worker (bank teller, bookkeeper, secretary, file clerk, typist, postal clerk or carrier, ticket agent) 05 Craft and kindred (baker, carpenter, electrician, bricklayer, mechanic, machinist, tool and die maker, telephone installer) 06 Operative (assembler, checker, gas station attendant, meat cutter, packer, laundry and dry-cleaning operator, miner, welder, garage worker). 07 Transportation equipment operative (bus or cab driver, chauffeur, truck driver, delivery person) 08 Non-farm laborer (construction, freight handler, sanitation worker, car washer, yard worker, odd-job person) 09 Private household worker (maid, butler, cook) 10 Service worker (cook, waiter, barber, janitor, practical nurse, caretaker for children, day care worker, beautician, police officer, firefighter) 11 Farmer or farm manager. 12 Farm laborer (field boss, picker) 13 Military service 14 Other 99 Never had a job 10. When did you start? MM/YYYY 11. When did you leave? If 00, Skip to Question # 13 MM/YYYY (Code 00 if currently at this job) 12. Reason for leaving: 1=Not enough money 3=Laid off 4=Injury 5=Illness (self) 6=Illness (family member) 7=Lack of childcare 8=Pregnant (had baby) 9=Went back to school 10=Problem with boss 11=Problems w/ co-workers 12=No health benefits 13=Transportation 14=Offered better job 15=Didn’t like job 16=Incarceration 16=Other 13. Does someone contribute to your support in any way? 0=NO If NO, Skip to Question # 16 1=YES 14. Who is the person who contributes the most to your support? 1=Spouse/partner 2=Parent/foster parent 3=Brother/sister 4=Grandparent 5=Other relative 6=Unrelated other 7=Not applicable 15. Does the support from [insert answer to Question # 14] constitute the majority of your support? 0=NO 1=YES 16. What has your usual employment pattern been the past 12 months (past year)? 1=Full-time (35 hrs/week) 2=Part-time 3=Student 4=Service/Military 5=Retired/Disability 6=Unemployed 7=In controlled environment 17. Including “under the table work,” how many days were you paid for working in the past last 30 days, or the last 30 days on the street? _________ days 18. How much money did you receive from the following sources in the last 30 days, or the last 30 days on the street? Sources $ Amount Employment (net income) Unemployment compensation Welfare (DPA) (AFDC) WIC Food stamps Pension, benefits, or social security 19. How many people depend on you for the majority of their food, shelter, etc? _____ people 20. Do you owe money for child support arrearage (back child support payment)? 0=NO 1=YES; If Yes, please indicate the category closest to the amount owed: a. Less than $500 b. $501-$2,000 c. $2,001-$5,000 d. $5,001-$10,000 e. $10,001-$15,000 f. $15,001-$20,000 g. $20,001-$25,000 h. $25,001-$30,000 i. $30,001 or above j. Not yet set by the court. 21. Do you owe money for court fees? 0=NO 1= YES; If Yes, please indicate the category closest to the amount owed: a. Less than $500 b. $501-$2,000 c. $2,001-$5,000 d. $5,001-$10,000 e. $10,001-$15,000 f. $15,001-$20,000 g. $20,001-$25,000 h. $25,001-$30,000 i. $30,001 or above j. Not yet set by the court. 22. Do you owe money for restitution? 0=NO 1= YES; If Yes, please indicate the category closest to the amount owed: a. Less than $500 b. $501-$2,000 c. $2,001-$5,000 d. $5,001-$10,000 e. $10,001-$15,000 f. $15,001-$20,000 g. $20,001-$25,000 h. $25,001-$30,000 i. $30,001 or above j. Not yet set by the court. 23. Do you owe money for legal fees? 0=NO 1= YES; If Yes, please indicate the category closest to the amount owed: a. Less than $500 b. $501-$2,000 c. $2,001-$5,000 d. $5,001-$10,000 e. $10,001-$15,000 f. $15,001-$20,000 g. $20,001-$25,000 h. $25,001-$30,000 i. $30,001 or above j. Not yet set by the court. 24. Do you owe money for other kinds of debts (do not include car loans and house mortgage payments)? (specify): (If there are multiple answers please separate by commas) 0=NO 1= YES; If Yes, please indicate the category closest to the amount owed: a. Less than $500 b. $501-$2,000 c. $2,001-$5,000 d. $5,001-$10,000 e. $10,001-$15,000 f. $15,001-$20,000 g. $20,001-$25,000 h. $25,001-$30,000 i. $30,001 or above j. Not yet set by the court. 25. How many days have you experienced employment problems in the past in the last 30 days, or the last 30 days on the street? _____ days 26. How troubled or bothered have you been by employment problems in the last 30 days, or the last 30 days on the street? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 27. How important to you now is counseling for employment problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely Interviewer Ratings for Education and Employment Information 28. How would you (interviewer) rate the client’s need for employment or support counseling? (circle one number next to your response ) 0 – 1 =No real problem 2 – 3 =Slight problem 4 – 5 =Moderate problem 6 – 7 =Considerable problem 8 – 9 =Extreme problem 29. Interviewer comments on employment and education information: Section 5: Drug and Alcohol Information The following questions ask about your substance use history. 