Services In Ghana Research Articles

The Birth and Growth of the National Ambulance Service in Ghana.

Data routinely collected by the Ghana NAS from 2004-2014 were described, including: patient demographics, reason for the call, response location, target destination, and ti1mes of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported. In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%-80% and 10%-57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described. The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services. Zakariah A , Stewart BT , Boateng E , Achena C , Tansley G , Mock C . The birth and growth of the National Ambulance Service in Ghana. Prehosp Disaster Med. 2017;32(1):83-93.

English

Human trafficking in this era has been conceptualized as a global event that is likened to slavery because of the inhumane treatment that the victims go through. The scope and the criminal aspect of it demands police initiative to curb the menace. The current researcher used semi-structured qualitative interview, direct observation, and review of documents to gather data from Ghana Police Service and some anti-human trafficking institutions in Ghana to identify the nature, scope and responses to reduce or eradicate this menace that has detrimental effect on the people of Ghana, as a case study. Contemporarily, in terms of origin, destination and transit of people to engage in this criminal act, the menace put Ghana into Tier Two Watch-List classification in 2015 on the international level. Human trafficking in Ghana was characterized as violence, debt bondage, exploitation, deprivation of the freedom of the victims, and confiscation of travelling and other documents. The study revealed that the government of Ghana had put in only a minimal effort to curb the menace, and that the trafficking of people had created a security concern that the police must be apt to control. There is a recommendation that the Government of Ghana puts in maximal effort to educate the people and equip the Police service in Ghana to enable the service take tough action to ensure the maximum implementation of the regulations against human trafficking. Key words: Human trafficking, Ghana, policing, inhumane treatment, criminalization, border crime.

Bottleneck analysis approach to accelerate newborn care services in two regions in Ghana: implications for national newborn care

ObjectiveThe aim of this work is to describe application of a data-driven approach (bottleneck analysis [BNA] approach process) to accelerate newborn care services in two regions and what effect it had on national-level newborn care interventions in Ghana. Study designA mixed-method approach was used for the study. The BNA tool generated quantitative data and group discussions provided phenomenological explanations to identified service gaps. MethodsRegional newborn care health service assessments were conducted in November 2013 through desk reviews, field and health facility visits and coaching/mentorship. The BNA tool (an excel-based tool) directly utilized service coverage data and programme monitoring and review reports in Ghana. Outputs were generated based on service coverage indicators: supply side/health system factors (commodities, human resource and access), demand side (service utilization) and quality/effective coverage. National targets were used as benchmarks to assess gaps in coverage indicators. ResultsKey health system bottlenecks included absence/stock-out of essential newborn care commodities/resuscitation kits and absence of updated policies at services delivery points. In both regions, less than 55% of health facilities had at least 80% of midwives trained to provide essential obstetric and newborn care, management of preterm babies, resuscitation and inpatient paediatric care. In addition, less than 35% of pregnant women were assisted by a skilled birth attendant (midwife) and monitored with a partograph in the two regions. Demand-side bottlenecks included cultural preference for home deliveries, limited knowledge on importance of postnatal care and poor community involvement.The BNA approach in the two regions resulted in the development of national and other regional operational plans and monitoring and evaluation framework for newborn care services in Ghana over the period 2012–2016, and a relative improvement in neonatal mortality at the regional and national level. ConclusionThe BNA tool and approach provided data-driven planning for newborn care service delivery in a low-income setting. It identified gaps in service coverage based on empirical data at lower levels of the health system and garnered strategies in addressing bottlenecks to newborn care services at the national level.

Stigmatized by association: challenges for abortion service providers in Ghana.

BackgroundUnsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns which mean it is highly stigmatized and this poses a threat to both providers and researchers. This study sought to explore challenges to providing safe abortion services from the perspective of health providers in Ghana.MethodsA descriptive qualitative study using in-depth interviews was conducted. The study was conducted in three (3) hospitals and five (5) health centres in the capital city in Ghana. Participants (n = 36) consisted of obstetrician/gynaecologists, nurse-midwives and pharmacists.ResultsStigma affects provision of safe-abortion services in Ghana in a number of ways. The ambiguities in Ghanaian abortion law and lack of overt institutional support for practitioners increased reluctance to openly provide for fear of stigmatisation and legal threat. Negative provider attitudes that stigmatised women seeking abortion care were frequently driven by socio-cultural and religious norms that highly stigmatise abortion practice. Exposure to higher levels of education, including training overseas, seemed to result in more positive, less stigmatising views towards the need for safe abortion services. Nevertheless, physicians open to practicing abortion were still very concerned about stigma by association.ConclusionsStigma constitutes an overarching impediment for abortion service provision. It affects health providers providing such services and even researchers who study the subject. Exposure to wider debate and education seem to influence attitudes and values clarification training may prove useful. Proper dissemination of existing guidelines and overt institutional support for provision of safe services also needs to be rolled out.

When the baby remains there for a long time, it is going to die so you have to hit her small for the baby to come out": justification of disrespectful and abusive care during childbirth among midwifery students in Ghana.

Despite global attention, high levels of maternal mortality continue to plague many low- and middle-income settings. One important way to improve the care of women in labour is to increase the proportion of women who deliver in a health facility. However, due to poor quality of care, including being disrespected and abused, women are reluctant to come to facilities for delivery care. The current study sought to examine disrespectful and abusive treatment towards labouring women from the perspective of midwifery students who were within months of graduation. Key Messages •Midwifery students in Ghana’s public midwifery schools report witnessing and participating in many forms of disrespect and abuse during deliveries as part of their education. While they are clear as to why respectful care is important and necessary, they are able to justify and explain reasons for disrespectful and abusive care. This poor treatment of labouring women was explicitly and tacitly supported by these students’ teachers and preceptors. •All study materials and methods were reviewed and approved by the Ghana Health Service Ethical Review Committee, the Kwame Nkrumah University of Science and Technology Committee on Publication and Human Ethics, and the University of Michigan Institutional Review Board. •This research was made possible through a grant from the African Studies Center, University of Michigan. For this study, we conducted focus groups with final year midwifery students at 15 public midwifery training colleges in all 10 of Ghana’s regions. Focus group discussions were recorded and transcribed. A multi-disciplinary team of researchers from the US and Ghana analysed the qualitative data. While students were able to talk at length as to why respectful care is important, they were also able to recount times when they both witnessed and participated in disrespectful and abusive treatment of labouring women. The themes which emerged from these data are: 1) rationalization of disrespectful and abusive care; 2) the culture of blame and; 3) no alternative to disrespect and abuse. Although midwifery students in Ghana’s public midwifery schools highlight the importance of providing high-quality, patient-centred respectful care, they also report many forms of disrespect and abuse during childbirth. Without better quality care, including making care more humane, the use of facility-based maternity services in Ghana is likely not to improve. This study provides an important starting point for educators, researchers, and policy makers to re-think how the next generation of healthcare providers needs to be prepared to provide high-quality, respectful care to women during labour and delivery in low-resource settings.

Perceptions of traditional, complementary and alternative medicine among conventional healthcare practitioners in Accra, Ghana: Implications for integrative healthcare

