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EVELYN AMOAH.Pdf KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY COLLEGE OF HEALTH SCIENCES SCHOOL OF MEDICAL SCIENCES DEPARTMENT OF COMMUNITY HEALTH ENROLLMENT IN NHIS AND ACCESS TO HEALTHCARE: A CASE STUDY OF MIGRANT FEMALE HEADPORTERS AT THE CENTRAL BUSINESS DISTRICT OF KUMASI, ASHANTI REGION, GHANA EVELYN AMOAH APRIL, 2014 i KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY COLLEGE OF HEALTH SCIENCES SCHOOL OF MEDICAL SCIENCES DEPARTMENT OF COMMUNITY HEALTH ENROLLMENT IN NHIS AND ACCESS TO HEALTHCARE: A CASE STUDY OF MIGRANT FEMALE HEADPORTERS AT THE CENTRAL BUSINESS DISTRICT OF KUMASI, ASHANTI REGION, GHANA A THESIS SUBMITTED TO THE DEPARTMENT OF COMMUNITY HEALTH IN PARTIAL FULFILLMENT OF THE AWARD OF DEGREE OF MASTERS IN PUBLIC HEALTH IN HEALTH SERVICES PLANNING AND MANAGEMENT EVELYN AMOAH MASTERS IN PUBLIC HEALTH (HEALTH SERVICES PLANNING AND MANAGEMENT) APRIL 2014 i DECLARATION I hereby declare that this script is my own work and that, to the best of my knowledge, it contains no material previously published by another person, nor material which has been accepted for the award of any other degree of the university, except where due acknowledgement has been made in the text. ………………………… EVELYN AMOAH (STUDENT) Signature …………………….. DR. AGATHA AKUA BONNEY (ACADEMIC SUPERVISOR) Signature………………… DR.ANTHONY K. ADUSEI (HEAD OF DEPARTMENT) ii DEDICATION This work is dedicated to my dear daughter Nana Abena Serwaa Dwomoh. iii ACKNOWLEGEMENT I wish to thank several individuals for their contributions to the research work. I would like to thank my able supervisor Dr. (Mrs.) Agatha Bonney for not only guiding me through this process with her keen insights and advice, but has also taught me many valuable lessons along the way. I would also like to thank Dr. Peter Agyei-Baffour for his suggestions throughout the dissertation process. I greatly appreciate the contributions of Mr. Samuel Arkorful Odzefo and Mr. Prince Amoako. Additional thanks go to everyone who helped me in the collection of the data for this study, especially co-operation from all the headporters. Special thanks to Dr. Awudzie Yeboah (Kumasi Metro Health Director-Ashanti Region-Ghana) and the management staff for their encouragement and support of this study. I also appreciate the assistance of my friend Dominic Nyarko. Finally, the greatest of all appreciations go to the Almighty God for taking me through the journey. iv TABLE OF CONTENTS TITLE PAGE……………………………………………………………………………...i DECLARATION ................................................................................................................ ii DEDICATION ................................................................................................................... iii ACKNOWLEGEMENT .................................................................................................... iv TABLE OF CONTENTS .................................................................................................... v LIST OF TABLES ............................................................................................................. ix LIST OF FIGURES............................................................................................................x ABBREVIATIONS/ACRONYMS....................................................................................xi ABSTRACT.....................................................................................................................xiv CHAPTER ONE 1.0 INTRODUCTION....................................................................................................... 1 1.1 CURRENT STATE OF KNOWLEDGE ...................................................................... 1 1.1.1 OVERVIEW OF THE PROBLEM ........................................................................... 3 1.1.2 KNOWLEDGE ON THE NHIS ................................................................................ 6 1.1.3 ENROLLMENT IN NHIS ......................................................................................... 7 1.1.4 ACCESS TO HEALTHCARE AND ITS CHALLENGES ...................................... 9 1.2 PROBLEM STATEMENT ......................................................................................... 11 1.3 THE RELEVANCE OF THE STUDY ....................................................................... 15 1.4 RESEARCH QUESTIONS ........................................................................................ 16 1.5 RESEARCH OBJECTIVES ...................................................................................... 