Predictive Factors for Health Service Utilization in Rural Ghana: A Community-Based Analytical Study
Abstract:
Achieving universal healthcare coverage in rural Ghana continues to be challenging despite considerable investments in the health system. This study predicted factors influencing health service utilization among residents in rural Ghana, to guide evidence-based strategies aimed at enhancing universal coverage. A community-based analytical study was conducted involving 1,738 adults. Participants were selected using multistage sampling method and a structured questionnaire based on the Andersen Behavioral Model was adopted. Chi-square tests, binary logistic regression, and multiple linear regression analyses were conducted using Stata 12.0, with statistical significance set at p<0.05. Results indicated that age, educational level, marital status, and monthly income were significant predictors of health service utilization. Also, rural resident with tertiary education were 1.99 times more likely to utilize health services than those with no formal education. Rural dwellers earning above GH¢2,000 monthly were 3.21 times more likely to utilize services than those earning below GH¢500. Unmarried individuals were 0.09 times less likely to utilize healthcare services compared to married ones. Health facility factors; distance, cost of treatment, perceived quality of care, and waiting time, explained 69.5% of the variation in health service utilization, where cost of treatment had the strongest influence. Health provider factors, including worker’s attitude, job knowledge, work experience, and in-service training were significantly associated with healthcare utilization. Several factors influence health service utilization among rural population. To improve utilization, interventions should incorporate multifaceted factors to tackle socioeconomic barriers, financial difficulties, geographic constraints and digital health technologies, enhancing residents’ competency through education and financial empowerment.
KeyWords:
Health service utilization, rural Ghana, Andersen model, health insurance, provider factors, universal health coverage.
References:
- Adawudu, E. A., Aidam, K., Oduro, E., Miezah, D., & Vorderstrasse, A. (2024). The Effects of Ghana’s Free Maternal and Healthcare Policy on Maternal and Infant Healthcare: A Scoping Review. Health Services Insights, 17, 11786329241274481. doi:10.1177/11786329241274481
- Adongo, A. A., Dapaah, J. M., Azumah, F. D., & Onzaberigu, J. N. (2024). Maternal and child health care access to skilled delivery services among Ghanaian rural mothers. Research in Health Service & Regions, 3, 6. https://doi.org/10.1007/s43999-024-00042-0
- Agyemang-Duah, W., & Rosenberg, M. W. (2023). Healthcare utilization among informal caregivers of older adults in the Ashanti region of Ghana: a study based on the health belief model. Achieve of Public Health, 81, 187. https://doi.org/10.1186/s13690-023-01200-5
- Agyemang-Duah, W., Peprah, C. & Peprah, P. (2020). Factors influencing the use of public and private health care facilities among poor older people in rural Ghana. Journal of Public Health (Berl.), 28, 53–63. https://doi.org/10.1007/s10389-018-01010-y
- Alhassan, R. K., Beyere, C. B., Nketiah-Amponsah, E., & Mwini-Nyaledzigbor, P. P. (2017). Perceived needs of health tutors in rural and urban health training institutions in Ghana: Implications for health sector staff internal migration control. PloS one, 12(10), e0185748. https://doi.org/10.1371/journal.pone.0185748
- Amalba, A., Abantanga, F.A., Scherpbier, A. J. J. A., & van Mook, W. N. K. A. (2018). Working among the rural communities in Ghana - why doctors choose to engage in rural practice. BMC Medical Education, 18, 133. https://doi.org/10.1186/s12909-018-1234-y
- Amoah-Nuamah, J., Agyemang-Duah, W., Prosper Ninorb, G., & Gladstone Ekeme, B. (2023). Analysis of Spatial Distribution of Health Care Facilities and its Effects on Access to Primary Healthcare in Rural Communities in Kpandai District, Ghana. Cogent Public Health, 10(1). https://doi.org/10.1080/27707571.2023.2183566
- Asamani, J. A., Chebere, M. M., Barton, P. M., D'Almeida, S. A., Odame, E. A., & Oppong, R. (2018). Forecast of Healthcare Facilities and Health Workforce Requirements for the Public Sector in Ghana, 2016-2026. International journal of health policy and management, 7(11), 1040–1052. https://doi.org/10.15171/ijhpm.2018.64
- Babagoli, M. A., Adu-Amankwah, D., Nonterah, E. A., Aborigo, R. A., Kuwolamo, I., & Jones, K. R. (2024). Sociodemographic and Behavioral Factors Associated with Hypertension and Depression in 4 Rural Communities in Northern Ghana: A Cross-Sectional Study. Journal of Primary Care & Community Health, 15, 21501319241242965. doi:10.1177/21501319241242965
- Domapielle, M. K., Dassah, C., Dordaa, F., Cheabu, B. S. N., & Sulemana, M. (2023). Barriers to health care access and utilization among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP): the perspective of users and service providers in north-western Ghana. Primary Health Care Research & Development, 24, e48. https://doi.org/10.1017/S1463423623000385
- Egbenyah, F., Udofia, E. A., Ayivor, J., Osei, M. M., Tetteh, J., Tetteh-Quarcoo, P. B., & Sampane-Donkor, E. (2021). Disposal habits and microbial load of solid medical waste in sub-district healthcare facilities and households in Yilo-Krobo municipality, Ghana. PloS one, 16(12), e0261211. https://doi.org/10.1371/journal.pone.0261211
- Escribano-Ferrer, B., Cluzeau, F., Cutler, D., Akufo, C., & Chalkidou, K. (2016). Quality of Health Care in Ghana: Mapping of Interventions and the Way Forward. Ghana Medical Journal, 50(4), 238–247. https://doi.org/10.4314/gmj.v50i4.7
- Ghana Health Service. (2024). https://oxfordbusinessgroup.com/reports/ghana/2024-report/health-education/
- Ghana Statistical Service. (2021). https://www.ghanadistricts.com/Home/District/103
- Ketor, C. E., McDonnell, J., Benneh, C. K., Sarkodie, E., Annobil, F. A., & Mensah, A. (2024). Determinants of health-seeking behaviour in rural district of Jasikan, Ghana: a cross-sectional study. BMC Public Health, 24, 2972. https://doi.org/10.1186/s12889-024-20400-4
- Kodom R. V., & Netangaheni, R. T. (2024). Challenges in accessing patient-centered care and ptient empowerment in selected Ghanaian hospitals. Health SA, 29, 2623.