1. Please indicate: A. Have you ever used [insert substance]? (Circle one) 0=NO 1=YES B. How old were you the first time you used [insert substance]? (record age) C. How many days have you used in the past 30 days on the street? (record # days) D. How many years have you used [insert substance] regularly in your lifetime? ( record # years) E. Write any substance specific comments on the next page. Drug/Alcohol information a Ever used 0=No 1=yes B Age 1st use C # days used in past 30 on the strt D #Years used in lifetime 1.1 Alcohol, any use 0 1 1.2. Marijuana (pot, weed, dope, grass, herb, joint, reefer, spliff, sinsemillia, doobie, cannabis, hashish, ganja, Colombian) 0 1 1.3. Cocaine (coke, base, dusts, freebase, snow, lady) 0 1 1.4. Crack Cocaine (rock) 0 1 1.5. Amphetamine (uppers) (crank, diet pills, bennies, black beauties, dexies, ice, white crosses, methamphetamine) 0 1 1.6. Barbiturates (downers) or Other sedatives/ hypnotics/tranq (sleeping pills, Valium, Librium, Xanax, Quaaludes, Seconal, Amytal, goofballs, reds, Yellowjackets) 0 1 1.7. Opiates/analgesics painkillers (Percodan, Dilaudid, opium, orphine, codeine, opium, Demerol, Talwin, Darvon, oxycontin, oxycodone) 0 1 1.8. Hallucinogens (psychedelics, to trip, to drop) (LSD, acid, tabs, microdots, blotter, mescaline, psilocybin, mushrooms, peyote, buttons, DMT, XTC, PCP, angel dust, Adam, STP) 0 1 1.9. Inhalants (glue, gas, paint, nitrous oxide—whip-its, laughing gas, balloons, etc) 0 1 1.10. Heroin (junk, scag, smack, horse, boy, China white) 0 1 1.11. Methadone, illegal 0 1 1.12. More than one substance per day (including alcohol) 0 1 Drug/Alcohol information E comments 1.1. Alcohol 1.2. Marijuana 1.3. Cocaine 1.4. Crack Cocaine 1.5. Amphetamine 1.6. Barbiturates or Other sedatives/ hypnotics/tranq 1.7. Opiates/ analgesics painkillers 1.8. Hallucinogens 1.9. Inhalants 1.10. Heroin 1.11. Methadone, illegal 1.12. More than one substance per day including alcohol) 2. Which substance is the major problem? 1=Alcohol 2=Marijuana 3=Cocaine 4=Crack 5=Amphetamines 6= Barbiturates 7=Opiates 8=Halluc 9=Inhalants 10=Heroin 11=Illegal Methadone 55=Alcohol & Drug (dual addiction) 66=Polydrug 0=No problem If NO PROBLEM, Skip to Question # 5 3. How many months long was your last period of voluntary abstinence from this major substance? _________ months 0=Never Abstinent If NEVER ABSTINENT, Skip to Question # 5 4. How many months ago did this abstinence end? ________ months 5. How many times have you: Had DT’s (horrors)? _______ times Overdosed on drugs? _______ times 6. How many times in the last 30 days, or the last 30 days on the street did you stay up past 4 a.m. because of drug or alcohol use? 0=None 1=Once 2=Twice 3=Three times 4=4 or more times 7. Have you ever been treated for alcohol abuse? 0=NO If NO, Skip to Question # 9 1=YES 8. Please tell me how many times, not including AA/NA you have been treated for alcohol abuse: Lifetime Past Year How many times were you treated for alcohol abuse in an outpatient treatment program? (not AA/NA) How many times were you treated for alcohol abuse in a residential or in-patient program? How many of those were detox only? 9. Have you ever been treated for drug abuse? 0=NO If NO, Skip to Question # 12 1=YES 10. Please tell me how many times, not including AA/NA, you have been treated for drug abuse: Lifetime Past Year How many times were you treated for drug abuse in an outpatient treatment program? (not AA/NA) How many times were you treated for drug abuse in a residential or in-patient program? How many of those were Detox only? 11. How many days have you been treated in an outpatient setting for alcohol or drugs in the last 30 days, or the last 30 days on the street? (Not including AA/ NA) __________ 12. Have you ever attended AA/NA meetings? 0=NO If NO, Skip to Question # 15 1=YES 13. Have you attended AA/NA in the past year? 0=NO If NO, Skip to Question # 15 1=YES 14. How many days have you attended AA or NA meetings in the past 30 days on the street? ______days 15. How much money in the past 30 days on the street did you spend on: Alcohol? $________ Drugs? $________ 16. How many days in the past 30 days on the street have you experienced? Alcohol problems? ______days Drug problems? ______days 17. How troubled or bothered in the past 30 days have you been by alcohol problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 18. How troubled or bothered in the past 30 days have you been by drug problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 19. How important to you now is treatment for alcohol problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 20. How important to you now is treatment for drug problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely Interviewer Ratings for Drug and Alcohol Information 21. How would you (interviewer) rate the client’s need for alcohol treatment? (circle one number next to your response ) 0 – 1 =No real problem 2 – 3 =Slight problem 4 – 5 =Moderate problem 6 – 7 =Considerable problem 8 – 9 =Extreme problem 22. How would you (interviewer) rate the client’s need for drug treatment? (circle one number next to your response ) 0 – 1 =No real problem 2 – 3 =Slight problem 4 – 5 =Moderate problem 6 – 7 =Considerable problem 8 – 9 =Extreme problem 23. Interviewer comments on drug and alcohol information Section 6: Criminal Justice History Informatio The following questions ask about your criminal justice history. 