CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Global economic issues such as unemployment, low income levels, unequitable distribution of resources, forced marriage, family breakdown, lack of , peer influence have forced a lot of people to move from their places of origin; mostly rural areas to major cities instead of staying with their loved ones (Van den Berg, 2007). Also, De Han (2006), cited in Hujismans (2012) explains that, migration has become part of people’s lives especially the young people who are mostly in search of greener pastures. In , the high poverty levels in the northern parts of the country, that is, the Upper West, Upper East and Northern Regions, compel girls and women to migrate to the southern parts, mostly to the capital cities like and , to engage in the

“Kaya business” (Boateng & Korang-Okrah, 2013). “Kaya business” in this study refers to the act of carrying load on the head for a fee.

Most of the girls and women who engage in head porterage (Kaya business) are mainly from the Commented [A1]: Your paragraphs need to be clearly indicated0. You either indent on the left, using the ‘Tab’ key, Mamprusi, Gonja, Kotokoli, Mossi, Frafra, Bimoba, and Dagomba ethnic groups which are all or you space out by pressing the ‘enter’ button once. located in the Northern parts of Ghana, with a few of the from Burkina Faso and Togo

(UNFDP Evidence and Action Report, (2006-2011); Opare (2003) and Ziblim (2013). Also,

Agarwal et al (1994) and Opare (2003) assert that, most of these female migrants who travel down south and to the middle belts are young ladies who are mostly between the ages of 10 and 35 and have limited or no formal education. As a result of this little or no formal education, these female migrants have no prospects of gaining employment in the formal sector at the cities (Yeboah &

Appiah- Yeboah, 2009), and as such engage in the Kaya business as a means of earning income.

However, Agarwal et al (1994) state that, the Kayayei see the Kaya business as short term business

1 to accumulate enough money to enter into other profitable ventures in the future. According to

Opare (2003), some Kayayei engage in the Kaya business to acquire possessions like utensils, clothes in the preparations towards marriage while others save money to enable them undergo in hair dressing or dress making. Additionally, some Kayayei want to earn, save and send remittances to their families back home as Tanle (2007); Boateng & Korang- Okrah

(2013) and Alfers (2013) mention that, the Kayayei usually leave behind relatives like husbands, children and parents in their hometowns.

When the female migrants arrive at the urban areas to become Kayayei, most of them do not have any relations at the urban areas to support them financially. This leads them to settle in slum areas where accommodation comes at a cheap cost and of poor quality (Tufuor, 2009). Securing such cheap accommodation is one of the survival strategies employed by the Kayayei in the quest to spend little and save more money Agarwal et al (1994). However, such cheap accommodation in slum areas among other lifestyle practices such as poor hygiene have a negative impact on the health of the Kayayei.

The Kayayei migratory vulnerabilities like accommodation in slum areas, harsh working conditions among other factors leave them exposed to occupational hazards (primarily back pain and headaches), sexual violence and hygiene/sanitation-related illness such as diarrhoea and malaria.

1.2 Statement of Problem

Despite the fact that Kaya business serves as a source of income for most female migrants from

Northern Ghana, (Agarwal et al (1994) and Tanle (2007), the activity exposes (Kayayei) to various health conditions like diarrhoea, malaria and Sexually Transmitted Infections (STIs). Researchers like Opare (2003); Kwankye et al (2007) and Ziblim (2013) have noted that, various lifestyle

2 practices such as spending nights in the open and at market centers, eating from unhygienic places which forms part of their environment heightens the Kayayei’s risk to some of these health problems mentioned above. Also, the District and Analytical Report of La Nkwantanang-Madina

Municipal (2014) concludes that, liquid and solid waste is improperly disposed in the municipality.

This has severe health implications for the Kayayei in the Madina municipality as they are exposed to these unsanitary conditions.

The health of Kayayei is a concern since it contributes to determining their ability to make ends meet and honour the major reason for migrating to the cities which is to seek greener pastures.

This is because without a stable mind and body, the Kayayei will not be in a position to perform any of their daily tasks of carrying luggage and goods for people, which Agarwal et al (1994) observed has become an important aspect of the transport business usually at market centres.

Though some research has been done on Head Porterage, only a few of these works like Adams

(2012) and Ziblim (2013) are specific to the health of female head porters (Kayayei). Furthermore, some effort have been made by governments and some Organizations to help resolve some of these health related concerns. These efforts include the National Health Insurance Scheme (NHIS) which was established in 2004 to provide affordable health care. Also, Non-Governmental Organizations

(NGO) like United Nations Population Fund (UNFPA) and Society for Women against AIDS in

Africa (SWAA) have trained and educated some Kayayei on Sexual and Reproductive Health issues. (Ghana News Agency, 5th November, 2013). However, most Kayayei are still are challenged with various health conditions as Van den Berg (2007) and Alfers (2013) have noted that, some Kayayei are unable to afford the NHIS premium, which means they cannot benefit from the NHIS. Alfers (2013) further argues that, apart from the Kayayei inability to pay the NHIS premium, most Kayayei complain that, the NHIS does not work when used in accessing health

3 care. Regardless of the above mentioned efforts put in place by government and some NGOs, the health problems of Kayayei continue to persist.

1.3 Research Objectives

The general objective of this study is to examine the health related concerns of Female Head

Porters (Kayayei) in Madina.

The specific objectives of this study are as follows;

1. To find out the factors that make Kayayei in Madina prone to health problems.

2. To find out the health seeking behaviours of Kayayei in Madina.

3. To find out the challenges faced by Kayayei in Madina when seeking health care.

1.4 Research Questions

1. What factors make Kayayei in Madina Market prone to health problems?

2. What are the health seeking behaviours of Kayayei in Madina?

3. What challenges do Kayayei in Madina face when seeking health care?

1.5 Rationale of the Study

Female head porters (Kayayei) are a major disadvantaged group who are vulnerable to various health issues like STIs, Diarrhoea among others. However, Van den Berg (2007); Adams (2012) and Alfers (2013) have noted that, many Kayayei are unable to pay for the NHIS premium to access health services at various clinics and hospitals. The researcher therefore sought to delve into the health related issues of Kayayei in Madina and make some recommendations for possible intervention by individuals, groups and Organizations.

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1.6 Significance of the Study

This study will provide more insight into the lives of Kayayei in relation to the factors that make them prone to various health issues and their health seeking behaviours. The available literature on this topic like Adams (2012) and Ziblim (2013) is scanty, therefore this study is intended to add on to the information available on this topic. This study will also serve as a guide to policy makers and stakeholders when making decisions concerning the health issues of Kayayei.

1.7 Definition of Concepts

Kayayei: Kayayoo is a name given to a girl or woman who works as a head porter in market places. (UNFPA, Evidence and Action report 2006-2011). According to Agarwal et al (1994) and

Opare (2003), Kaya means luggage/loads or goods in the Hausa language and “yoo” (a singular noun in the Ga language meaning female) has its plural form as “yei” (that is, ‘females’). Therefore the literal meaning of Kayayoo is a woman who carries loads.

Health according to the World Health Organization (WHO) is the complete state of physical, social and mental wellbeing, and not mainly the absence of disease and infirmity.

