How do emergency care providers and law enforcement officers navigate the competing imperatives of saving lives and serving justice? A qualitative case study in a Ghanaian secondary hospital

Objective

Emergency care departments often navigate the dual imperatives of providing timely medical care and cooperating with police as law enforcement officers (LEOs) involved in injury-related cases. Using Strauss’ negotiated order theory, we examined the engagements between clinicians and the police at the Upper West Regional Hospital in Ghana, analysing the structural and negotiation contexts shaping their interactions.

Design

We used a qualitative case study design.

Setting

The study was conducted at the Upper West Regional Hospital in Ghana.

Participants

Participants included clinicians (n=11; 7 nurses and 4 doctors) and police officers (n=10; 6 Criminal Investigation Department and 4 Motor Traffic and Transport Department) with experience engaging with each other during patients’ visits at the emergency department of the Upper West Regional Hospital.

Methods

Participants were recruited through snowball sampling. We first conducted semi-structured interviews (April 2024 and February 2025) with the 21 participants. We then conducted a validation workshop with clinicians, healthcare managers and police in April 2025, incorporating key insights from the workshop into the thematic analysis to strengthen the study’s credibility and contextual relevance.

Results

We found that interactions between clinicians and police were shaped by three key structural factors: (1) organisational structures like role boundaries and decision-making authority; (2) the policy environment, particularly legal and ethical obligations; and (3) wider cultural contexts, such as societal norms. Within these contexts, negotiations centred on how clinicians and police balanced autonomy with collaboration, shared information, resolved disputes and built interprofessional trust. Informal networks and feedback were particularly important mechanisms for building smoother engagements.

Conclusion

Clinician–LEO interactions are dynamic and require continuous negotiation to align healthcare priorities with law enforcement mandates. Clear policies on engagements, interprofessional training programmes and culturally responsive frameworks are needed to enhance emergency care.

Prevalence and associated factors of health facility delivery during COVID-19 in the Tamale Metropolis of Ghana: Analytical cross-sectional study

by Obed Kwaku Duah Asumadu, Gilbert Abotisem Abiiro, Joyce Aputere Ndago, David Abatanie Kanligi, Martin Nyaaba Adokiya

Introduction

Globally, the COVID-19 pandemic significantly impacted the provision of maternal health services, especially facility-based delivery. However, there is little evidence on the proportion of women who delivered at the health facility in various locations and the factors that influenced women’s decision-making in choosing a place of delivery during and amid the COVID-19 restrictions. Therefore, this study assessed the prevalence and factors associated with health facility delivery during the COVID-19 pandemic in the Tamale Metropolis of Ghana.

Methods

An analytical cross-sectional study design was conducted. A multistage sampling technique was used in selecting the study communities. At the individual level, random sampling technique was applied, and 461 women were recruited from 21^st February 2021–21^st March 2021. Using a questionnaire, a face-to-face approach was used to conduct the interviews. The questionnaire included questions on socio-demographic characteristics, place of childbirth and factors that led to the choice of delivery place. Using Statistical Package for Social Sciences version 25, descriptive and binary logistic regression analysis were conducted.

Results

The results revealed that 64.0% of the women delivered in health facilities during the pandemic. Health facility delivery was more likely to occur among women with higher educational status (AOR: 5.2; 95% CI: 1.40–19.40), married women (AOR:6.3; 95% C.I:1.10–35.80), active National Health Insurance Scheme holders during delivery (AOR: 13.8; 95% C.I: 4.60–41.90), women who received education on birth preparedness and complication readiness (AOR: 7.6; 95% C.I:3.30–17.50) and women with underlying conditions before pregnancy (AOR:3.3; 95% C.I:1.20–9.20). There were reduced odds of health facility delivery among women with a history of home delivery (AOR:0.2; 95% C.I:0.10–0.50), when the mother-in-law decides on the place of delivery (AOR:0.1; 95% C.I:0.03–0.50), longer distance to the place of delivery (AOR:0.3; 95% C.I:0.01–1.00) and when women perceived COVID-19 as a barrier to facility delivery (AOR:0.1; 95% C.I:0.03–0.20).

Conclusion

Our findings show that health facility delivery declined during COVID-19. Factors that affected health facility delivery were educational status, marriage, having an active National Health Insurance Scheme, education on birth preparedness and complication readiness, underlying conditions before pregnancy, history of home delivery, mother-in-law decision on place of delivery, distance to place of delivery and perceiving COVID-19 as a barrier to facility delivery. These contributed to low facility delivery. Thus, maternal health services need to be brought to the doorsteps of communities, including proper implementation of the Focused Antenatal Care and community-based pregnancy school programmes, especially during future pandemics.