Abstract
Introduction
Electronic health record (EHR) system is essential for modernizing healthcare delivery as it facilitates data-driven decision-making, reduce redundancies, and foster collaboration among healthcare providers. Real-time access to patient information enables effective coordination of patient-quality care in a robust manner. This study examined the perspectives of healthcare professionals in a semi-rural district in the Ashanti Region of Ghana.
Methods
The study was conducted at Kuntanase Government Hospital and St Michael's Hospital, Pramso in the Bosomtwe District in the Ashanti region of Ghana. The study used a cross-sectional design with a quantitative approach to select 135 healthcare professionals through simple random sampling. Using Yamane's formula; (n = N/1 + N(e)2) for finding the sample size, assuming a margin error of 5% and estimated target population size of 200 healthcare providers in the selected hospitals, the estimated sample size is 134.5 (approximately 135). Data were collected through a structured questionnaire and analyzed quantitatively through Stata version 16 and presented in percentages and frequencies.
Results
The results show that healthcare professionals hold positive perceptions of EHRs highlighting their ease of use, usefulness, and contribution to efficiency, reduced medical errors, and improved job performance. Training of staff on the system was found to be important while gender and profession also influenced satisfaction levels.
Conclusion
The results also emphasize the critical role of continuous training and support in sustaining user satisfaction, while variations across gender, profession, and experience highlight the need for tailored interventions that address the diverse needs of healthcare providers. The overwhelmingly high levels of satisfaction and enjoyment reported suggest that EHR Systems are gaining acceptance as valuable tools for transforming healthcare delivery. These benefits underscore the potential of EHR Systems to strengthen healthcare systems in resource-limited settings such as Ghana and the Bosomtwe District in Particular.
Introduction
The adoption of electronic health record (EHR) systems has been widely recognized as a critical milestone in modern healthcare delivery. Electronic health records support data-driven decision-making, reduce redundancies, improve diagnostic accuracy, and facilitate coordination among healthcare providers. 1 Evidence indicates that their implementation enhances clinical outcomes by reducing medical errors, improving chronic disease management, and strengthening patient safety. Beyond patient-level benefits, EHRs also play a transformative role in health system efficiency, streamlining workflows and contributing to sustainable service delivery. 1 In parallel with the growth of EHRs, artificial intelligence (AI) applications are emerging as valuable complements to digital health systems. Recent scholarship highlights the potential of AI-based tools such as ChatGPT to support health education, clinical training, and patient engagement, particularly in low- and middle-income countries (LMICs) where shortages of health personnel and financial constraints hinder service delivery. 2 These tools can enhance the usability of EHR systems by simplifying medical information for both providers and patients, improving communication, and reducing administrative burden. Furthermore, the global COVID-19 pandemic accelerated the integration of telemedicine into health systems, revealing the capacity of technology to sustain healthcare delivery during crises. Telemedicine solutions—ranging from mobile health applications to video consultations—proved instrumental in ensuring continuity of care, reducing infection risks, and extending access to underserved populations. 3 The pandemic underscored the broader value of digital health innovations as necessary complements to EHRs in ensuring resilient healthcare systems. In sub-Saharan Africa (SSA), the implementation of EHRs has expanded steadily over the past decade, reflecting the recognition of their potential to address inefficiencies in paper-based systems. Evidence from a decade of implementation efforts indicates that EHRs in SSA improve record accuracy, reduce errors, and strengthen continuity of care. 4 Similarly, experiences in Rwanda, Ethiopia, and Nigeria highlight the potential of EHR systems to transform care delivery in resource-limited contexts. 4 Despite these successes, EHRs implementation in SSA continues to face significant barriers. At the regional level, some barriers have been observed across SSA, where studies consistently report that 60% of EHRs initiatives encounter infrastructure challenges, 45% face financial constraints, and 35% report data privacy concerns. 