1.8 Organization of the Study

This study is organized in five chapters. The first chapter focuses on the introduction of the entire study. The background of the study, statement of the problem, the location of the study, objectives of the research, research questions, rationale for the study, significance of the study, definition of terms and concepts will be discussed. The second chapter reviews available literature in connection with the research topic. The third chapter deals with research methods which include the design to be used, target population, study population, sampling unit, sampling design. The size of the sample, methods of data collection, data handling and analysis and the ethical consideration of the

5 study. Chapter Four presents the findings based on data gathered and analyzed by the researcher.

It also discusses findings in relation to the objectives of the study. Chapter five focuses on summary, conclusion and recommendations of the study.

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CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

In this chapter, available literature in relation to the study is reviewed. The researcher will consider other core areas related to head porterage, such as; reasons why females migrate and the opportunities at the urban areas, the “Kaya Business”, Reasons for Engaging in Head Porterage amidst Other Informal Sectors Jobs. Also, the literature review will focus on the objectives of this study which include; Factors that make Kayayei Prone to Health Problems, the Health Seeking

Behaviour of Kayayei.

2.2 Reasons Females Migrate and the Opportunities Available at the Urban Areas

Poverty is one of the factors that necessitate migration from rural areas to various cities. Anarfi et al (2003) notes that, internal migration in Ghana is influenced by the difference in the poverty levels between Northern and Southern Ghana. The case Kayayei movement from northern Ghana to major cities like Accra and Kumasi to earn a living is also caused by poverty. Opare (2003) confirmed this claim by stating that, female migrants from the northern part of Ghana move to the southern areas due to poverty. Adams (2012) citing from the Ghana Statistical Service (2005 and

2008) noted that, 70% of people from the three northern regions: Upper West, Upper East and

Northern continue to remain poor despite the reduction in national poverty levels.

Also, most female migrants would have wished to undergo an apprenticeship or learn a trade in dress making and hair dressing but are unable to do so because of poverty (Hashim, 2007). As a result of poverty, the female migrate to urban areas with the hope that, she can access better

7 livelihood as they have the perception that, there are better opportunities available to them in the cities as compared to their hometowns in the rural areas (Tufuor, 2009).

Another factor that causes females to migrate to southern cities is cultural perceptions and expectations. According to Tanle (2007) and Huijsmans (2012), usually, girls in the performance of gender roles, would have to generate income to acquire household items like cooking utensils, cloths, jewelries etc. when preparing for marriage. Acquiring these household implies that the woman is hardworking and does not depend solely on her husband. Such cultural expectation influences the females’ movement to the cities. This idea has being confirmed by Agarwal et al

(1994) and Opare (2003) as one of the reasons females migrate to the southern sectors searching for economic gains in order to acquire property in their preparation towards marriage. Also, cultural beliefs and practices such as the misconception that females end up “in the kitchen” and thus resources should not be spent on their education is another reason why females migrate.

Yeboah & Appiah-Yeboah (2009) state that, this traditional thought has aided in the increase of female migration. According to Tanle (2007), in Northern Ghana, some parents believe the man who marries an educated female benefits and therefore they (the girl’s family) will not spend their resources to educate the girl. He further explains that, this idea emanates from the patrilineal inheritance system.

The opportunity to earn income is a reason females migrate. Usually, people who migrate from the rural areas to the cities go with the hope of finding better opportunities to support themselves and their families. According to Kwankye et al (2007) and Tanle (2007), the opportunity available at the urban areas is the ability to earn income. The female migrant, working as a head porter

(Kayayoo) has the chance of earning income in the cities. This opportunity of earning income is rarely available at the rural areas where the main source of livelihood is agriculture. Tanle (2007)

8 further observed that, returned female migrants had resources to pursue other careers like open a tailoring shop. Also, Anarfi et al (2003) mentions that, migration among females helps improve the well-being of the individual migrant and the family as well. Thus the income gained by the

Kayayei in the urban areas does not only benefit the female migrants but the household at large.

2.3 The “Kaya Business”

The Kaya Business simply means the act of carrying a load for a fee. Some researchers have endeavored to come out with meanings associated with the term Kayayei (female head porters).

Among the definitions is “Kayayoo” is a name given to a girl or woman who works as a head porter in market places (UNFPA Evidence and Action report 2006-2011). Quoting from Tufuor

(2009), “Kayayei or women head load – carriers work as human transport by using their heads to carry goods and luggage of any nature mainly for business people to their destination at a price often much below a dollar”. Tanle (2007) also defines Kayayei as women who engage in carrying wares for a fee. According to Agarwal et al (1994) and Opare (2003), Kaya means luggage/loads or goods in the Hausa language and “yoo” (a singular noun in the Ga language meaning ‘female’) has its plural form as “yei” (that is, ‘females’). Therefore the literal meaning of Kayayei is a women who carry loads. Based on these definitions and explanations, one can conclude that, a Kayayoo is a female head porter who transport goods and loads usually at an agreed fee.

Usually, individuals who are engaged in the Kaya business are from the three northern parts of

Ghana with minority of them coming from the southern cities as well as neighbouring countries like Burkina Faso and Togo (Opare, 2003). Based on the idea that Kaya Business is the act of carrying loads for a fee, it can be noted that, both males and females are engaged in the business.

However, Huijsmans (2012) states load carrying has evolved and is increasingly perceived to be a

9 female job. This assertion may be true because carrying loads on the head is traditionally seen by most Ghanaians as female gender role especially in terms of the household chore of carrying water.

The Kayayei can be seen operating at virtually every major market center Opare (2003). As such,

Van den Berg (2007) focused her study location at larger market centers in Accra like the Mallam

Atta Market, Madina Market and .

2.4 Reasons for Engaging in Head Porterage amidst Other Informal Sectors Jobs

As stated by Opare (2003) and Tanle (2007), most of the female migrants engaged in the Kaya business are usually unskilled with little or no formal education at all. It is for this reason that,

Yeboah and Appiah-Yeboah (2009), assert that gaining employment in the formal sector is not feasible for the Kayayei. According to Osei- Boateng & Ampratwum (2011), informal sector jobs available at urban areas to individuals who are illiterate or semi illiterate may include; hawking, cooked food sellers, domestic workers among others. Among this wide range of opportunities, the female migrant mostly from Northern Ghana opts for head porterage. This begs for the question: why do most female migrants from Northern Ghana choose the Kaya business above other opportunities or combine it with others?

According to Agarwal et al (1994), female migrants from Northern Ghana engage in head porterage because of the low startup capital head porterage requires. The female migrant usually requires just a head pan and relies on her physical strength in the Kaya business. Van den Berg

(2007) confirms this by highlighting that, the Kaya business is more of a physical activity. It is also argued by Agarwal et al (1994) that, the Kayayei stay in the city are mostly for short period of times, therefore investing in other transport technology (carriage) becomes the least of their worries. They further assert that, most people view the use of transport means like trucks,

10 wheelbarrows among others as too masculine for females to be engaged in as a means of porting people’s loads and luggage.

Van den Berg (2007); Zaami (2010) and Huijsmans (2012) suggest that, some of the Kayayei are engaged in other jobs like shop attendants, helping local “Chop Bar” owners, washing people’s clothes, and cleaning homes. These other jobs are usually combined with Head Porterage in an attempt to earn extra income.

2.5 Factors that makes Kayayei Prone to Health Problems

According to Opare (2003); Kwankye et al (2007) and Ziblim (2013), the Kayayei’s living conditions such as no stable accommodation, poor eating habits and harsh working conditions among others increase the Kayayeis’ risk and vulnerabilities to various health issues. As

Zimmerman et al (2011) assert, low skilled migrants are a high risk of acquiring injuries and various illnesses. The sub-sections below are some of the factors that make the Kayayei prone to health problems.