ObjectiveIntegrative medicine refers to ongoing efforts to combine the best of conventional and evidence-based complementary therapies. While this effort for collaboration is increasing, traditional complementary and alternative medicine (TM-CAM) remains poorly integrated into the current healthcare system of Ghana. At present, it is not clear if practitioners of mainstream medicine favor integrative medicine. The present study, therefore, sought to explore the perceptions of conventional healthcare professionals on integrative medicine. MethodsA qualitative design composed of semi-structured interviews was conducted with 23 conventional healthcare professionals comprising pharmacists, physicians, nurses and dieticians from two quasi-government hospitals in Accra, Ghana. ResultsParticipants' knowledge of TM-CAM was low, and although they perceived alternative medicine as important to current conventional healthcare in Ghana, they expressed anxieties about the potential negative effects of the use of TM-CAM. This paradox was found to account for the low levels of use among these professionals, as well as the low level of recommendation to their patients. The practitioners surveyed recommended that alternative medicine could be integrated into mainstream allopathic healthcare in Ghana through improving knowledge, training as well as addressing concerns of safety and efficacy. These findings are discussed under the themes: the knowledge gap, the paradox of TM-CAM, experience of use and prescription, and guided integration. We did not observe any differences in views among the participants. ConclusionThe conventional healthcare professionals were ready to accept the idea of integrative medicine based on knowledge of widespread use and the potential role of TM-CAM products and practices in improving healthcare delivery in the country. However, to achieve an institutional integration, practitioners' understanding of TM-CAM must be improved, with specific attention to issues of safety, regulation and evidence-based practice of TM-CAM products and services in Ghana.

Property taxation and its revenue utilisation for urban infrastructure and services in Ghana

Purpose – The purpose of this paper is to discuss property taxation and examine the extent of its contribution to financing urban infrastructure/services in Ghana. Dwelling on existing literature, it analyses the contribution of property tax to local level internally generated funds (IGF) and expenditure on urban infrastructure/services financed from IGF. Design/methodology/approach – Using a case study approach with a combination of both quantitative and qualitative research, this research was carried out in the Sekondi-Takoradi metropolis in the Western region, Ghana based on its economic and social diversity, business and economic opportunities and different land tenure systems. Data were collected through expert interviews and questionnaires, with a baseline study from 2006 to 2013. To check the veracity of data, triangulation of data were adopted. Findings – The study revealed that property rate accounted for 28 per cent of IGF of the Sekondi-Takoradi Metropolitan Assembly (STMA). This revenue was expended mostly on waste management, education, social services, street lights and health facilities. For the period between 2006 and 2013, property rates revenue alone was able to finance not less than 84 per cent of total expenditure from IGF. It was estimated that if the challenges to property taxation were resolved in Ghana, the tax could finance the entire annual IGF budget of the STMA on urban infrastructure and services over and above the expended expenditure with a surplus margin of 13 per cent. Practical implications – This paper makes available empirical evidence of property tax contribution to IGF of STMA that could stimulate and enhance revenue mobilisation of other local government authorities. Debate on property tax revenue contribution towards financing urban infrastructure/services is also stimulated. Originality/value – There exist many researches on property tax, however, none of these studies have examined the exact contributions of property rating revenue in financing urban infrastructure and services. This paper is the product of the original research conducted in Sekondi-Takoradi metropolis.

HIV/AIDS clients, privacy and confidentiality; the case of two health centres in the Ashanti Region of Ghana.

BackgroundWhile most studies on HIV/AIDS often identify stigmatization and patients’ unwillingness to access health care as critical problems in the control of the pandemic, very few studies have focused on the possible consequences of accessing health care by sero-positives. This paper examines the socio-psychological trauma patients experience in their desire to access health care in two health facilities in the Ashanti Region of Ghana.MethodsThrough participant observation, informal conversation and in-depth interviews, data were collected from health workers and clients of the voluntary counselling (VCT) and antiretroviral therapy units in the two hospitals.The data gathered were analysed and categorized into themes and supported with illustrative quotes obtained from health workers and clients.ResultsThe study found that the mere presence of a person at the HIV counselling centre or clinic is enough for the person to be labelled as or suspected to be HIV patient. It demonstrates that stigmatization may occur not only in the community but also overtly or covertly, in the health facility itself. Consequently, for many HIV/AIDS patients, access to antiretroviral therapy and treatment of related nosocomial infections are problematic. Besides, the study found that many clients and potential users of services were uncomfortable with the quality of care given by some health workers, especially as they overtly and covertly breached confidentiality about their clients’ health status. This has compelled many patients and potential users of the services to adopt a modus vivendi that provides them access to some care services while protecting their identity.ConclusionThe paper argues that by examining issues relating to privacy and confidentiality in the provision of care for and use of services by seropositives, more light will be shed on the whys of the limited uptake of HIV-related health care services in Ghana.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-016-0123-3) contains supplementary material, which is available to authorized users.