4 Nevertheless, persistent challenges—such as infrastructural gaps, financial limitations, and privacy concerns—continue to constrain long-term adoption. Importantly, the attitudes and perceptions of health professionals remain central to the success or failure of these systems. Physicians, for example, have been shown to vary in their acceptance of EHRs, with positive attitudes often linked to perceptions of enhanced efficiency and better patient outcomes. 5 Similarly, studies among nurses demonstrate that favorable perceptions strongly influence sustained usage, while negative experiences can foster resistance to adoption. 6 Barriers to EHR adoption are not unique to SSA. In Ethiopia, challenges related to limited infrastructure, inadequate training, and resource constraints have undermined the effectiveness of EHR systems despite their recognized benefits. 7 In the Middle East, studies have also documented mixed physician perceptions, with many acknowledging the value of EHRs in enhancing documentation but expressing concern about system complexity, confidentiality, and workload.8,9 These findings echo broader global evidence that successful EHR adoption depends not only on technological functionality but also on addressing human factors such as training, user satisfaction, and motivation. The Ghanaian context reflects many of these broader trends. Research shows that health professionals in Ghana generally recognize the potential of EHRs to improve efficiency and care coordination but remain cautious due to infrastructural weaknesses and implementation gaps. 10 Similar patterns have been reported in other LMICs, where nurses’ attitudes toward EHRs vary according to the degree of system integration into existing workflows. 11 Experiences from Oman further reinforce this reality, as healthcare providers have expressed satisfaction with EHR systems when usability and reliability are assured. 12 Conversely, the absence of adequate training and support can result in resistance, as observed in studies across Eastern Province in Saudi Arabia. 13 National policy efforts in Ghana have aimed to mainstream digital health through initiatives such as the 2010 National E-Health Strategy, which emphasized integrated patient management and bio-surveillance systems. 14 While such policies highlight strong political commitment, practical implementation has faced barriers including limited internet connectivity, inadequate interoperability, and concerns over data confidentiality. Nonetheless, when effectively integrated, EHRs in Ghana have been associated with reduced waiting times, enhanced documentation accuracy, and improved service delivery. 15 These outcomes mirror broader evidence from SSA, where EHRs have improved patient monitoring, particularly in HIV care, maternal health, and emergency settings. 16 Despite this progress, structural and human factors continue to constrain adoption across the region. A study in Malawi revealed that utilization of EHRs is strongly influenced by provider perceptions, system reliability, and organizational culture, with inadequate training remaining a major barrier. 17 Similar findings in Kuwait demonstrate that physician satisfaction is shaped by user training, support structures, and the degree to which systems are adapted to professional needs. 18 Beyond these technical and organizational determinants, the design of EHR systems has also been linked to broader concerns such as provider burnout. Poorly designed systems have been criticized for contributing to documentation burden and reducing the time available for direct patient care. 19 Conversely, when usability is optimized, EHRs can improve provider satisfaction and enhance perceived patient outcomes. 20 Against this backdrop, the perspectives of healthcare professionals in semi-rural Ghanaian districts remain underexplored. Most studies to date have focused on urban or tertiary hospital settings, overlooking the unique infrastructural and resource challenges in semi-rural contexts. Understanding the perceptions of healthcare providers in these environments is critical, as their experiences shape adoption, satisfaction, and long-term sustainability of EHR systems. This study therefore assessed the perspectives of healthcare professionals in a semi-rural district in the Ashanti Region of Ghana to contribute to the evidence base needed to guide effective EHR implementation and support the broader digital transformation of healthcare in resource-limited settings.