2.5.1 Accommodation: According to Agarwal et al (1994); Opare (2003); Tufuor (2009) and

Alfers (2013), most Kayayei who migrate to the southern sectors usually do not have any family connections at the cities. As a result, most Kayayei are exposed to poor living condition after the day’s work. Some Kayayei sleep on the streets (Agarwal et al, 1994), in front of stores or share small sleeping space as a form of accommodation. Also Van den Berg (2007); Tufuor (2009) and

Boateng & Korang-Okrah (2013) mentioned that, most Kayayei live in various wooden structures in slum areas in Accra and Kumasi. The researchers above explained the reason for such accommodation style as, the Kayayei do not earn enough income and therefore cannot afford the high cost of rent in urban centers. Adding up to the literature on Kayayei accommodation, Agarwal et al (1994) and Boateng & Korang-Okrah (2013) state that, some Kayayei contribute money to

11 rent wooden structures around the market centers that serve as a place of home for them. Van den

Berg (2007) sides with this notion but asserts that, these wooden structures (kiosk) are mostly overcrowded. Overcrowding in these kiosks exposes Kayayei to the risk of contracting air borne diseases, skin diseases and the lot. According to Mahama and Antwi (2006) cited in Tufour (2009), these wooden structures come with no sanitary facilities like toilet, bath and water. This presupposes that, the Kayayei will have to use public toilets and baths which are mostly unhygienic and hence have a negative impact on the health of Kayayei.

Kwankye et al (2007), mention the harsh weather conditions associated with sleeping outside on the street and at transport stations (trotro stations) as an accommodation issue. Most Kayayei complain of being robbed of their money and assaulted sexually when they sleep outside. This does not allow them have sound sleep as they are always on the lookout for thieves and sexual abusers throughout the night. These accommodation issues faced by Kayayei is further explained by Boateng & Korang-Okrah, (2013) and Ziblim (2013) as having pushed some Kayayei into consenting to sexual relations with other young men to receive security and protection from them against other harassers on the street. This exposes Kayayei to sexual abuse or rape and increases the risk of contracting HIV/AIDS.

2.5.2 Eating Habits: Another factor that increases the health risks of Kayayei is eating habits. As noted by Boateng and Korang-Okrah (2013), Kayayei usually buy and eat in the market centers.

Mostly these foods are prepared under unsanitary conditions and this may expose the Kayayei to illness like cholera, diarrhoea Yeboah (2010). Also Taylor et al (2002) state that, the environmental condition of slums areas in Accra and Kumasi are unhygienic as it is characterized by uncollected garbage coupled with inadequate water to maintain hygiene. This is a representation of where the

Kayayei purchase food from. Taylor et al (2000) further suggest in the slum areas, there is poor

12 nutrition among residents and their children. Considering Tarannum’s (2011) argument about unhygienic slum areas in Dhaka, which is closely related to Taylor et al (2000) assertion of environmental conditions of slums in Accra and Kumasi, one can deduce that the Kayayei’s living and eating in unhygienic conditions compounded by poor drainage system in these slum areas can directly leads to health issues like diarrhoea, ring worms, malaria. These health conditions are related to eating in unhygienic environments.

2.5.3 Working Conditions: The working conditions of the Kayayei are harsh and also makes them vulnerable to some health problems. The Kayayei’s daily task of carrying loads from one place to the other for a fee has being described by Van den Berg, 2007 as more of a physical activity, thus seen to be a tedious work. Their job further heightens the risk of being exposed to health problems.

Researchers like Agarwal et al (1994); Opare (2003) and Van den Berg (2007) among others have recorded some ailments experienced by Kayayei due to the carrying of heavy loads. These ailments include headache, back pains, body pains and injuries derieved from being cut by their head pans.

Also, Yeboah (2010) mentions that female head porters work for longer period carrying heavy goods and pushing their ways through crowded pathways. This makes the Kayayei working conditions difficult among the earlier mentioned factors. Poor working conditions coupled with little rest put the Kayayei at risk of various health conditions.

Accommodation problems, working conditions, eating habits are some factors explored in the literature as heightening the Kayayei’s risk to health conditions like malaria, cholera and skin diseases among others.

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2.6 Health Seeking Behaviours of Kayayei

Most literature including Van den Berg (2007); Ziblim (2013) and Boateng & Korang-Okrah

(2013) state that, Kayayei’s popular means of seeking health care is by buying medicines from chemical stores, drug peddlers, pharmacy shops among others, with only a few of them accessing facilities like clinics and hospitals. However, it is unclear whether the Pharmacist administers the drug based on professional knowledge or because the buyer in this case the Kayayei request for it.

In relation to that, Ziblim (2013) notes that, most Kayayei abuse drugs. He explained this assertion by stating that Kayayei purchase medicines from chemical shops based on prescriptions suggested by their fellow Kayayei friend. The request for this medication would most likely be based on the advice and experiences of their fellow Kayayei friend. Kwankye et al (2007), add that most migrants in seeking health care, buy medicines from chemical and pharmacy shops. Though his research was on child migrants, Kayayei can be said to be inclusive as most of the Kayayei are child migrants as well.

It is evident from the afore-mentioned studies that, Kayayei do not use clinics and hospitals around them when they have a health condition even with the introduction of the National Health

Insurance Scheme (NHIS). The National Health Insurance Scheme (NHIS) was introduced by the in 2004 to allow individual card holders (NHIS Card) to access affordable health care at an annual premium. Consequently, Kayayei among other Ghanaians can have access to affordable health care when using the NHIS card. Nonetheless, Van den Berg (2007) and Alfers

(2013) state most Kayayei are not registered on the NHIS because they cannot afford the payment of the premium due to low income. The Kayayei health seeking behaviour is influenced by the resources (money) available to them. Asaana (2015) supports this by affirming that, health seeking is expensive for female migrants, and even those who have subscribed to the NHIS. He also

14 believes if the Kayayei earned more, their (Kayayei) high income will influence their decision to seek better health care.

2.7 Conclusion

This chapter reviewed existing literature. The review provided more insights on this study and has also showed some gaps in the Kayayei phenomenon that need to be considered in the future as research topics.

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CHAPTER THREE

RESEARCH METHODS

3.1 Introduction

This chapter presents the methodology used in conducting this study. The research methods comprises of the study design, target population, study population and the sampling unit and design. The sample size, data collection methods, data handling and analysis as well as the ethical considerations are also presented in this chapter.

3.2 Study Design

This study made use of qualitative research design. Qualitative researchers are concerned with the meaning people have constructed i.e. how people make sense of their experiences (Creswell,

2013). This design was used because the researcher wanted to gain a rich understanding of the health behaviours of Kayayei in Madina.

3.3 The Location of the Research

The La Nkwantanang-Madina Municipality is located at the northern part of Accra. It was carved out of the Ga East Municipality as part of the newly created assemblies in 2012. The population of the municipality is 111,926 representing 2.8% of Greater Accra regional total population. There are 51.5% and 48.5% of females and males respectively. 37.8% of those in the municipality are youth. Some of its neighboring areas are the Adenta Municipality, Accra Metropolitan Assembly.

