The Role of Institutions on the Effectiveness of Treatment in the Ghanaian Health Sector

Abstract

Background: Universal health coverage is achieved in a given economy when all residents of a country have ready access to quality healthcare regardless of ability to pay. Access to quality healthcare then is an important condition for the achievement of universal health coverage. The Ghanaian health sector has undertaken several policies to help improve the quality of care received by patients. This includes the construction of several health facilities, the increase in the training of health workers, especially nurses, and the introduction of incentive packages (such as salary increase) to motivate health workers. The important question is to what extend does the institutional arrangement between the health facilities and the government as well as between health workers and public health facility administration affect the quality of care. The objective of this study is to find the effect of institutional factors on the quality of care. The quality indicator used was effectiveness of treatment as determined by the patient. The institutional factors examined were mainly the extent of decentralization between government and health facilities, as well as between health workers and facility administration, the hiring procedure, and job satisfaction.Methodology: The study used primary data on former patients from sixty six health facilities in three administrative regions of Ghana: the Northern, the Ashanti and the Greater Accra regions. The data had information on patient’s demographic and socioeconomic characteristics as well as the characteristics of the facility in which care was received. There was also information on the working conditions for health workers. Ordered logit regression was used for the analysis. The sample size was 2248.Results: The results showed that the patient’s level of formal education had a strong influence on the effectiveness of treatment received. In addition, effectiveness of treatment differed according to the administrative region in which the facility was located, and according to the extent of decentralization between health facility and government. The quality of instruments used for treatment, the working conditions for health workers, and job satisfaction had no effect on the effectiveness of treatment. Conclusion: Institutional factors play important role in the achievement of universal coverage because they affect quality of care which is fundamental to the achievement of universal health coverage. Decentralization, the flow of information between government and health facilities on new methods of treatment as well as between health facility administrations and health workers are important in ensuring effectiveness.The paper recommends for further study on decentralization between health facilities as well as between health workers and administrators. In addition, the paper recommends the need for equity in access to treatment techniques across all administrative regions of the country.