Unpacking the Barriers to Reproductive Health Services in Ghana: HIV/STI Testing, Abortion and Contraception

Youth report embarrassment, cost, and poor access as barriers to sexual and reproductive health (SRH) services. Interventions to address barriers like youth friendly services have yet to conclusively demonstrate impact on protective behaviours like condom or contraceptive use. SRH encompasses a range of services so we aimed to assess how perceived barriers differed depending on the service being sought between common services accessed by young people: HIV/STI testing, abortion, and contraception. 1203 Ghanaian youth were interviewed. Data was analysed to identify barriers by service type, demographics, and between high and low HIV prevalence communities. Being embarrassed or shy was the most commonly reported barrier across services. Overall being embarrassed or shy, fear of safety, fear of family finding out and cost were the most reported barriers across all services. Further analysis by service indicated that being embarrassed was a significantly greater barrier for HIV/STI testing and contraception when compared with abortion (p<0.001) and safety concerns and cost were significantly greater barriers for abortion and contraception compared with HIV/STI testing (p<0.001). Efforts to develop interventions that consider the service being sought may help address the range of barriers faced by youth with diverse SRH needs.

Disparities in Abortion Experience and Access to Safe Abortion Services in Ghana: Evidence from a Retrospective Survey.

In Ghana, abortion mortality constitutes 11% of maternal mortality. Empirical studies on possible disparities in abortion experience and access to safe abortion services are however lacking. Based on a retrospective survey of 1,370 women aged 15-49 years in two districts in Ghana, this paper examines disparities in women's experiences of abortion and access to safe abortion care. Disparities in rates of abortion experience and access to safe abortion care were assessed using absolute (the difference in rates between groups), relative (the ratio of rates between selected and reference groups), and mean measures. Results suggest that 24% of women had at least one abortion in the five years preceding the survey. However, large gradients of socio-spatial disparities in abortion experience exist. The majority of abortions were also potentially unsafe: 53% of abortions occurred outside of any healthcare facility. Women themselves and medical doctors, respectively, performed 57% and 4% of all abortions. The majority of women also felt they could not get safe abortion even if they wanted one. Together, these results highlight the need for concerted multi-sectorial strategies, including legislative reform and provision of family planning services, to help transition from unsafe to safe abortions.

Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study.

BackgroundWhile a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana.Methods and FindingsA qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability.ConclusionsMaternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare providers as well as the provision of disability-friendly transport and healthcare facilities and services are needed.

An Exploration of Managerial Views on Positioning Services in Ghana

ABSTRACTThe paper constitutes an analysis of the views of managers of service firms on positioning strategies in Ghana. The research employed a qualitative research method. Data were collected from 21 service managers and analyzed using content analysis procedures. The results indicate that for service managers, the perceived dominant positioning strategies of their organizations were: service quality, customer relationship, innovation, availability of service, community support, and leading organization, among others. The findings suggest that the dominant managerial views of Ghanaian service managers form a ‘hybrid’ of those of the Western manager. This research is important in clarifying this position. Additionally, as an exploratory piece, the study provides bases for further research on a topic in Ghana with a rather scant evidence of research.

Seeking Paths for Collaboration between Religious Leaders and Mental Health Professionals in Ghana

The treatment gap for mental illness is wide between low- and middle-income countries. The World Health Organization and other relevant bodies are seeking to reduce this gap through culturally innovative and sensitive programming. In Ghana, for example, only 2 % of the mentally ill access treatment, which means that 98 % do not receive care. Various discourses are ongoing to scale up mental health services in Ghana. One of these is the fostering of a collaborative framework between lay mental health workers (such as religious leaders or faith healers) and professional mental health workers. This article seeks to provide a framework within which collaborative linkages between religious leaders (e.g., the clergy, traditional healers) and professional mental health workers can be established. The article begins with a brief overview of Ghana’s mental health landscape, followed by a description of the challenges that make collaboration a difficult task. Next, the need for a holistic view of health in Ghana is addressed by examining Engel’s biopsychosocial model and Twumasi’s work on the complementary role of traditional systems. The essay ends by providing a three-step approach—understanding, task shifting, and broadened curricula—as a model to guide any collaboration between religious leaders and health practitioners in Ghana.