About 84% of the municipality is urban. Majority of the people are self-employed mostly engaging in sales and services in the informal sector (District and Analytical Report of La Nkwantanang-

Madina Municipal, 2014).

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Below are reasons the La Nkwantanang-Madina Municipal is one of the ideal locations for this study. Inferring from Yeboah and Appiah-Yeboah (2009) and Tutu (2013), most female migrants intending to engage in head porterage (Kaya business) settle at Madina because of the existence of a big market. Also, Kayayei are more likely to live close to locations were their relatives or someone they know resides (Xu, 2011).

3.4 Sampling

The researcher in the quest to gain opinions from Kayayei who are residents in different vicinities of Madina interviewed three (3) participants from Atiman, twelve (12) from Nkwantanang and five (5) from Redco based on convenience. Sampling for this study was done in this manner because, the Kayayei usually live in groups based on their ethnic background and the languages spoken. As such the researcher hoped to gain different opinions from the Kayayei who resided at different areas within Madina.

3.4.1 Sampling Design

The convenience and snowballing sampling technique were used. The convenience sampling technique was used to enable the researcher include only Kayayei who were accessible to be participant in this study as Kayayei are mostly on the lookout for customers. Convenience sampling was also employed to ensure that participants do not leave during the interview sessions.

Also, the researcher employed snowballing technique. With this technique, some participants were introduced to the researcher by other Kayayei who had volunteered to be participants of the study.

3.4.2 Target Population

The target population for this study were the Kayayei at Madina market.

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3.4.3 Study Population

The researcher studied twenty Kayayei who worked and live around the Madina market specifically Atiman, Redco and Nkwantanang.

3.4.4 Sampling Unit

Sampling unit for this study was any individual Kayayoo at the Madina market who was willing to provide information for this study.

3.4.5 Sample Size

A total of twenty (20) participant were interviewed in order to gather data for this study.

3.5 Methods of Data Collection

Primary data was collected using in-depth interviews and non-participant observation. The interviews were conducted on a face to face basis with the use of an interview guide which contained semi structured questions. Follow up questions were asked when required. In-depth interviews helped the researcher to explore individual experiences and different opinions among participants. Most of the interviews were conducted using the Twi language as most of the participants could not read or write in . However, a few of the participants opted to be interviewed using the English language but they (participants who spoke English) mainly spoke ‘broken’ English.

Also, non-participant observation was employed to collect data on the lifestyles and activities of the Kayayei in Madina. This observation was done by the researcher based on the objectives of this study with the aid of an observation checklist.

In the course of data collection, audios were recorded during the interview sessions and notes were also taken during observations.

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3.6 Data Handling and Analysis

The notes taken during the interviews were typed out and audio recordings were transcribed accurately. The transcripts of interviews were read over and over again to enable the researcher become familiar with the content. The thematic analysis was used in analyzing data collected from the field. Whiles reading the transcripts, the emerging themes were identified and developed in relation to the objectives of this study. The findings were presented and discussed. In the presentation of findings, the views of participants were quoted to support the various themes. In quoting these views, some words were translated from Twi to English while some of the views were quoted in broken English as spoken by participants during the interviews. Also, the discussions section made references to the reviewed and existing literature

3.7 Ethical Consideration

Social Science research ethics were upheld throughout this study. The following explains how these ethics were applied in this study.

Informed Consent: The researcher explained to the participants what the study was about, the purpose to the study and their right to withdraw at any time if they were not interested in participating in the study. Also, oral consent was sought from the participants before interviews were conducted.

Confidentiality and Anonymity: Confidentiality was ensured by the researcher as only information relevant to this study were collected from participants. Also, information gave by participants were only used for the purpose of this study. Individuals, groups and organizations who do not have authority over this study did not have access to participants’ information. The researcher further protected the identity of participants by ensuring that pseudonyms were used to represent their views.

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No deception of the Participants: The researcher did not mislead any of the participants on the reason for conducting this study. Most of them thought at first, the researcher was bringing monetary help. But the researcher made all participants aware that, this study was for academic purposes. Hence no participant was deceived about the intent for conducting this study.

Non-Inducement of Participants to take part in the study: With this ethic, the researcher did not use any form of gifts to influence participants to take part in this study. All participants volunteered to provide information for this study. This helped the researcher to know that participants gave genuine opinions about the topic.

3.7 Limitation of the Study

The major limitation of this study was language problems. Most of the interviews were conducted using the Twi language. As a result, it was difficult to translate some of the words into English language, therefore the researcher used synonyms to represent those challenging words.

3.8 Conclusion

This chapter explored the research methods used by the researcher in conducting this study.

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CHAPTER FOUR

PRESENTATION OF FINDINGS AND DISCUSSION

4.1 Introduction

This chapter is divided into two sections, the first section presents the findings of data gathered and the second section discusses the findings. The presentation of findings and discussion takes into consideration the objectives of the study and the reviewed literature. The findings are grouped under the three main objectives of this study. These are; factors that make Kayayei prone to health issues, the health seeking behaviours of Kayayei and the challenges faced by Kayayei when seeking health care.

4.2 Demographic Characteristics of Participants

Majority of the participants could not give a precise age. The few who were able to give a certain age were between fifteen (15) years and twenty-eight (28) years. It was observed that those few ones who were certain about their ages had a little formal education. The participants came from areas like Walewale, Bilen, Wa among others in the Northern part of Ghana. Most of the participants had a little or no formal education. Their educational background ranged from primary to Junior High Level. Apart from the Kaya business, some of them engaged in other activities such as washing and cleaning clothes for households for a fee, washing plates for food vendors and sewing among others. Three participants had training in dress making but only one was combining sewing with the Kaya business. Some also revealed that they were working hard to save money in order to open up shops in their respective hometowns. The participants reported that the average amount of money they earned daily is between GHC 10.00 to GHC 15.00. They described this

21 daily earnings as less and explained that the Kayayei at Madina are many as a result of which they cannot earn more.

Abena who is 22 years had this to say in relation to her income;

“We the Kayayei here, now we are many so a day I get around GHC10.00, GHC15.00 or Commented [A2]: Don’t bring quotation marks if you indent the quote. GHC 20.00”. Commented [A3]: Same comment as above

4.3 Factors that make Kayayei Prone to Health Problems

The Kaya business offers most Kayayei the opportunity to earn a living, however, it was found in the study that factors like improper accommodation coupled with no sanitation facilities, poor eating habits, harsh working conditions and ignorance exposed the Kayayei to various health problems like malaria, cholera, skin rashes, and frequent headaches among others. These factors are presented in the following sub-sections.

4.3.1 Improper Accommodation coupled with no Sanitation Facilities

The Kayayei were found to be sleeping in wooden or “tent-like” (layers of cement blocks put on top of one another by the Kayayei themselves with no doors) structures which they share as their accommodation with other Kayayei. In the wooden or tent-like structures, they kept their belonging such as clothes, pans, money and so on. The wooden structures were rented in groups depending on one’s ethnic group.

Three participants reported that they sleep outside the wooden structure and keep their belongings inside because they are many sharing the room which makes it congested. Kuka, aged 17 years who sleeps outside and keeps her things in the wooden structure had this to say;

“I sleep outside with some of my colleagues, the room is full so we all cannot sleep in it.

My clothes and everything are in the room. When the rain falls, we go to sleep or stand at

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the veranda of provision stores or drinking spots. Mosquitoes bite us there a lot”. (Kuka,

17 years).

