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).