1. Was this program admission prompted by or suggested by someone in the criminal justice system like a judge, a probation/parole officer, etc.? 0=NO 1=YES 2. Are you on probation or parole now? 0=NO 1=YES 3. Please tell me how many times you have been charged with: Total # times Shoplifting Vandalism Parole/Probation violation Drug charges Disorderly conduct, vagrancy, public intoxication Driving while intoxicated Other major driving violations such as reckless driving, speeding, no license, etc Assault or other charges related to domestic violence Assault not related to domestic violence Forgery Weapons offense Burglary, larceny, B & E Robbery Arson Rape Homicide/manslaughter Prostitution Contempt of Court Other (specify): 4. How many of these charges resulted in convictions? convictions 5. How long have you been incarcerated in your life? 0=Never been incarcerated If 0 months, Skip to Question # 8 1=Less than 1 month 2=1-3 months 3=3-6 months 4=6 months to 1 year 5=1-3 years 6=More than 3 years 6. How long was your last incarceration? 1=Less than 1 month 2=1-3 months 3=3-6 months 4=6 months to 1 year 5=1-3 years 6=More than 3 years 7. Reason(s) for your last incarceration? Charge 0=No 1=yes Shoplifting 0 1 Vandalism 0 1 Parole/Probation violation 0 1 Drug charges 0 1 Disorderly conduct, vagrancy, public intoxication 0 1 Driving while intoxicated 0 1 Other major driving violations such as reckless driving, speeding, no license, etc 0 1 Assault or other charges related to domestic violence 0 1 Assault not related to domestic violence 0 1 Forgery 0 1 Weapons offense 0 1 Burglary, larceny, B & E 0 1 Robbery 0 1 Arson 0 1 Rape 0 1 Homicide/manslaughter 0 1 Prostitution 0 1 Contempt of Court 0 1 Other (specify): 0 1 8. Are you presently awaiting charges, trial, or sentence? 0=NO If NO, Skip to Question # 10 1=YES 9. Reason(s) for awaiting charges? Charge 0=No 1=yes Shoplifting 0 1 Vandalism 0 1 Parole/Probation violation 0 1 Drug charges 0 1 Disorderly conduct, vagrancy, public intoxication 0 1 Driving while intoxicated 0 1 Other major driving violations such as reckless driving, speeding, no license, etc 0 1 Assault or other charges related to domestic violence 0 1 Assault not related to domestic violence 0 1 Forgery 0 1 Weapons offense 0 1 Burglary, larceny, B & E 0 1 Robbery 0 1 Arson 0 1 Rape 0 1 Homicide/manslaughter 0 1 Prostitution 0 1 Contempt of Court 0 1 Other (specify): 0 1 10. How many days in the past 30 were you engaged in illegal activities for profit? _________days 11. How serious do you feel your present legal problems are? (Exclude civil problems) 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 12. How important to you now is counseling or referral for legal problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely Interviewer Ratings for Criminal Justice Involvement Information 13. How would you (interviewer) rate the client’s need for legal services or counseling? (circle one number next to your response ) 0 – 1 =No real problem 2 – 3 =Slight problem 4 – 5 =Moderate problem 6 – 7 =Considerable problem 8 – 9 =Extreme problem 14. Interviewer comments on criminal justice involvement information: Section 7: Family/Social History Information The following questions ask about your family and social history. 1. Have any of your relatives had what you would call a significant drinking (ALC), drug use (DRG), or psychiatric (PSY) problem – one that did or should have led to treatment? (Interviewer, record a 0, 1, 2, or 3 in each space corresponding the tabled question) 0=NO 1=YES 2=Uncertain 3=No relative from that category Mother’s side father’s side siblings alc drg psy alc drg psy alc drg psy Grand mother Grand mother Brother #1 Grand father Grand father Brother #2 Mother Father Sister #1 Aunt Aunt Sister #2 Uncle Uncle 2. What is your current marital status? 1=Married 2=Remarried 3=Widowed 4=Separated 5=Divorced 6=Never Married 3. How long have you been in this current marital status? (If never married, estimate time since 18 years old) ________ Years _______ Months 4. Are you satisfied with marital status? 0=NO 1=YES 2= Indifferent 5. How many times have you been married? times 6. How many times have you been divorced? times 7. How many different sexual partners have you lived with that you were not married to? partners 8. What has your usual living arrangements been in past 12 months (past year)? 