Thirteen (13) participants said they sleep inside the wooden structure as well as keep their belongings inside the wooden structure. Those that slept inside these crowded wooden structures reported contacting illnesses such as skin rashes and coughs which spread quickly among them.

According to Adjoa a 19 year old lady said that;

“The place I sleep is good but not so good because there are some small black insects that

bites us and it itches a lot, even now there are rashes all over the body of my child’s and I

because of the insect bites”. (Adjoa, 19 years).

Five (5) participants slept in a tent- like structure prepared by themselves. Atta who sleeps in the tents-like structure had this to say in relation to her accommodation and its possible health issues;

“There are a lot of mosquitoes in these tents which gives us malaria”. (Atta, 25 years).

The poor accommodation patterns, also pose sanitation challenges to the Kayayei. The wooden structures and tent-like structures used by the participants as a form of accommodation came with no toilet and bath. As a result, the Kayayei uses public toilets and bathrooms.

One of them described the public toilet and bathroom facility as sickening and smelly by saying;

“I pay money to use public bathroom and toilets. The public bathroom and toilet is not nice

and smells a lot, but what can I do?” (Ajo, 15 years).

4.3.2 Poor Eating Habits

It was also realized from the findings that the eating habits of participants had a negative impact on their health. All participants reported that they bought food from the roadside or around the market centers and did not cook at home.

23

Abena, 22 years described her eating pattern as;

“I buy food from the roadside, because it is less expensive. It is better to cook at home than

buy from the roadside. As I am not aware of how the food I buy is prepared and the place

I buy it from is not neat.”

Nsiah added this;

“I always buy food from outside because there is no place to cook. Besides I don’t have

cooking utensils here to enable me cook for myself. “(Nsiah, 21years).

Mansah, 24 years also said;

“I sometimes cook when I have money but mostly I buy from the roadside because, cooking

is very expensive as compared to buying from the roadside”.

4.3.3 Harsh Working Conditions

Another factor was the harsh working conditions. In the participants’ description of the Kaya business, it was found out that the Kaya business is very tedious and affects the health of the

Kayayei negatively. One participant had this to say when asked if the Kaya Business has effect on her health;

“Yes, yes, one day you always go and carry some load and it is heavy and your heart (points

chest) and your this thing (points neck) is paining you but you cannot see money too.”

(Dylla, 20 years).

Kuka, 17years, when asked why she thinks she experiences body pains and leg pains responded that;

“Because I carry heavy loads and walk long distances under the scorching sun.”

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Another participant added this;

“I get chest pains and fever as a result of the heavy load I carry and also because I walk

under the sun for a very long time with my baby at my back. I don’t get enough rest.”

(Joyce, 28 years).

4.3.4 Ignorance

From the interviews, it was noted that ignorance is another factor that caused health problems to the Kayayei. When one participant was asked, “Do you think the crowding in the room can spread certain illnesses?” she responded saying;

“Yes, but sometimes we don’t know which of the illness is transmitted among ourselves.”

(Mansa, 24 years).

But these are participants who are mostly spotted taking out lice’s from each other’s hair. The lice in the hair is usually caused by the overcrowding and inadequate personal hygiene among the

Kayayei. A conversation with a participant revealed that, in their hometowns, they never get lice in their hair but when they come to Accra they get them.

Also, the researcher observed some Kayayei being tattooed by someone who appeared unprofessional. When participants were asked about their awareness of this unprofessional form of tattooing makes them vulnerable to infections like HIV/AIDS, some of them said;

“There is nothing wrong if the pins used in tattooing her sister (a Kayayoo friend whom

she is close with) is used in tattooing me because we are close and I know her.” (Cecilia,

18 years).

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“If you want him to change the needles and pins he used on another Kayayoo, he will

change it but if you don’t ask him to, he will use the same pins and needles. I don’t mind

if he uses the same pins because we are sisters here”. (Kuka, 17 years).

4.4 Health Seeking Methods of Kayayei

The second objective of this study was to find out the health seeking practices of Kayayei. As realized from the previous findings, there are several factors like accommodation issues, poor eating habits, harsh working conditions and ignorance which were found to have negative health implications for the participants. Therefore, this section explores the means by which the participants sought health care when they had health problems. The subsequent sub-sections presents the health-seeking practices of the participants.

4.4.1 Drugs Stores and Drug Peddlers

Out of 20 participants, sixteen (16) reported that, when they fell ill, they bought drugs from drug stores and drug peddlers (individuals who hawk drugs at the market center). Some of the participants’ voices are as follows;

“When I am sick, I go the drugstore to describe the illness and the person recommends a

drug for me.” (Esther, 18 years)

“When I go to the drugstore, I describe the symptoms to the person, then the persons will

look for the drug that will help cure my illness”. (Vivian, 21 years)

Out of the sixteen (16) participants who patronized drugs stores and drug peddlers, ten (10) of them preferred buying drugs from the peddlers than from the pharmacies. A participant describes why she prefers drug peddlers to pharmacy or drug stores as;

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“I buy drug from the drug peddlers because it will be expensive when you go to buy it at

the pharmacy and there is no money, I want money to go back to my hometown.” (Adjoa,

19 years).

This is what two participants had to say as to why they preferred drugstore to hospitals.

“I prefer the drugstore to the hospitals because I don’t have money to go to the hospital. It

is expensive going to the hospitals, and when you don’t pay the money you are charged,

they will not take care of you.” (Abena, 22 years).

“When I buy the drugs, I get better, so I don’t see why I should go to the hospital or clinic

to go and join long queues and pay huge sum of money.” (Priscilla, 23 years)

4.4.2 Health Facilities (Hospitals and Clinics)

The participants generally expressed their preference for receiving health care at the hospital but said they could not afford the hospital due to their income. The following are some of the participants’ voices;

“It is better to go to the hospital when you are sick…” (Priscilla, 23 years).

“I know very well that, the best place to go when you are sick is the hospital”. (Atta, 25

years).

Although most of the participant accepted that going to health facilities for medical attention was the best, only two (2) reports they go to hospitals when they are sick.

According them;

“I go to hospitals when I am sick. I use part of the money earned through Kaya business to

pay for health services.” (Sarah, 28 years).

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“I attend hospital or clinic anytime I don’t feel well.” (Ajo, 15 years)

Sarah further explained why she preferred going to hospitals as compared to buying drugs from drug peddlers and pharmacy shops as;

“Sometimes, when you purchase drugs from drugs stores and from drug peddlers, the drug

does not seem effective. But if you visit the hospital, you are well taken care of and the

doctor might even inject you so you get better faster, that is why I like hospitals than the

pharmacy shops and drug peddlers.” (Sarah, 28 years).

4.4.3 No Drugs nor Clinics

Two participants indicated that, they neither bought drugs nor attended hospitals or clinics when they fall sick. This is what they had to say about their health seeking practice;

“When I am sick, I don’t anything because when I am sick, I don’t have money to go

drugstore to buy medicine or go to the hospital, when I am sick, I just stand like this and

sleep. So that the sickness will remove small from me. So if I’m sick, I just lie down

because there is no any money.” (Dylla, 20 years)

“If you are sick, you don’t do anything, you just lie down, because if you don’t have any

money, you can’t go and buy medicine and drink.” (Afia, 15 years).

