ABSTRACT
Primary health care is vital in the general health care system in every country. Therefore, it is highly imperative to provide facilities and services to enhance access to healthcare services to benefit all individuals independent of their location. The effective provision and implementation of these services will encourage the utilization of primary health care. The present study, therefore, is aimed to contribute to existing literature by examining the phenomenon in a rural community in the Central region- Gomoa East sub-district. The focus of this study is to identify the determinants of the utilization of primary healthcare; the perception, identification of the factors that influence the use of primary health care and the health seeking behaviours. This study used the mixed method approach which is a combination of both quantitative and qualitative research approaches. Data collection instruments employed included questionnaire and interviews. Sample sizes of 200 respondents from two communities (Okyereko and Adawukwa) were selected for the survey. The study has confirmed that the key factors that determine the utilization of health care in the sub district are mainly the accessibility to the health facility and the age of the person. On the contrary, the observation made from the findings on level of education and the average monthly income showed a non-significant role as determinants of the utilization primary health care. The health seeking behaviour of the people showed that 46% report to the health facility when they become ill, another 36% self-diagnosis and self-medicate.
CHAPTER ONE GENERAL INTRODUCTION
Chapter Introduction
This chapter presents the focus and the relevance of the study. In this chapter, the background of the study, the problem statement and the specific objectives of the study are discussed. The identification of the scope of the research and the limitations encountered have been included in this chapter. The chapter is concluded with the significance of the research.
Research Background
The provision of primary health care is a crucial aspect of the general health care system in every nation. As stated in Alma Ata declaration, primary health care should be based on scientifically sound, practical and socially approved methods of health care delivery widely distributed to the inhabitants, both individuals and families in a community (World Health Organization &United Nations Children’s Fund, 2018). The effective practice of primary health care is mainly dependent on the high involvement of these communities and a sustainable approach financially by the community and the government to maintain the spirit of self-reliance at every level of its development (Makaula, Bloch, Banda, Mbera, Mangani, de Sousa & Muula, 2012).
Globally, advanced countries such as the United Kingdom, United States of America, Japan, Germany, amongst many others have demonstrated high commitment to providing quality, reliable and sustainable primary health care. Currently, the Japanese healthcare system provides universal health coverage through both a fee-for-service system under governmental control and a free-access system(Yoshikawa, Bhattacharya & Vogt 1996). Under these systems, Japan has
maintained top-class global health indicators, including life expectancy at birth and infant mortality (Kaneko & Matsushima, 2017). Unfortunately, the capacity in the delivery of primary health care in the Low and Middle Income Countries (LMIC) in the world is lacking, resulting in poor health related outcomes. For example, an extensive study in northern India revealed that diagnoses were provided in only 36% of reported cases and only 12% of these diagnoses were right. Similar cases displaying poor diagnoses were also found in Paraguay, Tanzania and Indonesia (Bitton, Ratcliffe, Veillard, Kress, Barkley, Kimball & Bayona, 2017).
Okpokoro (2013), in his study mentioned that the uneven distribution of social determinants of health such as income, housing, healthy environment, employment as well as the limited accessibility, affordability and availability of essential health services has led to widening health inequities between the high and low socio economic communities in developing countries of which Ghana is no exception. For the past two decades, Ghana has been committed to a series of actions to boost access in delivery of health services and making financial reforms in compliance with the WHO’s policy on Universal Health Coverage (UHC) aimed at pursing the well-being of all people health wise (Nyonator, Ofosu., Segbafah & d’Almeida, 2014). This is evident in the national budget released in 2017 showing an allocation of GHc 4,226.15 million out of the total budget of GHc 44,961.64 representing 9.4% to implement the activities of the health sector (Citizens’ Budget, 2017). The development of a close-to-client health care delivery system, called the Community-based Health Planning and Services Strategy (CHPS) and the implementation of the National Health Insurance Scheme (NHIS) are nationwide projects by the Government of Ghana to bridge geographic barriers and provide financial protection respectively (Awoonor-Williams, Tindana, Dalinjong, Nartey & Akazili, 2016).
However, despite the efforts of government to make primary healthcare assessible to all, it has over the years encountered various major hurdles impeding the effective health care delivery Novignon and Nonvignon (2017) in their study discovered many challenges faced in the delivery of health care especially to the rural communities across the country. Inadequate health facilities, unwillingness of health personnel to work in rural areas, long travel distances to health facilities and the cost of health care services were identified as the major factors affecting the provision of primary health care. It is imperative to understand the attributes of the primary health delivery that is creating inefficiencies and its negative impact on the people in the community.
