The Limitations Of Ghana’s Rural Health Care Access: Case Study: GA East, Greater Accra Maria Polychronis International Policy Network Occasional Paper 4 1 GLOBAL FUTURES Global Futures, a flagship project of the Rutgers University MA Program in Political Science - United Na- tions and Global Policy Studies, is an international association of global policy analysts. By creating a forum for global policy experts, including scholars, practitioners, decision-makers and activists from diverse back- grounds and cultures, Global Futures promotes a constructive international dialogue centered on the chal- lenges we all face as global citizens. Through its publications, conferences and workshops, Global Futures seeks to generate a more comprehensive understanding of contemporary global affairs and, consequently, develop innovative solutions for a more stable, tolerant, and sustainable global society. 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Members of Global Futures include: MA Program in Political Science – United Nations and Global Policy Studies; the Rutgers University Division of Global Affairs; the UNESCO Chair in Islamic Inter-Faith Dialogue Studies, the University of Kufa; the Institute of Iraqi Studies, Boston University; the International Center for Development and Decent Work, University of Kassel; the Center for Shia Studies, Washington, DC; the School of International and Public Affairs, Jilin University; the Center for Good Governance Studies, the University of Novy Sad. For information on Global Futures, please contact us at: [email protected] Maria Polychronis is a recent graduate of Rutgers University with a Master’s degree in United Nations and Global Policy Studies. As an international development professional, Maria has managed health, governance and human rights programs in the United States, United Kingdom and West Africa. Prior to development, she worked as a policy researcher in the House of Commons in London, and as a program coordinator in New York for the World Federation of the United Nations Association and the Permanent Mission of Iraq to the United Nations. Maria is currently living in New York City and preparing for her next project in East Africa. This research was commissioned by the Ghana Health Services, executed by two non-governmental organizations: SEND Ghana and Alliance for African Women Initiative and conducted prior to the author’s enrolled in MA Program United Nations and Global Policy Studies. Therefore, Rutgers the State University of New Jersey is not responsible for data collection and content of the paper. unstudies.rutgers.edu 2 3 The Limitations Of Ghana’s Rural Health Care Access: Case Study: GA East, Greater Accra Contents I. Introduction ........................................................................................................................................................ 6 II. Ghana Health Services And The NHIS .............................................................................................................. 7 III. Rural Access To Health Care And The Poor ....................................................................................................... 9 IV. Cultural And Political Considerations For The Distribution Disparity ..........................................................11 V. Implications Of Poor Rural Access To Health Care - Child And Maternal Health Crisis ................................................................................................................... 13 VI. The Practical Solution With Limitations – Community Based Health Care ................................................. 14 VII. Case Study: Ga East, Greater Accra .................................................................................................................. 16 A. Objective ..................................................................................................................................................... 16 I. Abokobi Hospital ................................................................................................................................. 16 1. Statement Of The Problem ........................................................................................................... 16 2. Methodology .................................................................................................................................. 16 3. Findings .......................................................................................................................................... 16 4. Limitations ..................................................................................................................................... 19 II. CHPS Compound ................................................................................................................................ 19 III. National Polio Imunization Campaign .............................................................................................. 20 B. Discussion And Analysis ............................................................................................................................. 20 VIII. Recommendations ............................................................................................................................................ 22 A. Community Involvement ........................................................................................................................... 22 B. Logistical Improvements ............................................................................................................................ 22 C. Training Of Hospital Staff And Human Resources For Health ................................................................ 23 IX. Suggestions For Further Research ..................................................................................................................... 24 X. Conclusion ........................................................................................................................................................ 25 Bibliography ............................................................................................................................................................. 26 Notes ......................................................................................................................................................................... 26 Annex 1: Ghana Demographic Information .......................................................................................................... 27 Annex 2: Health Facilities Access Survey ................................................................................................................. 28 Annex 3: Community Monitoring Forms ............................................................................................................... 30 2 3 The Limitations Of Ghana’s Rural Health Care Access: Case Study: GA East, Greater Accra LIST OF ABBREVIATIONS AFAWI – Alliance for African Women Initiative ANC – Antenatal Care CHO – Community Health Officer CHPS – Community Health Participation Scheme GDHS – Ghana Demographic and Health Survey GHS – Ghana Health Services MDGs – Millennium Development Goals MMR – Maternal Mortality Ratio NGO – Non Governmental Organization NHIS – National Health Insurance Scheme OOP – Out of Pocket Payments PNC – Postnatal Care SSNIT – Social Security and National Insurance Trust UN – United Nations UNICEF – United Nations Children’s Fund WHO – World Health Organization 4 5 The Limitations Of Ghana’s Rural Health Care Access: Case Study: GA East, Greater Accra I. Introduction Health care in Ghana has improved significantly throughout the years, especially since the introduction of the National Health Insurance Service (NHIS) in 2003. However, the issue has since become a matter of equity, leading many to question if the scheme is a pro-poor solution as was originally envisaged. There is no doubt that universal health coverage can increase access to health services, but in the case of Ghana, a foremost concern is that the NHIS is regressive, meaning that on average the richer segments of the population are paying less as a proportion of their income for health care than the poorer segments. This paper seeks to highlight the inequalities in the distribution of health care benefits particular as poor rural access has perpetuated sub-standard maternal delivery services, which have caused an increase in maternal mortality rates. Implementing the NHIS is remarkable accomplishment for the government of Ghana, not only within a sub-Saharan context but globally as well, particularly given that some of the most developed nations, such as the Untied States, have yet to implement universal health coverage for their