Affordability of healthcare services in the Central Gonja District of Ghana Keywords: Affordability, Catastrophic health, Expenditure, Chemical Seller, Household, Out-of-Pocket Payment ABSTRACT: Financial access to health care remains a challenge to the majority of people especially in the rural areas. In Ghana, it is estimated that four out of every ten persons are poor. In the Northern region of Ghana and the Central Gonja District, poverty level is 70% and 90% respectively. Over 50% of the residents of Central Gonja District are not insured and as a result the same proportion or more incur out of pocket health expenditure. The purpose of the study was to determine the affordability of healthcare services in Central Gonja District. A cross sectional study design and a mixed-method [quantitative and qualitative methods] were used. The two stage cluster sampling approach was used to draw the sample for the study. A sample of 403 household was interviewed using semi-structured questionnaires and three key informant interviews were conducted. The findings showed that in the Central Gonja District, 83.6% (337) of households were poor, 17.1% (N=204) of those who sought care from a formal or informal provider incurred catastrophic cost of care. Direct average cost of healthcare was US$ 21.40 (SD 30.14) while indirect average cost of care was US$ 28.50 (SD 40.98). In conclusion, healthcare is unaffordable to a good number of the people of Central Gonja District and therefore efforts at financial protection especially of the poor should be stepped up. 073-084| JRPH | 2014 | Vol 2 | No 1 This article is governed by the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/2.0), which gives permission for unrestricted use, non-commercial, distribution and reproduction in all medium, provided the original work is properly cited. www.jhealth.info Journal of Research in Public Health An International Scientific Research Journal Authors: Adam Soale 1 and Reuben K. Esena 2 . Institution: 1. University of Ghana , SPH -HPPM, P. O. Box LG 13 Legon-Accra Ghana. 2. University of Ghana, School of Public Health, P. O. Box LG 13 Legon-Accra Ghana. Corresponding author: Reuben K. Esena Email: Web Address: http://www.jhealth.info/ documents/PH0017.pdf. Dates: Received: 20 Sep 2013 Accepted: 08 Nov 2013 Published: 06 Feb 2014 Article Citation: Adam Soale and Reuben K. Esena. Affordability of healthcare services in the Central Gonja District of Ghana. Journal of Research in Public Health (2014) 2(1): 073-084 Journal of Research in Public Health Journal of Research in Public Health An International Scientific Research Journal Original Research
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Affordability of Healthcare Services in the Central Gonja District of Ghana
Financial access to health care remains a challenge to the majority of people especially in the rural areas. In Ghana, it is estimated that four out of every ten persons are poor. In the Northern region of Ghana and the Central Gonja District, poverty level is 70% and 90% respectively. Over 50% of the residents of Central Gonja District are not insured and as a result the same proportion or more incur out of pocket health expenditure. The purpose of the study was to determine the affordability of healthcare services in Central Gonja District. A cross sectional study design and a mixed-method [quantitative and qualitative methods] were used. The two stage cluster sampling approach was used to draw the sample for the study. A sample of 403 household was interviewed using semi-structured questionnaires and three key informant interviews were conducted. The findings showed that in the Central Gonja District, 83.6% (337) of households were poor, 17.1% (N=204) of those who sought care from a formal or informal provider incurred catastrophic cost of care. Direct average cost of healthcare was US$ 21.40 (SD 30.14) while indirect average cost of care was US$ 28.50 (SD 40.98). In conclusion, healthcare is unaffordable to a good number of the people of Central Gonja District and therefore efforts at financial protection especially of the poor should be stepped up.
Article Citation: Adam Soale and Reuben K. Esena. Affordability of healthcare services in the Central Gonja District of Ghana. Journal of Research in Public Health (2014) 2(1): 073-084.
Full Text: http://jhealth.info/documents/PH0017.pdf
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Affordability of healthcare services in the Central Gonja District of Ghana
Keywords: Affordability, Catastrophic health, Expenditure, Chemical Seller, Household, Out-of-Pocket Payment
ABSTRACT: Financial access to health care remains a challenge to the majority of people especially in the rural areas. In Ghana, it is estimated that four out of every ten persons are poor. In the Northern region of Ghana and the Central Gonja District, poverty level is 70% and 90% respectively. Over 50% of the residents of Central Gonja District are not insured and as a result the same proportion or more incur out of pocket health expenditure. The purpose of the study was to determine the affordability of healthcare services in Central Gonja District. A cross sectional study design and a mixed-method [quantitative and qualitative methods] were used. The two stage cluster sampling approach was used to draw the sample for the study. A sample of 403 household was interviewed using semi-structured questionnaires and three key informant interviews were conducted. The findings showed that in the Central Gonja District, 83.6% (337) of households were poor, 17.1% (N=204) of those who sought care from a formal or informal provider incurred catastrophic cost of care. Direct average cost of healthcare was US$ 21.40 (SD 30.14) while indirect average cost of care was US$ 28.50 (SD 40.98). In conclusion, healthcare is unaffordable to a good number of the people of Central Gonja District and therefore efforts at financial protection especially of the poor should be stepped up.
