Abstract
Background. Access to healthcare remains a challenge towards the achievement of the Sustainable Development Goals in Ghana. There still remain inequalities in the distribution of health services especially among vulnerable groups despite sustained efforts to strengthen the health system. This study was conducted to analyze access differentials among different vulnerable groups in the context of primary healthcare under a National Health Insurance Scheme (NHIS) in Ghana. Methods. This study was a descriptive cross-sectional study conducted among multilevel participants of vulnerable groups in Kumasi Metropolis: 710 vulnerable people constituting elderly/aged (n = 359), pregnant women (n = 117), head poters (teenage girls who migrated from the northern Ghana mainly to the capital cities of the Ashanti and Greater Accra region to help in carrying of goods for their livelihood) (n = 86), sex workers (n = 75), and other vulnerable groups (people with disabilities and street participants) (n = 73). Data were collected using a semistructured questionnaire. Poisson regression with robust variance was used to access the association between vulnerability and access to healthcare. Results. Close to a fifth, 18.5% of the study respondents were unable to access care at any point in time during the last 12 months. Reasons for the inability to access healthcare included limited funding (69.7%), poor attitude of service providers (7.6%), distance to health centers (8.3%), and religious reasons (6.2%). More than 95% of respondents were insured under the NHIS, but acceptability of service provision under the NHIS was low among the vulnerable groups. In the crude models, pregnant women had lower prevalence of access to medications as compared to the elderly (prevalence ratio (PR): 0.88; 95% CI: 0.80–0.98). Head poters and other vulnerable groups were also less likely to view healthcare as affordable as compared to the elderly. The differences in healthcare access observed were attenuated after adjustment for sociodemographic characteristics and healthcare-related factors. Conclusions. Despite the introduction of a NHIS in Ghana, this study highlights challenges in healthcare access among vulnerable populations independent of the type of vulnerability. This suggests the need for stakeholders to work to address access differentials in the NHIS and adopt other innovative care strategies that may have broader applicability for all populations.
Highlights
Access to healthcare remains a challenge towards the achievement of the Sustainable Development Goals (SDGs) in many low- and middle-income countries (LMICs) including Africa [1]
Data were first presented as frequency tables or charts to assess the distribution. is was followed by bivariate analysis where selected study variables were related to the various outcomes of interest from the study objectives. e final stage of the analysis explored the strength of study independent variables in influencing the outcomes of interest, where necessary relevant variables were controlled for in assessing their influence or impact on the outcome of interest. e bivariate analysis involved the use of Pearson chi-square to aess differences in access, utilization, service availability, and affordability among various vulnerable groups
As disclosed by participants in this study, the use of the National Health Insurance Scheme (NHIS) card is associated with copayment issues, drug unavailability, rejection of the NHIS card occasionally, problems with renewal, expensive premium, and refusal of some facilities to accept NHIS
Summary
Access to healthcare remains a challenge towards the achievement of the Sustainable Development Goals (SDGs) in many low- and middle-income countries (LMICs) including Africa [1]. If services are available and there is an adequate supply of services, the opportunity to obtain healthcare exists, and a population may “have access” to services Most often, this depends on economic, organizational, and sociocultural barriers that limit the utilization of health services. Access to healthcare remains a challenge towards the achievement of the Sustainable Development Goals in Ghana. Is study was conducted to analyze access differentials among different vulnerable groups in the context of primary healthcare under a National Health Insurance Scheme (NHIS) in Ghana. Despite the introduction of a NHIS in Ghana, this study highlights challenges in healthcare access among vulnerable populations independent of the type of vulnerability.
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