Methods
The study used a cross-sectional design to quantitatively examine the perspectives of healthcare professionals on the implementation and use of EHR system on healthcare delivery in the study district. The study was conducted at Kuntanase Government Hospital and St Michael's Hospital, Pramso in the Bosomtwe District in the Ashanti region of Ghana. Bosomtwe District is one of the 43 districts in Ashanti Region, Ghana. It is located in the central part of the Ashanti Region and has Kuntanase as its capital town. This area was selected as the study setting because the selected hospitals are major hospitals in the district that recently adopted the use of the EHRs system and there are no studies done to assess its impact on healthcare delivery in the District. The respondents were healthcare providers in Kuntanase Government Hospital and St Michael's Hospital, Pramso in the Bosomtwe District in the Ashanti region of Ghana who had worked in the hospital for more than six months and directly use the EHRs for their day-to-day engagements. The Kuntanase Government hospital is a public hospital that provides general healthcare services within the Bosomtwe District. It is a National Health Insurance Scheme accredited facility. The St Michael's Hospital was established and commissioned as a Health Centre on 22nd November, 1958. Upgraded to a Hospital Status in the year 1960 to serve the Bosomtwe District. It was established in 1958 as a clinic to take care of the health of the people in the hospital's catchment area, and later in 1960, it was upgraded to a hospital status to serve the inhabitants of Bosomtwe and its environs. It is supervised by the National Catholic Health Secretariat, an affiliate of Christian Health Association of Ghana, which oversees the activities of all Christian health facilities in Ghana. The two hospitals were selected because they are the two main hospitals that use the EHRs in the District as the rest are all health centers that rely on paper records. The study employed a simple random sampling technique, in which respondents have an equal and fair chance of being selected. This allows for the generalizations about a specific population and leave out any bias. Using Yamane's formula; (n = N/1 + N(e)2) for finding the sample size, assuming a margin error of 5% and estimated target population size of 200 healthcare providers in the selected hospitals, the estimated sample size is 134.5 (approximately 135). 135 healthcare providers were recruited into the study. Healthcare providers in the selected hospitals were selected through simple random sampling technique. In this study, each member of the population had an equal chance of being selected. All health providers from the selected hospitals who have been using the EHRs system six months or more for their routine work were included in the study and those whose work procedures did not require the use of the system or who had been using the system for less than 6 months were excluded. The staff records of the hospitals were obtained and the names of those who met the inclusion criteria were selected and random numbers assigned to these names. The numbers were placed in a container and shuffled and the numbers were randomly picked. The corresponding names to the numbers randomly picked were selected as study respondents. This approach gave each member an equal chance of being selected. Data collection was done using structured questionnaires to gather quantitative data from the population. The questionnaire was structured to capture data on demographic information of respondents, perception and attitude of users, perceived benefits and challenges. Each question had five response options for respondents to select from. The data collection took place from October to November 2024. Questionnaires provide structured and standardized responses, making the analysis process more streamlined and less time-consuming, and often have clear response options and scales, making it easier to quantify and measure the data The questionnaire was pre-tested at the Ejisu government hospital as it shares similar features in terms of the hospital status and the district demographics. This allowed for the revision of the instrument as complex and unclear questions that were identified during the pretesting were modified. The field data collectors were also trained on the instruments and the specific questions. The questions contained in the questionnaire were based on the specific objectives of the study. Data were collected within a period of five continuous days. The data were collected in English since all respondents speak, write and understand English and then cleaned with Excel. The data were analyzed using Stata 16 data analysis software and the results are presented in logical sequence without bias or misinterpretation.
Results
Demographic information of respondents
Most respondents were female (52.59%) and fell within the 26–35 years age group (72.59%), indicating a young and relatively gender-balanced workforce. In terms of education, the majority held a bachelor's degree (51.85%), while religious affiliation was overwhelmingly Christian (88.89%). Professionally, the largest groups were nurses (34.07%) and medical doctors (29.63%). Most respondents had 1–5 years of work experience (80.00%), worked mainly at Kuntanase Government Hospital (60.74%), and were concentrated in the wards (37.78%) and emergency unit (21.48%) (Table 1).
Demographic information of respondents.
Source: Author's survey, 2024.
Perspective of healthcare professionals
From Table 2, the study revealed that majority of the respondents (61.48%) find the EHRs system easy to learn and use for daily practice, and 28.15% indicate it is very easy. Also, 60.00% of the study respondents are satisfied with the usage of the system, with 32.59% very satisfied. Only 0.74% indicated very dissatisfied. Among the respondents, almost half (47.41%) believe patients/clients are satisfied, with 17.78% were very satisfied. However, 6.67% believe patients/clients are dissatisfied. Again, majority of the study respondents (56.30%) believed their colleagues were satisfied while 26.67% very satisfied. Additionally, 55.56% deem the system to be reliable, 26.67% very reliable and 2.22% not reliable. A higher percentage of the study respondents (82.22%) indicated the system has enhanced job performance, 8.15% had a contrary opinion and 9.63% indicated maybe. Also, almost all respondents (97.78%) think that the system is useful with 0.74% indicating it is not useful; 1.48% were not sure about its usefulness. The study also found that 64.44% enjoy working with it, 30.37% strongly agreed that they enjoy working with it and 0.74% disagree enjoying working with the system.
Perspectives of healthcare professionals on applicability of the system.
Source: Field survey, 2024.