- Korah, P. I., Nunbogu, A. M., & Ahmed, A. (2023). Measuring access to health facilities in Ghana: Implications for implementation of health interventions and the Sustainable Development Goal 3. Applied Geography, 158, 103026. https://doi.org/10.1016/j.apgeog.2023.103026
- Krejcie, R. V., & Morgan, D. W. (1970). Determining sample size for research activities. Educational and Psychological Measurement. 1970 Autumn, 30(3), 607-610.
- Krzyż, E. Z., Antunez Martinez, O. F., & Lin, H-R. (2023). Uses of Andersen health services utilization framework to determine healthcare utilization for mental health among migrants—a scoping review. Front. Public Health, 11, 1284784. doi: 10.3389/fpubh.2023.1284784
- Kumah, E., Asana, Y., Agyei, S. K., Kokuro, C., Ankomah, S. E., & Fusheini, A. (2024). Does health insurance status influence healthcare-seeking behavior in rural communities? evidence from rural Ghana. Health policy OPEN, 6, 100119. https://doi.org/10.1016/j.hpopen.2024.100119
- Nsiah-Boateng, E., Nonvignon, J., Aryeetey, G. C., Salari, P., Tediosi, F., & Akweongo, P. (2019). Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana: a cross-sectional study. Health Economics Review, 9, 23. https://doi.org/10.1186/s13561-019-0241-y
- Nsiah, R. B., Larbi-Debrah, P., Avagu, R., Yeboah, A. K., Anum-Doku, S., & Takramah, W. (2024). Mapping Health Disparities: Spatial Accessibility to Healthcare Facilities in a Rural District of Ghana Using Geographic Information Systems Techniques. American Journal of Health Research, 12(5), 110-123. https://doi.org/10.11648/j.ajhr.20241205.11
- Nuamah, G. B., Agyei-Baffour, P., Mensah, K. A., Boateng, D., Quansah, D. Y., & Dobin, D. (2019). Access and utilization of maternal healthcare in a rural district in the forest belt of Ghana. BMC Pregnancy Childbirth, 19, 6. https://doi.org/10.1186/s12884-018-2159-5
- Okyere, E., Ward, P., Marfoh, K., & Mwanri, L. (2021). What do Health Workers say About Rural Practice?. Global Qualitative Nursing Research, 8, 23333936211054812. https://doi.org/10.1177/23333936211054812
- Peprah, P., Abalo, E.M., Agyemang-Duah, W., Badu, H. I., Appiah-Brempong, E., & Morgan, A. K. (2020). Lessening barriers to healthcare in rural Ghana: providers and users’ perspectives on the role of mHealth technology. A qualitative exploration. BMC Meicald Informatics and Decision Making, 20, 27. https://doi.org/10.1186/s12911-020-1040-4
- Saah, F. I., Amu, H., Seidu, A. A., & Bain, L. E. (2021). Health knowledge and care seeking behaviour in resource-limited settings amidst the COVID-19 pandemic: A qualitative study in Ghana. PloS one, 16(5), e0250940. https://doi.org/10.1371/journal.pone.0250940
- Salehi, R., de Young, S., Asamoah, A., Aryee, S. E., Eli, R., & Couper, B. (2023). Evaluation of a continuing professional development strategy on COVID-19 for 10 000 health workers in Ghana: a two-pronged approach. Human Resource for Health, 21, 18. https://doi.org/10.1186/s12960-023-00804-w
- Sarkodie, A. O. (2021). Effect of the National Health Insurance Scheme on Healthcare Utilization and Out-of-Pocket Payment: Evidence from GLSS 7. Humanities and Social Science Communications, 8, 293 (2021). https://doi.org/10.1057/s41599-021-00984-7
- Tuolong, J. G., Alatinga, K. A., & Yendaw, E. (2024). Supply-side factors influencing national health insurance uptake, access and use of primary health care: Evidence from the Upper West Region, Ghana. SSM - Health Systems, 3, 100036. https://doi.org/10.1016/j.ssmhs.2024.100036
- Tuoyire, D. A., Baatiema, L., Dwomoh, D., & Bosomprah, S. (2024). Healthcare utilization in Ghana: Insights from the 2017 Ghana Living Standard Survey. PloS one, 19(6), e0306032. https://doi.org/10.1371/journal.pone.0306032
- UK DHSC, 2023; https://www.gov.uk/government/news/15-million-funding-to-strengthen-health-workforce-in-kenya-nigeria-and-ghana