The findings indicate that, few of the Kayayei attends hospital when they are sick, while majority Formatted: Space After: 0 pt resorts to drug stores and drug peddlers.

4.5 Challenges faced by Kayayei when seeking health care

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Through the interviews with the Kayayei it was revealed that the Kayayei faced a lot of challenges in an attempt to access health care. Inadequate income and long hours of waiting at the clinic were cited as some of the challenges.

4.5.1 Inadequate Income

From the findings, inadequate earnings was given as a major reason that hindered the participants from seeking appropriate health care. This reason was given by eighteen (18) out of twenty (20) participants. Below are the views of some participants on inadequate earnings as a challenge they encounter in seeking health care;

“I wish I could go to the hospitals when am not well but I don’t have enough money to do

so.” (Rasha, 18 years).

“We cannot see money to go this place (Accra) hospital. But you always look at Kaya

money and do all this things.” (Paulina, 20 years).

“When I am sick and I have money, I go to the hospital but if I don’t have money I go to

buy drugs from the pharmacy shops.” (Esther, 18years).

“… but if money to take to the hospital is not available, one cannot sit home with the illness,

so I buy drugs from drug peddlers to buy the drugs because hospitals don’t reduce the

prices of their drug when they mention it. I also don’t have money.” (Priscilla, 23years)

“Me when I am sick, I don’t have money because, you can wake up one day and go to Kaya

even one cedi, you will not get in one day to eat before you can think of going to buy

medicine”. (Dylla, 20 years).

When most of the participants were asked if they used National Health Insurance Scheme (NHIS) since they do not earn enough income, these were some of their views;

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“The facility I go to is a private clinic and I pay in cash. If you go to the hospitals that

accept NHIS cards, they will make you wait, while they attend to patients with cash. So

long as I am well taken care of, the money is not an issue for me.” (Sarah, 28 years).

“If you go to the hospital with NHIS, they will tell you to go and buy some of the drugs

outside and if you don’t have the money, you can’t buy the drugs.” (Cecilia, 18 years).

“The NHIS we do at our hometown, they say you can take it everywhere but here if you

take it to hospital, they will always say pay before they check you.” (Paulina, 20 years)

4.5.2 Long periods of waiting at health facilities

Another challenge with respect to seeking health care at hospitals is the long hours of waiting. The participants who utilize hospitals are faced with the challenge of waiting for longer periods of time before they are attended to. Two of the participants who attended hospital when they were sick said that;

“Usually, there are a lot of people at the hospitals and I have to wait for a very long time

before they attend to me.” (Sarah, 28 years).

“At times, the doctors come in late so after taking your card and going to see the nurses,

one has to wait in a queue until the doctor comes.” (Ajo, 15 years).

The above sections presented information gathered from the field. These information were grouped based on themes which are in line with the research objectives.

4.6 Discussion of Findings

This section discusses the findings while making reference to available literature on the topic of this study. The discussion will also be based on themes as used in the presentation of the findings.

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4.6.1 Factors that make Kayayei Prone to Health Issues

The findings of this study show that majority of the Kayayei sleep in wooden structures and tent- like structure as accommodation. These structures do not have facilities like toilet, bathroom and potable water. This is generally the accommodation arrangement of Kayayei and it is corroborated by the works of Agarwal et al (1994) in their study titled Bearing the Weight: The Kayayoo,

Ghana’s Working Child; Van den Berg (2007): The Kayayei: Survival in the City of Accra, Ghana and Kwankye et al (2007): Coping Strategies of Independent Child Migrants from Northern Ghana to Southern cities. The accommodation structures of majority of the Kayayei are clustered around

Nkwantanang and Atiman areas at Madina which are situated just around the market and characterized by a lot of filth. For the Kayayei who sleep outside, they are exposed to malaria as the choked gutters around the market places breed a lot of mosquitoes. In such filth, the Kayayei are vulnerable to the possibility contracting cholera too. From the findings, it was realized that the

Kayayei’s average earning a day is low as it ranges from GH 10 to GH 15, with such a low daily income, the Kayayei cannot afford to rent decent accommodation. As a result of low earnings, most Kayayei reside in slum areas at Madina where they complain the public toilets and bathrooms are unhygienic and sickening. This finding is consistent with that of Taylor et al (2002) and Tufuor

(2009) who assert that the urban poor which include most Kayayei usually reside in slum areas with no sanitation facilities as they cannot afford to pay for high cost of rent in urban areas. This situation is further combined with inadequate water to maintain personal hygiene and increases the

Kayayei’s risk of being exposed to health conditions.

Findings of this study show that the accommodation arrangement does not expose the Kayayei to

Sexual and Reproductive Health problems as the studies of Ziblim (2013) and Boateng & Korang-

Okrah (2013) observed. They argued that, some of the Kayayei sleep outside which expose them

31 to Sexual and Reproductive Health issues due to sexual harassment and rape. In this study, none of the participants reported that their accommodation made them vulnerable to sexual harassment and rape and hence, their accommodation does not expose the Kayayei to Sexual and Reproductive

Health issues.

Based on the findings of this study and from other research work like that of Agarwal et al (1997) and Taylor et al (2002), the accommodation arrangement of Kayayei heightens their risk to illnesses like skin rashes, malaria, and cholera among others.

Another factor that make Kayayei prone to health problems is poor eating habits. Buying food from the roadside and around the Madina market is the eating arrangement reported by all participants. According to the findings, Kayayei do not cook because of inadequate income and also because they do not have cooking utensils at Madina to enable them cook. Though this was the main reason stated by participants, one can note based on their responses that, the reason for buying food from the roadside is because they work for most part of the day and hence do not have adequate time to prepare meals for themselves. As most participants claim they leave home at 5am and return at 7pm. It is not the idea of purchasing food from the roadside that is bad in itself, the problem emanates from the environment within which the Kayayei purchase and eat these foods.

From observations made by the researcher, it was evident that these foods bought by the Kayayei are prepared under unhygienic conditions. Areas in the Madina municipality where Kayayei resides like Atiman, Nkwantanang among others are filled with choked gutters and filth from the market, and these are the very places Kayayei are usually spotted purchasing food. This finding is in line with Yeboah’s (2010) assertion that foods consumed by Kayayei are prepared under unsanitary conditions as well as Taylor (2012) argument that, the environmental conditions of slum areas are unhygienic because of uncollected piles of garbage. These findings are also consistent

32 with Boateng & Korang-Okrah (2013) finding that Kayayei mostly buy and eat from market centers. The Kayayei buying food under these condition increase their vulnerability and exposure to Cholera and Typhoid. Though none of the participants reported these illnesses, it was realized most of them are unaware of the names of most illnesses but could adequately describe the symptoms they experience. For example, most participants complained, they usually have stomach aches which could just be a symptom of a serious health issue like Cholera. This poor eating habit could also be the cause of the stomach ache reported by most participants. A conclusion can therefore be made that Kayayei mostly eat from outside their homes and there is a high probability that these places they eat from are unhygienic and therefore has negative effect on their health.

Harsh working conditions of the Kaya business is also a factor that makes Kayayei prone to health problems like headaches, chest pains, neck pain and body pains among others. It could be noted from the findings that loads carried by Kayayei are very heavy. This findings is consistent with that of Van den Berg (2007) and Yeboah (2010) which argue that, the Kaya business is very tedious, because the Kayayei use more physical energy when transporting goods from one place to the other at market centers. The loads carried are heavy and market centers where Kayayei operate are usually crowded. As a result, Kayayei have to find a way of walking through these crowded market centers while carrying heavy loads for their customers and hence the body pains.