Health professionals’ perspective on benefits of the system
Majority of the study respondents (54.07%) and 34.8% agree and strongly agree, respectively, that there is improvement in their efficiency at work while 3.70% disagrees. Also, 65.41% indicated that there has been significant reduction in medical errors. 25.93% of the respondents were neutral and 6.67% disagreed. Again, 73.33% indicate patient confidentiality is assured, 14.07% disagreed, while 12.59% were neutral. Additionally, 47.41% of the study respondents agree that their workload has reduced, 25.93% strongly agreed while 10.37% and 1.48% disagree and strongly disagree, respectively. Lastly, 59.26% indicated that waiting times in the hospital has also reduced, 16.29% disagreed (see Table 3).
Health professionals’ Perspective on benefits of the system.
Source: Field survey, 2024.
Factors influencing healthcare professionals’ perspective on the EHR system
From Table 4, it can be observed that 39.26% of the respondents has intermediate level skills, 32.59% has advanced level, 16.30% are at the basic level, 6.67% are experts while 5.19% were novice and have little to no experience using computers. Majority of the participants (64.44%) indicated their computer literacy level affect usage, 35.56% of the study participants indicated their computer literacy level does not affect usage. Again, 94.81% have received some form of training in the hospital, 5.19% have not received any form of training. The study also found that 62.96% strongly agrees that trainings on basic ICT should be organized to enhance computer literacy skills (see Table 4).
Showing factors influencing Healthcare providers’ perspectives on EHRs system.
Source: Field survey, 2024.
Ordinal Logistic Regression analysis on satisfaction and healthcare provider factor
Table 5 shows a result of an ordinal logistic regression analysis on the relationship between healthcare provider factors and overall satisfaction of the use of the EHRs system. The p-value associated with this statistic is 0.0008 indicating that it is statistically significant at the 5% margin of error. Pseudo R-squared = 0.1068. With regards to computer literacy, the adjusted odds ratio (AOR) was 0.6826513 with p value of 0.337, which is not statistically significant. The computer literacy greatly decreases the odds of the higher response, but the wide confidence interval indicates imprecision (95% CI −1.16172, 0.3981775). The number of years working (work experience) slightly decreases the odds of a higher response, but this effect is not statistically significant (AOR 0.5575135; 95% CI −1.264143, 0.0956062). Also, receiving training increases the odds of a higher response by approximately 4.78 times (AOR 4.777714). However, there is a borderline statistical significance (p = 0.052; 95% CI −0.0159921, 3.143916). Age group has a positive impact on the odds of a higher response (AOR 2.254089), but the relationship is not strongly significant (p = 0.062; 95% CI −0.0391927, 1.664684). The category of professions reduce the odds of a higher response by approximately 34% (1–0.657) and this relationship is statistically significant (p = 0.004; 95% CI −0.7033224, −0.1361543). Additionally, being in a certain gender category increases the odds of a higher response by approximately 2.97 times, holding other variables constant with p value of 0.006 which is statistically significant (AOR 1.087061; 95% CI 0.3100947, 1.864028).
Ordinal Logistic Regression analysis on the overall satisfaction and healthcare provider factors (Outcome = Overall satisfaction among healthcare providers).
Source: Author's survey, 2024.
Lastly, educational level slightly reduces the odds of a higher response (AOR 0.6983598), but this effect is not statistically significant (p = 0.234; 95% CI −0.9507885, 0.2327467).
Therefore, there is a statistically significant relationship for gender and profession, and borderline statistically significant relationship for training which increases the odds of a higher response of overall satisfaction.
Discussion
This study provides valuable insights into healthcare professionals’ perceptions of EHR systems in a semi-rural district in Ghana, offering important implications for both practice and policy. The findings reveal overwhelmingly positive attitudes toward the EHR system, with respondents highlighting its ease of use, reliability, and usefulness in improving efficiency, reducing errors, and enhancing job performance. These results align with global evidence that EHRs are transformative tools in healthcare delivery, improving diagnostic accuracy, coordination of care, and patient safety.1,4,6 Again, another study also showed that while electronic prescribing systems improve accuracy and reduce medication errors, physicians face challenges with interface design, navigation, and response time. These usability concerns highlight the need for systems tailored to end-user needs to ensure efficiency and wider acceptance. 21 In the Ghanaian context, where health facilities continue to grapple with inefficiencies associated with paper-based records, the strong acceptance of EHRs by frontline professionals underscores the system's potential to strengthen service delivery, streamline workflow, and improve patient outcomes. Comparable findings have been reported in SSA, where EHRs have improved data accuracy by 20–30% and reduced medical errors by enhancing record reliability and timeliness. 4 These outcomes affirm that healthcare providers, as primary end-users, recognize the value of EHRs, particularly in contexts where resource limitations and high patient loads demand efficiency.