Statement of the Problem
The significance of a sturdy health care system cannot be overemphasized. According to Gocking (2005), the stability of a country’s health care system underpins the state of its economy. This stands to reason that, the healthier a populace is, the better position it will be to engage in economic activities that will inure to the aggregate economic benefits of the country- aggregate health is positively related to the state of the economy (Amamoo, 2000). No wonder, governments invest a lot to accomplish sturdy health care system thereby bolstering accessibility and utilization of primary health care.
Unfortunately, however, governments’ investment in primary health care alone does not fully determine the utilization of same (Hoyle, 2016). In most hinterlands in most African countries, for example, the levels of utilization of primary health care facilities remains problematic (Marc, 2012; Dunn & Mutti, 2004). This has triggered the need for studies into the health seeking behaviors of people in such hinterlands. However, most of these studies conducted on primary health care were conducted one the impact of the use of National Health Insurance Scheme (NHIS)as a determinant of primary health care utilization (Dixon & Schafer, 2014; Matsumura,
Uemura, Okamoto, Yamamoto, Yamaguchi, Yamakido & Schlemper, 2001; Addai, 2000). The problem with these studies is that, they limit the determinants of primary health care utilization to only NHIS to the exclusion of others. In Ghana, most of the related studies were mainly conducted on maternal healthcare utilization- which is on one level of analysis (Abor, Abekah‐Nkrumah, Sakyi, Adjasi & Abor, 2011; Saeed, Oduro, Mills & Zhao, 2012). This therefore warrants a study that will broaden the level of analysis to other factors.
Studies that specifically focused on the determinants of primary health care were mostly conducted in foreign jurisdictions (Brettschneidera et al., 2019) which presents a context gap for this study. More to it, the related studies were predominantly qualitative (Addia, 2000; Brettschneidera et al,. 2019; Abor et al., 2011), none of the studies, so far, have been sighted using the mixed method approach. This presents a methodological gap for the present study. The present study, therefore, is aimed at contributing to existing literature by examining the phenomenon in a rural community in the Central region- Gomoa East sub-district, using a mixed method approach.
Research Objectives
The general objective of this study is to identify the determinants of the utilization of primary healthcare
Specific Objectives
- To assess the perception of the populace on primary healthcare.
- To identify the factors that influence the use of primary healthcare at Gomoa East sub district.
- To identify the health seeking behaviors of the sub district.
Research Question
The following questions serve a guideline to achieve the objects of the study.
- What are the perceptions of the populace on primary healthcare?
- What are the factors that influence the use of primary healthcare at Gomoa East sub district?
- How does the populace of Gomoa East district perceive primary health care?
Scope and Limitation of the study
This study explores the various factors influencing the utilization of primary health care and the kind of health facilities available to the community. Also, as part of the study, the identification of health seeking behaviours of the populace in the community will be examined. The study is limited to the factors affecting the provision of primary health care in rural communities specifically in the Gomoa East sub district of the country.
Significance of the Study
The study will highlight the availability and access of primary health facilities in the study area as a rural dwelling. The purpose of the study will reveal the factors inhibiting access to primary health facilities and services by the rural populace which is related to causative factors ranging from physical accessibility problems, low income levels, low technological issues, high illiteracy amongst others. This research will provide valuable information to the district health care authorities on the state of the delivery of primary health care. This will aid in the formation of health policies peculiar to the district.
Definitions of key terms
Primary healthcare: Primary health care is a whole-of-society approach to health and well- being centred on the needs and preferences of individuals, families and communities. It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing (WHO, 2013). Additionally, primary health care involves the services and products which aim to address acute and episodic health conditions which also includes health promotion efforts. Primary healthcare is the first level of care.
Utilization:Health Care Utilization is the quantification or description of the use of services by persons for the purpose of preventing and curing health problems, promoting maintenance of health and well-being, or obtaining information about one’s health status and prognosis. (Turner, 2013).
Determinants: The determinants refer to the factors which affects the nature and outcome of a service. The determinants of health care include:
the social and economic environment, the physical environment, and
the person’s individual characteristics and behaviours.
Chapter Outline
The research is in five chapters. Chapter one consists of the introduction to the study. Background of the study, problem statement, objectives of the study, research questions, scope, limitations and significance of the study are the main sub-topics of the first chapter. Chapter two
entails review of both theoretical and empirical literature that are relevant to this research. The methodology used in the research is captured in the third chapter. This chapter describes the research design, research setting, population, the sampling technique, sample size, sources of data, the analysis of the data and the ethical considerations.
Chapter four contains the presentation of data, key findings, analysis and discussion, whilst the last chapter finally summarizes the findings of this research, and conclude with recommendations for practitioners, policy, academia and the general public.