Evidence-based practice in local public health service in Ghana

While the role of evidence-based public health in improving health outcomes is frequently touted, there remains a dearth of research examining the use of evidence in public health service particularly in low- and middle-income countries. Therefore, the aim of this research was to examine the use of evidence in local public health service in Ghana, a lower middle-income country. Semi-structured in-depth interviews were conducted with local health managers from 11 District Directorates of Health in Ashanti Region. Three organising themes emerged from the interview transcripts: understanding of evidence-based public health; the process of using evidence; and the value of evidence in public health practice. The study suggests that though evidence-based practice was not new to the local health managers, its application was very low. The process of using evidence commenced with making a decision about the direction of a programme which had been already prioritised and planned by other high-level actors and then various sources of information, including available research evidence, were used to justify the decision. The study has revealed that there is an urgent need for pre-service and in-service training programmes that build and maintain common skill sets and language among local public health practitioners in Ghana to accomplish evidence-based public health goals. Similarly, giving local health managers flexibility to prioritise and make decisions would result in increased uptake of evidence in local public health service.

Population-level Spatial Access to Prehospital Care by the National Ambulance Service in Ghana

Background: Conditions requiring emergency treatment disproportionately affect low- and middle-income countries (LMICs), where there is often insufficient prehospital care capacity. To inform targeted prehospital care development in Ghana, we aimed to describe spatial access to formal prehospital care services and identify ambulance stations for capacity expansion. Methods: Cost distance methods were used to evaluate areal and population-level access to prehospital care within 30 and 60 minutes of each of the 128 ambulance stations in Ghana. With network analysis methods, a two-step floating catchment area model was created to identify district-level variability in access. Districts without NAS stations within their catchment areas were identified as candidates for an additional NAS station. Additionally, five candidate stations for capacity expansion (e.g., addition of an ambulance) were then identified through iterative simulations that were designed to identify the stations that had the greatest influence on the access scores of the ten lowest access districts. Results: Following NAS inception, the proportion of Ghana's landmass serviceable within 60 minutes of a station increased from 8.7 to 59.4% from 2004 to 2014, respectively. Over the same time period, the proportion of the population with access to the NAS within 60-minutes increased from 48% to 79%. The two-step floating catchment area model identified considerable variation in district-level access scores, which ranged from 0.05 to 2.43 ambulances per 100,000 persons (median 0.45; interquartile range 0.23-0.63). Seven candidate districts for NAS station addition and five candidate NAS stations for capacity expansion were identified. The addition of one ambulance to each of the five candidate stations improved access scores in the ten lowest access districts by a total 0.22 ambulances per 100,000 persons. Conclusions: The NAS in Ghana has expanded its population-level spatial access to the majority of the population; however, access inequality exists in both rural and urban areas that can be improved by increasing station capacity or adding additional stations. Geospatial methods to identify access inequities and inform service expansion might serve as a model for other LMICs attempting to understand and improve formal prehospital care services.

Socioeconomic determinants of use of reproductive health services in Ghana.