The positive user experiences reported in this study are significant given the mixed outcomes of eHealth initiatives in Ghana. 10 While previous projects have been undermined by infrastructural weaknesses, limited training, and provider resistance, the results here suggest that when systems are designed to be user-friendly and supported with adequate training, healthcare professionals are willing to adopt them. Globally, usability and satisfaction have been consistently associated with sustained adoption of health technologies,1,15,16 and similar patterns were observed in this study, where over 90% of respondents expressed satisfaction and enjoyment in using the system. Moreover, reductions in workload and waiting times reported by respondents, mirror findings from earlier Ghanaian studies, where EHRs were credited with reducing redundancies and improving patient flow.10,13 These findings demonstrate that EHRs are not only feasible but also effective in semi-rural healthcare settings when implementation challenges are addressed.
The analysis also highlights the importance of user training and computer literacy in shaping perceptions and satisfaction. Nearly all respondents had received some form of training, and training increased the odds of higher satisfaction by almost five times. This finding supports global evidence that structured and continuous training is one of the strongest predictors of user satisfaction and long-term EHR adoption.1,2,3 Similar to earlier reports on digital health tools such as ChatGPT, training and capacity building enhance competence, reduce resistance, and build confidence in technology use. 2 However, the borderline statistical significance of training (p = 0.052) in this study suggests that while training is critical, its benefits must be reinforced through consistent refresher programs and supportive supervision. Without such reinforcement, initial gains in competence may fade, leading to frustration and reduced use.
Professional role and gender also emerged as significant factors influencing satisfaction, consistent with evidence that different cadres of health workers interact with EHRs in distinct ways. For instance, doctors and nurses, whose work is heavily documentation-driven, may derive greater benefits compared to pharmacists or laboratory staff, whose workflows are less integrated into EHR platforms.4,7,18 This variability highlights the need for customizing EHR interfaces to suit diverse professional needs, rather than imposing generic designs that fail to capture specialized workflows. Gender differences in satisfaction, with women being nearly three times more likely to report higher satisfaction, may reflect differential workloads and roles within the Ghanaian healthcare system, where female-dominated professions such as nursing often benefit more directly from EHR-related efficiency gains.1,19,20 Such findings point to the importance of adopting user-centered approaches in system design and implementation, ensuring inclusivity across professional categories and demographic groups.
Another critical finding relates to concerns about confidentiality. While most respondents agreed that patient confidentiality was assured, a notable minority expressed reservations about indiscriminate access to records. These concerns echo broader debates in Ghana and other LMICs about the adequacy of data governance and security safeguards in digital health systems. 10 Internationally, breaches of confidentiality and inadequate role-based access controls have been identified as major barriers to EHR trust and adoption.12,13 Addressing these concerns requires stronger policies, enforcement of “need-to-know” access protocols, and investments in cybersecurity. Without adequate safeguards, professionals’ trust in the system may erode, undermining its sustainability despite the recognized benefits.
Interestingly, computer literacy, work experience, and educational level did not emerge as significant predictors of satisfaction. This contrasts with the assumption that digital competence or higher education automatically translates into better adoption. Instead, the findings suggest that satisfaction is less dependent on individual skill sets and more closely tied to systemic enablers such as infrastructure reliability, system usability, and institutional support. Similar outcomes have been documented in other SSA settings, where even highly computer-literate staff expressed dissatisfaction due to frequent downtimes, poor user interfaces, and inadequate technical support.4,15 These findings reinforce the idea that user satisfaction hinges not merely on individual attributes but on the quality and stability of the technological and institutional ecosystem.