0=Alone 2=With sexual partner alone 1=With sexual partner and children 3=With children alone 4= With parents 5=With other family members 6=With friends 8=In a controlled environment like jail or hospital 9=No stable arrangements (include shelter) 9. How long have you lived in these usual living arrangements? (If living with parents or family and always has estimate time since 18 years old) ________ years ________ months 10. Are satisfied with these living arrangements, with the people you are living with? 0=NO 1= YES 2=Indifferent 11. Do you live with anyone that has a drug and/or alcohol problem? 0=NO 1=YES 12. Have you been homeless at all in the last 30 days, or the last 30 days on the street? 0=NO If NO, Skip to Question # 14 1=YES 13. Where did you stay mostly during homeless period? 1=Shelter 2=With friends 3=In a car 4=In a building 5=Outside 6=Other 14. How many different places have you lived in the past 12 months? places 15. How many close friends do you have? friends 16. Have any family members or any others such as strangers, acquaintances, intimate partners ever abused you: Abuse type 0=No 1=yes Emotionally (made to feel bad through harsh words, humiliation, manipulation)? (Do not include verbal abuse by strangers) 0 1 Physically (cause or threaten to cause physical harm such as: slapping, punching, kicking, hitting with an object, assaulting with a knife or other weapon, etc.)? 0 1 Sexually (rape, forced sexual advances or non-consensual sexual acts)? 0 1 Has anyone ever sexually harassed you (inappropriate physical contact, stalking, using threats to secure sexual contact, etc.)? 0 1 17. How many days in the past 30 have you had serious conflicts (problems which threaten your relationship): a. With family members? _________ days b. With other people (excluding family)? _________days 18. How troubled or bothered have you been in the past 30 days by family problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 19. How troubled or bothered have you been in the past 30 days by social problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 20. How important to you now is treatment or counseling for family problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 21. How important to you now is treatment or counseling for social problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely Interviewer Ratings for Family and Social History Information 22. How would you (interviewer) rate the client’s need for family and/or social counseling? (circle one number next to your response ) 0 – 1 =No real problem 2 – 3 =Slight problem 4 – 5 =Moderate problem 6 – 7 =Considerable problem 8 – 9 =Extreme problem 23. Interviewer comments on family and/or social history information: Section 8: Mental Health Information The next set of questions ask about your mental health. 1. Have you ever been treated as an outpatient for psychological or emotional problems? 0=NO 1=YES 2. How many times have you ever been treated for any psychological or emotional problems in a hospital? ______times 3. Have you ever been prescribed medication for any psychological or emotional problems? 0=NO 1=YES; If yes, What? (If there are multiple answers please separate by commas) 4. Have you been prescribed medication (or taken any prescribed medication) for any psychological emotional problem in the past 30 days? 0=NO 1=YES; If yes, What? (If there are multiple answers please separate by commas) 5. Do you receive a pension for a psychiatric disability? 0=NO 1=YES 6. Have you had a significant period (that was not a direct result of drug or alcohol use) in which you: past 30 days 0=No 1=Yes in Lifetime 0=No 1=Yes Experienced serious depression? 0 1 0 1 Experienced serious anxiety or tension? 0 1 0 1 Experienced hallucinations? 0 1 0 1 Experienced trouble understanding, concentrating, or remembering? 0 1 0 1 Experienced trouble controlling violent behavior? 0 1 0 1 Experienced thoughts of suicide? 0 1 0 1 Attempted suicide? 0 1 0 1 Experienced anorexia, bulimia, or other eating disorders? 0 1 0 1 7. In the past 30 days, to what degree have you been bothered by past experiences involving: 0=Not at all 1=A little 2=Somewhat 3=A lot Emotional abuse 0 1 2 3 Physical abuse 0 1 2 3 Sexual abuse or rape 0 1 2 3 Sexual harassment 0 1 2 3 8. How many days in the past 30 have you experienced psychological problems? ______ days 9. How much have you been troubled or bothered by psychological or emotional problems in the past 30 days? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely 10. How important to you now is treatment for psychological or emotional problems? 0=Not at all 1=Slightly 2=Moderately 3=Considerably 4=Extremely Interviewer Ratings for Mental Health Information 11. How would you (interviewer) rate the client’s need for psychiatric/psychological treatment? (circle one number next to your response ) 0 – 1 =No real problem 2 – 3 =Slight problem 4 – 5 =Moderate problem 6 – 7 =Considerable problem 8 – 9 =Extreme problem 12. Interviewer comments on mental health information: Section 9: Interviewer Ratings 1. Time assessment ended __ __: __ __ 1=a.m. 2=p.m. 2. Please rate the client interview on each of the questions: at the time of the interview, Client was: 0=no 1=yes Obviously depressed/withdrawn. 