A multidimensional study of public satisfaction with the healthcare system: a mixed-method inquiry in Ghana

Padmore Adusei Amoah,Kingsley Atta Nyamekye,Ebenezer Owusu-Addo

doi:10.1186/s12913-021-07288-1

Abstract

BackgroundMany governments in sub-Saharan Africa have recently sought to improve their health systems by increasing investment in healthcare facilities and introducing social insurance programmes. However, little is known about the impact of these intended improvements on public perceptions about the healthcare systems. This article examines whether and why people of different socioeconomic and ideological backgrounds are satisfied (or not) with the current healthcare system in Ghana from a social ecological perspective.MethodData were elicited from a cross-sectional mixed-method study conducted in four regions in Ghana in 2018. We used ordinal logistic regression and thematic analysis techniques to analyse the data.ResultsSatisfaction with the healthcare system was generally low. From our quantitative study, intrapersonal factors (e.g., being older and having good health and well-being status); interpersonal factors (e.g., linking social capital); community factors (e.g., living in rural areas); and organisational and public policy factors (e.g., trust in the health system, favouring welfare policies, and being interested in politics) were positively associated with satisfaction with the healthcare system. These were corroborated by the qualitative study, which showed that poor attitudes of health personnel, financial constraints, perceived poor health facilities, and perceived inefficacy of services contribute to dissatisfaction with the healthcare system.ConclusionStrategies to improve satisfaction with the healthcare system in Ghana should incorporate ecological perspectives by considering factors such as demographic profile, health needs, political orientation, issues of trust in the healthcare system, and the dynamics and impact of social relationships of populations concerned.

Highlights

Many governments in sub-Saharan Africa have recently sought to improve their health systems by increasing investment in healthcare facilities and introducing social insurance programmes
Intrapersonal factors; interpersonal factors; community factors; and organisational and public policy factors were positively associated with satisfaction with the healthcare system. These were corroborated by the qualitative study, which showed that poor attitudes of health personnel, financial constraints, perceived poor health facilities, and perceived inefficacy of services contribute to dis‐ satisfaction with the healthcare system
We found evidence from quantitative and qualitative perspectives that factors relating to all four adapted domains of the social ecological model are associated with public satisfaction with healthcare

Summary

Introduction

Many governments in sub-Saharan Africa have recently sought to improve their health systems by increasing investment in healthcare facilities and introducing social insurance programmes. Initiation of social welfare policies such as the Livelihood Empowerment against Poverty (LEAP) programme and free maternal healthcare policy are considered critical in protecting the health-related well-being of vulnerable groups in the country [23, 42, 50, 52, 53] Key health indicators such as under-five mortality rate (a decline from 111 per 1000 live births in 2003 to 48 in 2018); maternal mortality (a decline of between 610 and 720 per 100,000 live births in 1990 to 308 in 2017); and increased life expectancy (from 57 in 2000 to 63 in 2016) are indicative of significant improvements in health outcomes in recent years [56, 61, 63]

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Discussion

Conclusion