BackgroundThe study examines trends in the consumption of reproductive health services (use of modern contraceptives, health facility deliveries, assisted deliveries, first trimester antenatal visit and 4+ antenatal visits) and their determinants using four rounds of Ghana Demographic and Health Surveys (1993, 1998, 2003 and 2008) data.MethodsThe study uses cross-sectional and pooled probit and negative bionomial regressions models to estimate the determinants of use of the above listed reproductive health services for the period from 1993 to 2008.ResultsSummary statistics suggest that the above-listed reproductive health services have consistently improved from 1993 to 2008. However, use of traditional methods of contraception increased in urban centers between 2003 and 2008, although the reverse was the case in rural areas. Regression results suggest that place of residence, access to and availability of health services, religion, and birth order are significant correlates of use of reproductive health services. Additionally, the study suggests that the number of living children has the largest effect on use of modern contraception. The effect of a partner’s education on use of modern contraception is higher than that of the woman, and a much stronger correlation exists between household wealth and use of reproductive health inputs than expected.ConclusionThe study associates the increasing use of traditional contraceptives in urban centers and the much stronger effect of household wealth with urban poverty and the increasing indirect cost of health services, and argues for interventions to improve quality of service in public facilities and reduce inequities in the distribution of health facilities. Finally, the study advocates for family planning-related interventions that involve and target partners given the importance of partner education in the use of modern contraception.

Impact of NHIS free maternal healthcare policy on utilization of maternal care services in Ghana

Impact of NHIS free maternal healthcare policy on utilization of maternal care services in Ghana

Examining consumer adoption and perception of Mobile Money in Ghana

This paper investigates the consumer perception of a new electronic financial service in Ghana, namely mobile money (MM). We analyse the relationships among five MM-related constructs, which are perceived ease of use (PEOU), perceived usefulness (PU), perceived mobile money security (PMMS), attitude (ATT), and intention to use (IU). Importantly, the impact of age, family income, and gender on the relationships among the five MM constructs has been studied using a multi-group analysis approach. We find that PEOU, PU, and PMMS are significant determinants of ATT in the MM market in Ghana when age, family income, gender are not considered. However, the relationships among the five constructs exhibit significant variations when age, family income, and gender are considered. We also find an evidence that the effects of age, family income, and gender on consumers' perception of, ATT towards, and intention of using MM are significant in Ghana. The results of this study provide more insights into the research on MM, thus helping the development of marketing strategies for the service.

Implicit and explicit loyalty: the role of satisfaction, trust and brand image in mobile telecommunication industry

This paper assesses the moderating role of satisfaction, trust and brand image within implicit and explicit brand loyalty framework in mobile telecommunication services in Ghana. The proposed model was evaluated based on data from 338 consumers obtained from a cross-sectional survey. Partial least square (PLS) structural equation modelling (SEM) was used to analysed data. The results show that implicit loyalty, comprising of cognitive, affective and conative, makes significant influence on explicit loyalty; the moderating role of satisfaction on this relationship was strongly supported while the role of trust and brand image were partially significant. This paper provides theoretical extensions to sequential loyalty models. Despite its contextual limitations, the paper implies that marketing managers need to develop marketing and loyalty strategies that result in better customer satisfaction, induce more trust in the brand and project the image of the brand high to build a stable customer base which is a core business asset.

Effect of National Health Insurance Holding on the Choice of Health Facility for Childbirth in Ghana

Maternal and child mortalities are among major health problems facing developing countries such as Ghana. Most of these deaths can be avoided by utilization of maternity health care services. The study examines the effect of health insurance holding and other socioeconomic and demographic factors on the choice of health facility for childbirth in Ghana. The study used data from the 2008 Ghana Demographic and Health survey. Data were analyzed for descriptive statistics as well as a Multinomial Logistic Regression for identification of factors that influence delivery in health facility. The study results have shown that, holding of health insurance and wealth significantly influences expectant mother’s decision to use government health facilities for childbirth. Also, the study revealed considerable variations in region and between rural and urban utilization of this services in Ghana. It is recommended that in order to improve the utilization of health facility for childbirth services and hence maternal health care utilization, there is the need to improve public awareness and efforts should also be taking by policy makers to integrate the private sector properly into the National Health Insurance scheme. Policy should also target mothers who have had the experience of child birth on the need to use health care facility services for each pregnancy. The government and other service providers (NGOs, religious institutions and private providers) may endeavor to improve on the distribution of health facilities, human resources, good roads and necessary infrastructure among other things in order to facilitate easy access to health care providers especially for rural dwellers.