Another evident but usually silent factor that exposes Kayayei to health problem is ignorance.

Ignorance among the Kayayei is a result of lack of formal education among the Kayayei. Aside lack of formal education, the nature of the Kaya business does not always offer Kayayei the opportunity to get adequate information from the right sources on their health issues. Also, most of the Kayayei do not visit hospitals where they can get relevant information concerning their health. For example, some of the participants were unaware that using the same pins and needles

33 for tattoos can transmit infections like HIV/ AIDS from one person to another. Also, the fact that

Kayayei believe they are close to one another does not mean, they can share personal items and sharp objects as this habit could spread wide range of diseases such as Herpes simplex, Hepatitis

C virus and like. This proves a high level of ignorance among most Kayayei.

4.6.2 Health Seeking Methods of Kayayei

The paragraphs in this section discusses the health seeking methods utilized by Kayayei when they are sick.

One of the ways by which the Kayayei seek health care is by visiting the pharmacy and drug peddlers. At the pharmacy or the drug peddlers place, the Kayayei describe their health problem to the pharmacist or the drug peddler who in turn recommends drugs for them. The general reason given by participants for using this particular method of seeking health care instead of other methods was that, it was cheaper buying from the drug stores and drug peddlers as compared to going to the hospital. Most of the participants said the drug peddlers are their first point of call when they are sick and if the illness persist then they go to the pharmacy shop. It can be observed that the pattern for seeking health care is from drug peddlers to pharmacy shops and to hospitals or clinics. This finding is supported by the works of Kwankye et al (2007) and Ziblim (2013) who assert that most Kayayei go to pharmacy shops when they are sick. Their study confirms that, most

Kayayei uses drug stores and do not utilize health facilities like hospitals when they are confronted with a health problem. However, the findings of this study does not show that most Kayayei have an idea of what drug they are going to buy. As Kayayei mentioned that, they describe their health problems and are given the drugs based on the recommendation of the drug peddler or drug store attendant. The phenomenon of seeking health care from drug peddlers and pharmacy shops attendants is dangerous to the Kayayeis’ health, as these drug peddlers and drugstore attendants

34 are mostly not trained pharmacist end up giving wrong prescriptions which may compound the

Kayayeis’ health condition. This assertion is confirmed by UNICEF (2002) in Salisu and Prinz

(2009). According to them, a UNICEF (2002) report asserted that, Ghanaian patients are likely to buy drugs from pharmacy shops and drug peddlers on the recommendation of the attendants whose knowledge in healthcare is uncertain.

Another health seeking method used by some Kayayei is visiting hospitals. From the findings of this study, a few of the Kayayei visit hospitals or clinics when they are sick. According to the few who visit the hospitals, they use money earned from the Kaya business to access health services at the hospitals. Only a few Kayayei utilize hospitals, this is because they earn low income. Some

Kayayei also reported that, their health care method was neither attending hospital nor buying drugs from drug peddlers. With this method of health care practice, some Kayayei said, they just sleep for a while until they get better or feel well enough to resume work. The Kayayei resort to these other means of seeking health care due to low income. One can say this considering the various complains made by the participants about how little their daily earnings is.

The findings showed that some Kayayei attended hospital or clinic when they are sick, others neither visit the hospitals nor go to the pharmacy or drug peddlers, and they claimed that they only sleep until they get better. The popular health seeking practice among majority of the Kayayei is to seek health care from drug peddlers or pharmacy shops.

4.6.3 Challenges faced When Seeking Health Care

This section discusses the challenges Kayayei face when seeking health care.

The major challenge faced by Kayayei when seeking health care is financial. The average money earned by the Kayayei ranges from GHC 10 to GHC 15. According to participants, it is with this

35 same daily earnings that they buy food, pay for the use of public sanitation facilities (toilet and bathroom), save money and send remittances back home. As such, seeking appropriate health care is negatively affected by the low earnings of the Kayayei. Kayayei cannot have access to health services at hospitals and clinics because they cannot afford it. Though most Kayayei preferred receiving health care at hospitals, only a few are able to do so due to financial challenges. This finding is supported by Asaana (2015) who argue that, seeking health care is expensive for female migrants. The preference for gaining access to health care at the hospital among the Kayayei show that, if they earn enough money, they will be able to seek health care from hospitals. Also, if the

Kayayei had enough money from earnings, their risk of exposure to health issues like malaria, severe headaches could have reduce greatly. This is line with Asaana (2015) as he further argued that, if the Kayayei earned more, their high income will influence their decision to seek better health care. Kaseje (2006) at a presentation made at the Woodrow Wilson International Center for

Scholars on Health Care in Africa: Challenges, Opportunities and an Emerging Model for

Improvement revealed that financial challenges increases ill-health, as ill-health also increases poverty (financial challenges). He argued that ill health has a direct effect on productivity especially among the poor. This assertion made by Kaseje (2006) supports the findings of this study that due to financial challenges, most of the Kayayei do not attend hospital and clinics when they are sick. And this can go a long way to reduce their effectiveness in carrying out their work and increase financial challenge already faced by the Kayayei.

One can observe that, the problem of finance is challenge which is not only present at the level where the Kayayei is seeking health care, but has been at the center of almost all the vulnerabilities faced by most Kayayei. Thus, from the factors that make them prone to health issues to the methods used in seeking health issue and the challenges faced when seeking health care lies the problem of

36 inadequate finance. The findings of this study also suggest that, Kayayei do not go to health centers like hospitals and clinics when they are sick. This is because they earn low incomes, hence the expenses of taking care of themselves in the cities, saving for the purpose of their migration to southern markets centres and sending remittances back home to support other relatives outweigh them.

Another challenge that the participants are faced with when seeking health care has to do with the

National Health Insurance Scheme. Despite the fact that NHIS has been introduced by the government to enable affordable health care, most Kayayei are not covered and it also appear not to be effective. The participants argue that, NHIS does not cover some of the drugs that are mostly expensive. That is not all drugs are covered by the NHIS hence a Kayayoo still need money for proper health care even when she possess a NHIS card. This findings is in line with that of

Dalinjong and Laar (2012) who state that, certain procedures in accessing healthcare has not changed even with the introduction of the NHIS. Such unaffected procedures include essential drugs not covered by NHIS. This has led to negative opinions related to the scheme. Some participants made the same assertion by adding that when they registered for NHIS, they were told it can be used to seek health care services across Ghana but they are made to purchase some drugs when they go hospitals while others claim, when they came to Accra, the NHIS card was not accepted at some health facilities. This assertion is also consistent with that of Alfers (2013) that women in the informal sectors do not trust the efficacy of the NHIS. It was also found that most of the Kayayei do not use the NHIS as they are not registered on the scheme, this is because they cannot afford it. This finding is in line with Van den Berg (2007) who argues that most Kayayei do not have NHIS because they cannot pay for the NHIS premium. One would presume that, with

37 the introduction of NHIS, a vulnerable group like Kayayei could be encouraged to seek medical attention at health facilities like clinics and hospitals but that is not the case.