073-084| JRPH | 2014 | Vol 2 | No 1
This article is governed by the Creative Commons Attribution License (http://creativecommons.org/
licenses/by/2.0), which gives permission for unrestricted use, non-commercial, distribution and reproduction in all medium, provided the original work is properly cited.
www.jhealth.info
Journal of Research in
Public Health An International
Scientific Research Journal
Authors:
Adam Soale1 and
Reuben K. Esena2.
Institution:
1. University of Ghana ,
SPH -HPPM, P. O. Box
LG 13 Legon-Accra Ghana.
2. University of Ghana,
School of Public Health,
P. O. Box LG 13
Legon-Accra Ghana.
Corresponding author:
Reuben K. Esena
Email:
Web Address:
http://www.jhealth.info/
documents/PH0017.pdf. Dates: Received: 20 Sep 2013 Accepted: 08 Nov 2013 Published: 06 Feb 2014
Article Citation: Adam Soale and Reuben K. Esena. Affordability of healthcare services in the Central Gonja District of Ghana. Journal of Research in Public Health (2014) 2(1): 073-084
Journal of Research in Public Health
Jou
rn
al of R
esearch
in
Pu
blic H
ealth
An International Scientific Research Journal
Original Research
INTRODUCTION
Background
The poverty-health status syndrome shows
spatial variation. The urban areas are better served with
modern health facilities by government, whilst the rural
areas suffer from acute lack of these facilities. (Bour,
1999). In most developing countries healthcare is usually
inaccessible to a large proportion of the population
especially those living in remote rural areas. In Ghana
the main cause of poor access to healthcare services
which result in poor health status is inability to bear
service cost (Takyi and Anamuah-Mensah, 1993).
The health system of the country has
communicable disease conditions, malnutrition, high
infant mortality and poor reproductive health. There are
also non-communicable diseases, such as, diabetes and
cardiovascular diseases. These health conditions are
largely worsened by poor access to health services and
the geographical and financial access to health care is a
challenge (Gyapong et al., 2007).
According to the 2009 Health Sector Programme
of work, maternal mortality ratio in 2008 stood at 451
per 100 000 live births (GHS, 2010) and one out of
every thirteen Ghanaian children died before the age of
five (GDHS, 2008). Anaemia which is said to be a major
threat to maternal and child health is said to be on the
increase. Among children, it is estimated that 78 per cent
have anaemia while in women it increased from 45 per
cent in 2003 to 59 per cent in 2008 (GDHS, 2008).
As a result of the widespread poverty in the
northern region, many cannot afford basic healthcare. It
is estimated that seven out of every ten persons is poor in
the region. Incidentally it is more deprived than the
southern sector of the country in terms health
infrastructure. The 2005 annual report of the Ghana
Health Service (GHS) of the northern region reveals that
maternal and under-five mortality are a major challenge
with under–five mortality as high as 137 per 1000 live
births (GDHS, 2008). The direct and indirect causes of
the maternal mortality are predominantly caused by
poverty, poor access to care, and poor quality of care,
which are preventable. Despite the fact that membership
of the National Health Insurance Scheme (NHIS) is
mandatory [unless one is enrolled to a private health
insurance] enrolment in NHIS is low among informal
sector workers especially in rural areas, posing a
challenge to access to health care.
Problem statement
It has been established that 7 out of every 10
persons in the northern region is poor (GLSS-4,
1998/1999). Widespread poverty in the region makes
basic healthcare unaffordable to a large number of
people in the region (ACDEP, 2007).
Some intra regional disparities in the prevalence
of poverty are observed with some districts such as the
Central Gonja having poverty levels as high as 90%
(Nine out of every ten persons)- (CGDA, 2008).
In communities with such high level of poverty,
financial access to healthcare is a major challenge. This
poor financial access is manifested in the high under-five
mortality rate of 181 per 1000 live births in the district
(CGDA, 2008) exceeding both the regional and national
rates. There were also cases of increased malnutrition
among children under-five. The top ten ailments in the
District are malaria, diarrhea, Urinary Tract Infection