The results demonstrate that healthcare professionals in Ghana largely perceive EHRs as valuable tools capable of transforming service delivery. High levels of satisfaction, enjoyment, and perceived usefulness reflect growing acceptance, while the identified challenges underscore areas requiring policy attention. Addressing infrastructural deficits, ensuring continuous training, safeguarding confidentiality, and tailoring systems to professional needs will be critical for sustaining adoption. These findings resonate with broader global and regional evidence that EHRs can revolutionize healthcare delivery when implementation is user-centered, context-sensitive, and adequately supported.4,10,18 In semi-rural Ghana, where healthcare facilities face unique constraints, these insights provide an important foundation for strengthening eHealth strategies, ensuring sustainability, and realizing the full potential of digital transformation in healthcare.
Limitation
In terms of limitation, the study did not include the perspective of patients and therefore recommends that future studies should be conducted on the perspectives of patients. The cross-sectional design of this study limits the ability to establish causal relationships between healthcare professionals’ characteristics and their perspectives on EHR adoption. Since data were collected at a single point in time, changes in perceptions over time, particularly as users gain more experience with the system, could not be captured.
Additionally, reliance on a structured questionnaire introduces the potential for response bias. Participants may have provided socially desirable responses, overstating satisfaction or underreporting challenges with the system. Recall bias could also have influenced the accuracy of responses, especially when participants were asked to reflect on past experiences with EHR use. Again, the closed-ended nature of some items may have restricted respondents from fully expressing nuanced opinions, potentially limiting the depth of insights.
Conclusion
This study demonstrates that healthcare professionals in Ghana generally hold positive perceptions of EHRs, highlighting their ease of use, usefulness, and contribution to efficiency, reduced medical errors, and improved job performance. The overwhelmingly high levels of satisfaction and enjoyment reported suggest that EHRs are gaining acceptance as valuable tools for transforming healthcare delivery. The results also emphasize the critical role of continuous training and support in sustaining user satisfaction, while variations across gender, profession, and experience highlight the need for tailored interventions that address the diverse needs of healthcare providers. These benefits underscore the potential of EHRs to strengthen healthcare systems in resource-limited settings such as Ghana and the Bosomtwe District in Particular.
Recommendation
Regular training and refresher programs should be provided to health professionals to build their competence and confidence in using EHR systems
Training should not only cover technical skills but also emphasize the broader benefits of EHRs, including patient safety and improved quality of care, to foster positive attitudes toward adoption.
EHR systems should be tailored to fit the clinical workflows of diverse health professionals, including specialists such as radiologists and laboratory scientists. Interfaces must be user-friendly, intuitive, and adaptable to specific departmental needs.
Developers should collaborate closely with end-users during the design and implementation phases to ensure usability aligns with real-world healthcare practices.
Supplemental Material
sj-docx-1-dhj-10.1177_20552076251393400 - Supplemental material for Electronic health record system and service delivery: Using cross-sectional survey to assess the perspective of healthcare professionals in a semi-rural district in the Ashanti region of Ghana
Supplemental material, sj-docx-1-dhj-10.1177_20552076251393400 for Electronic health record system and service delivery: Using cross-sectional survey to assess the perspective of healthcare professionals in a semi-rural district in the Ashanti region of Ghana by Enoch Acheampong, Derrick Kwaku Oppong and Grace Kisiwaa Agyei in DIGITAL HEALTH
Footnotes
Acknowledgements
The authors wish to acknowledge the participants from the two hospitals who took part in the study.
Ethical considerations
Ethical approval was obtained from the Committee on Human Research, Publication, and Ethics at the Kwame Nkrumah University of Science and Technology Kumasi, Ghana. Copies of the ethical approval letters were then submitted to the district health directorate as well as the directorates of the two hospitals for final permission to be granted before the data collection.
Consent to participate
A consent form was completed for each respondent upon agreement to participate in the study. Respondents’ consent to participate in the study was solicited formally through the signing of the participant consent form after the purpose of the study had been explained to them. Participation in the study was voluntary. And identifiers such as names and contacts were not taken as a way to ensure anonymity and confidentiality.
Contributorship
EA conceptualized the work and designed the data collection tool, the data analysis and cleaning as well as the discussion of the work. DKO searched for related literature and wrote the pertinent literature, contributed to the design and write-up of the methodology, as well as field Data Collection. GKA designed and wrote the methodology section of the work, data analysis and write-up for the results. All the authors have read and reviewed the manuscript for it to be submitted for publication.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement
The complete data can be found at the Department of Health Policy and Economics database at the Kwame Nkrumah University of Science and Technology.
Supplemental material
Supplemental material for this article is available online.
References
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