Accessibility and utilization of health-care services among rural–urban migrants in Ghana: A scoping review

Abstract

Since the second half of the 20th century, internal migration patterns in Ghana have been dominated by movements from rural (or northern) to urban (or southern) areas. Numerous studies report wide socioeconomic gaps between the geographical north and south of Ghana, explaining the unidirectional movement in search of better opportunities. Differences in personal health profiles, values, and beliefs mean that internal migrants face a higher risk of ill health than urban natives. Compounding this issue is the barriers that impede their access to and utilization of health-care services. We synthesized evidence from existing literature to understand internal migrants’ access to and utilization of healthcare in Ghana, as well as their coping strategies. This review followed Arksey and O’Malley’s guidelines for conducting scoping reviews. We searched PubMed, EconLit, CINAHL, PsychINFO, and Medline (Ovid) electronic databases for studies published from January 2012 to June 2022. In addition, a manual literature search was conducted on Google by examining the reference lists of selected articles to identify other relevant studies. The majority of the studies (n = 12 [75%]) focused on female migrants, while 4 (25%) included both male and female migrants. This review identified several factors affecting access to health-care services for internal migrants in Ghana. These factors included infrastructural, financial, and language barriers, as well as long patient waiting times. Significantly, these barriers resulted in increased self-medication and self-diagnosis among internal migrants, leading to overall poor health outcomes. Based on the study findings, we propose a multidimensional approach to bridging the health access gap for internal migrants. This approach involves improving health system factors such as health service delivery, health workforce, availability of essential medicines, and health finance reforms to provide quality health-care services at affordable or no cost, while considering the socioeconomic and cultural conditions of the internal migrants.