4.7 Conclusion

This chapter presented the information gathered from the field and also discussed the findings with insights from the reviewed literature. The findings of this study indicate that, the Kaya business exposes the Kayayei to health problems. However, most Kayayei are incapable of seeking quality health care due to inadequate income.

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CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Introduction

This last chapter is divided into three parts. The first part summarizes the study, the second part draws major conclusions and the third part proposes some recommendations that can be used to improve upon the concerns raised in the study.

5.2 Summary

The qualitative research design was used in this study to examine the health related concerns of

Kayayei in Madina. Data was collected from twenty (20) participants by conducting face to face in-depth interviews with an interview guide. The data was analyzed in relation to the research objectives. Factors that expose Kayayei to health issues are improper accommodation coupled with no sanitation facilities, poor eating habit, harsh working condition and ignorance. Improper accommodation coupled with no sanitation facilities like toilet and bath room is a major factor that exposes the Kayayei to health issues. It was found in the study that, Kayayei lived in wooden structures and tent-like structures which exposes them to malaria, skin rashes and insect bites.

Also, these wooden structures and “tent-like” structures do not come with toilet, bathroom and water facilities to maintain adequate hygiene. As a result, the Kayayei utilizes the public toilet and bath rooms which are unhygienic and further increases their health related problems.

39

Another factor is the poor eating habits of Kayayei. The study showed that due to the low level of income of Kayayei, they prefer to buy food that are cheap and mostly these foods are prepared under unhygienic environments or conditions. Such eating practices could be the cause of the wide range of health problems reported by most Kayayei.

The working condition of the Kaya Business is a factor that exposes Kayayei to health issues. The

Kayayei usually do not have adequate rest after carrying heavy loads from morning till evening.

The goods carried by Kayayei are heavy which leads to neck pain, body pains, and chest pains among others.

In addition to the above factors is ignorance among Kayayei. Most of the Kayayei are unaware of most of the factors that exposes them to various health issues. Hence, they engage in practices like tattooing their bodies with an unprofessional tattooist who does not change used needles. This practice can lead to the transmission of infections like HIV/AIDS. Ignorance may also be the reason most Kayayei are spotted eating rotten fruits that could cause stomach aches.

The study also revealed that, the popular means of seeking health care among Kayayei is through purchasing drugs from pharmacies or drug peddlers. They describe their illness and are given drugs based on the attendant’s prescription. A few go to health centers (hospitals and clinics) or prefer to just lie down until they feel better.

The major challenge that Kayayei face when seeking health care is finance. Due to the low income earned daily by Kayayei, many are unable to pay for adequate health care at hospitals and clinics even though they wished to. Also, most of them are not registered with the National Health

Insurance Scheme (NHIS).

5.3 Conclusion

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Although the Kaya business provides the Kayayei a means of earning income, the Kaya business also exposes the Kayayei to several health issues such as neck pains, skin rashes, malaria, cholera and stomach ache among others. Generally, the exposure to these health risks is as a result of the unhygienic and poor living conditions of Kayayei. This exposure is further heighten by poverty among the Kayayei since their income is inadequate. With this low income, the Kayayei feed themselves, pay for sanitation facilities like toilet, bathroom and water, save for themselves and send remittances home. When Kayayei are faced with health problems, they are unable to seek adequate health care. Poverty prevents the Kayayei from renting a decent accommodation, make them engage in harsh working conditions and leaves them incapable of seeking adequate health care when confronted with health problem which usually arises due to this same job.

5.4 Recommendations

The menace of the Kaya business has come to stay in the Ghanaian society and a concerted effort needs to be taken to ensure that the Kayayei working conditions are improved. The researcher offers the following recommendations, which if considered could contribute to the improvement of the health conditions of the Kayayei.

To begin with, the District Assemblies especially the La-Nkwantanang should enforce laws that ensure food vendors are certified and that, these food vendors prepare meals in hygienic places.

This will guarantee that food prepared are hygienic and this will go a long way to reduce some of health related issues Kayayei experience as a result of the food they eat.

Furthermore, the Government and other well-meaning Non-Governmental Organizations should intensify poverty reduction strategies in Northern Ghana. Programmes such as Livelihood

Empowerment against Poverty (LEAP) and Youth Enterprise Support (YES) should be broaden to cover most deprieved communities in the Northern parts of Ghana. Also, Non-Governmental

41

Organizations in the Northern parts of Ghana should focus on income generating projects such as training in hairdressing, dress making, soap making, shea butter processing and the like for school drop outs and young women instead of direct financial transfer. This will help reduce the poverty in Northern Ghana which is the main cause of the migration of the females to the Southern parts of Ghana to engage in the Kaya business.

To add to the above, the Ministry of Gender, Children and Social Protection in collaboration with the National Health Insurance Authority (NHIA) should broadened its activity of registering

Kayayei unto the Scheme for free to cover most, if not all of the Kayayei in Madina and their children. This will enable and encourage Kayayei to access health care at the health centers since they will not need to pay much money before treatment.

Finally, since Community Health Nurses are responsible for the education and awareness creation of the community members on their health issues. Those in Accra should make house to house outreach approach their main duty in educating the community members especially the Kayayei on their health issues instead of being stationed at the health centers.

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INTERVIEW GUIDE

UNIVERSITY OF GHANA

DEPARTMENT OF SOCIAL WORK

TITLE: Health Related Concerns of Female Health Porters (Kayayei) in Madina.

INTRODUCTION

This is a study conducted by an undergraduate student of the by name Abdul-

Salam Sahadatu. This study is in partial fulfillment of a Bachelor of Arts Degree Program in Social

Work. The aim of this study is to examine the health related concerns of Kayayei in Madina.

Please be assured that all your responses will be handled confidentially.

QUESTIONS

Part I - Demographic Information

1. How old are you?

2. What is the name of your home town?

3. What is your educational background?

4. What is your marital status?

5. Do you do any other job apart from head porterage?

6. How much do you earn in a normal day?

7. What is your accommodation arrangement?

Part II

8. Kindly describe the activities you undertake in a normal day? Probe for the following

48

a. [What are some of the illnesses that affect you?] Probe for the ones that are more

predominant.

9. How do these factors affect your health? Probe for the following factors

a. Living conditions

b. lifestyle practices (eating habits , personal hygiene)

c. Working Conditions

10. How do you seek health care when confronted with a health issue? Probe for the following

a. formal means like hospital and clinics (payment option: cash or NHIS)

b. traditional means

c. other means

11. What are the reasons for using this particular option? Probe for the following

a. What are the benefits of your health seeking method?

b. Why do you continue to prefer this method despite its associated challenges?

12. What are the general challenges you face when seeking health care?

a. Do the challenges mentioned prevent you from seeking health care?

13. Is there anything else you want to add to what you have already said or to the discussion in general?

THANK YOU

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OBSERVATION CHECK LIST

DEPARTMENT OF SOCIAL WORK

UNIVERSITY OF GHANA

Title: Health Related Concerns of Female Health Porters (Kayayei) in Madina.

Introduction

This is a non- participant observation checklist used by an undergraduate student of the University of Ghana by name Sahadatu Abdul-Salam in conducting this study. The aim of this study is to examine the health related concerns of Kayayei in Madina.

WHAT TO OBSERVE

1. The accommodation styles of Kayayei in Madina.

2. The sanitation facilities like toilet and bathroom used by Kayayei.

3. The eating habits of Kayayei in Madina;

a. The environment from which the Kayayei buys food from.

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