Abstract
BackgroundRural settings in low- and middle-income countries are bedeviled with poverty and high disease burden, and lack adequate resources to deliver quality healthcare to the population. Drug shortage and inadequate number and skill-mix of healthcare providers is very common in rural health facilities. Hence, rural healthcare providers have no choice but to be innovative and introduce some strategies to cope with health delivery challenges at the health centre levels. This study explored how and why rural healthcare providers cope with clinical care delivery challenges at the health centre levels in Ghana.MethodsThis study was a multiple case studies involving three districts: Bongo, Kintampo North, and Juaboso districts. In each case study district, a cross-sectional design was used to explore the research question. Purposive sampling technique was used to select study sites and the study participants. The authors conducted 11 interviews, 9 focus group discussions (involving 61 participants), and 9-week participant observation (in 3 health centres). Transcription of the voice-recordings was done verbatim, cleaned and imported into the Nvivo version 11 platform for analysis. Data was analysed using the inductive content analysis approach. Ethical clearance was granted by the Ethics Review Committee of the Ghana Health Service.ResultsThe study found three main coping strategies (borrowing, knowledge sharing and multi-tasking). First, borrowing arrangements among primary health care institutions help to address the periodic shortage of medical supplies at the health centres. Secondly, knowledge sharing among healthcare providers mitigates skills gap during service delivery; and finally, rural healthcare providers use multi-tasking to avert staff inadequacy challenges during service delivery at the health centre levels.ConclusionBorrowing, knowledge sharing, and multi-tasking are coping strategies that are sustaining and potentially improving health outcomes at the district levels in Ghana. We recommend that health facilities across all levels of care in Ghana and other settings with similar challenges could adopt and modify these strategies in order to ensure quality healthcare delivery amidst delivery challenges.
Highlights
Rural settings in low- and middle-income countries are bedeviled with poverty and high disease burden, and lack adequate resources to deliver quality healthcare to the population
Study design The study used multiple case studies involving three districts selected from the northern (Bongo district), middle (Kintampo North district) and southern (Juaboso district) belts of Ghana to analyse how and why rural healthcare providers cope with clinical care delivery challenges in resource-constrained settings
The findings revealed that rural healthcare providers adopt three main coping strategies in order to mitigate clinical care delivery challenges at the health centre levels in Ghana
Summary
Rural settings in low- and middle-income countries are bedeviled with poverty and high disease burden, and lack adequate resources to deliver quality healthcare to the population. Health systems worldwide are ambitious to enhance performance by improving access, quality, equity and financial protection during health service delivery [25] This desire supports the core values of the Primary Health Care (PHC) initiative under the Alma Ata declaration in 1978 [4, 24]. A well-integrated PHCbased district health system is made-up of healthcare institutions that are linked in harmonious relationships to provide appropriate treatment for common diseases and injuries, basic laboratory services, essential drugs and referral services, as well as preventive healthcare services [3] These core activities ensure that quality, affordable and comprehensive healthcare services are delivered to sick individuals, families and communities especially in rural settings [18]
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