0 1 Obviously hostile. 0 1 Obviously anxious/nervous. 0 1 Having trouble with reality testing, thought disorders, paranoid thinking. 0 1 Having trouble comprehending, concentrating, or remembering. 0 1 Having suicidal thoughts. 0 1 Do you believe any of the client answers were significantly distorted by misrepresentation? 0 1 Do you believe any of the client answers were significantly distorted because the client did not understand the questions? 0 1 3. Please record any final comments you have about this client and/or this client’s interview. ( This ASI was downloaded from http://www.officesoon.com/?api=download&id=96917&link=aHR0cDovL2NkYXIudWt5LmVkdS9BU0klMjBQYXBlci5kb2M=) Appendix B. Qualitative Research Questionnaire 1. How long have you had HIV and or AIDS? 2. Did you contract HIV before or after the National Health Insurance Scheme was introduced in your nation? 3. Did the information your government provided to its citizens have any affect on your activities or belief systems? 4. Have you been able to obtain your medications to treat your HIV? 5. How do you feel about the government’s help for your HIV status? 6. What would you most like to say about your experiences as an HIV patient? Appendix C Questionnaire (to be used for both the pilot study and the actual study) Please agree of disagree with the following statements using the five point scale. 1. The government of Ghana is sympathetic towards HIV/AIDS patients. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 2. The citizens of Ghana are sympathetic towards HIV/AIDS patients. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 3. The reason the government does not cover antiviral medications for HIV/AIDS patients is based solely on financial considerations. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 4. The government treats HIV/AIDS patients with respect and dignity in consideration of their illness. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 5. The people of the nation treat HIV/AIDS patients with respect and dignity in consideration of their illness. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 6. The government programs should cover the costs of antiviral medications. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 7. I receive and take my antiviral medications on a regular basis without missing any doses. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 8. The medications are affordable for most HIV/AIDS patients. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 9. Medical services are readily available to HIV/AIDS patients. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 10. I participate in the ART program in Ghana Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 11. I believe the ART program is effective Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 12. I understand the ways in which to prevent, manage, and live with HIV/AIDS due to governmental programs. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 13. If current services had been available before I contracted HIV, I would have better understood how to prevent the spread of the virus. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 14. Information would have had no effect on my behaviors that could lead to contracting the HIV virus. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 15. Fewer people are getting HIV since the government has started its programs towards prevention. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 16. The government is doing a good job in addressing the issue of the spread of HIV in Ghana. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 17. The government has no interest in addressing the issue of HIV in Ghana. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 18. Everyone who needs services who has HIV/AIDS are getting services in Ghana. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 19. There is a lot of room for improvement in the services that are currently available in Ghana. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 20. I have hope that the government will make changes to better service my needs. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 21. Women are of equal status to men. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 22. Women are responsible for the spread of HIV. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 23. Gender is relevant to the way in which the government addresses the HIV/AIDS issue. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 24. HIV/AIDS is a women’s disease. Greatly agree Somewhat agree Neutral Somewhat disagree Greatly disagree 1 2 3 4 5 Read More