17 1.5.1 Main Objective:. ...................................................................................................... 17 1.5.2 Specific Objectives .................................................................................................. 17 1.6 CONCEPTUAL FRAMEWORK ............................................................................... 17 1.7 ORGANIZATION OF THE STUDY.......................................................................19 1.8 DEFINITION OF TERMS.........................................................................................20 v CHAPTER TWO 2.0 LITERATURE REVIEW ........................................................................................ 21 2.1THEORETICAL BASIS OF THE STUDY ................................................................ 21 2.2 DEFINITION AND OVERVIEW OF NHIS ............................................................. 21 2.3 MIGRATION AND THE MIGRANT FEMALE HEADPORTERS (KAYAYEI‟S) IN GHANA ....................................................................................................................... 24 2.4 MIGRANT FEMALE HEADPORTERS ENROLLMENT IN NHIS........................ 26 2.4.1THE LEVEL OF KNOWLEDGE OF MIGRANT FEMALE HEADPORTERS ON THE NHIS ........................................................................................................................ 26 2.4.2THE PREVALENCE OF MIGRANT FEMALE HEADPORTERS‟ ENROLLMENT IN NHIS ................................................................................................ 29 2.5 ACCESS TO HEALTHCARE AND ITS CHALLENGES ”KAYAYEI‟S” ............. 32 CHAPTER THREE 3.0 RESEARCH METHODOLOGY ............................................................................ 37 3.1 INTRODUCTION.......................................................................................................37 3.2 STUDY TYPE AND DESIGN ................................................................................... 37 3.3STUDY POPULATION…..........................................................................................37 3.4 PROFILE OF THE STUDY AREA ........................................................................... 37 3.5 SAMPLING TECHNIQUES .................................................................................... ..40 3.6 SAMPLE SIZE CALCULATION .............................................................................. 40 3.7 DATA COLLECTION TOOLS AND TECHNIQUES .............................................. 41 3.8 DATA QUALITY ASSURANCE MEASURES........................................................ 42 3.8.1 RECRUITMENT AND TRAINING OF RESEARCH ASSISTANTS .................. 42 3.8.2 PRE-TESTING OF RESEARCH TOOLS .............................................................. 42 3.9 STUDY VARIABLES ................................................................................................ 42 3.10 DATA HANDLING AND ANALYSIS ................................................................... 45 3.11 ETHICAL CONSIDERATIONS .............................................................................. 45 3.12 STUDY LIMITATIONS ......................................................................................... 45 3.13 ASSUMPTIONS OF THE STUDY ......................................................................... 46 vi CHAPTER FOUR 4.0 STUDY RESULTS .................................................................................................... 47 4.1 INTRODUCTION.......................................................................................................47 4.2 BACKGROUND CHARACTERISTICS OF RESPONDENTS ............................... 47 4.3 LEVEL OF KNOWLEDGE OF MIGRANT FEMALE HEADPORTERS ON THE NHIS ................................................................................................................................. 48 4.4 PREVALENCE OF MIGRANT FEMALE HEADPORTERS ENROLLMENT IN NHIS ................................................................................................................................. 53 4.5 MIGRANT FEMALE HEADPORTERS ACCESS TO HEALTHCARE ................. 59 4.6 CHALLENGES FACING FEMALE MIGRANTS IN ACCESSING HEALTHCARE IN THE KUMASI METROPOLIS ....................................................... 62 CHAPTER FIVE 5.0 DISCUSSION ............................................................................................................ 66 5.1 INTRODUCTION.......................................................................................................66 5.2 LEVEL OF KNOWLEDGE OF MIGRANT FEMALE HEADPORTERS ON THE NHIS ................................................................................................................................. 66 5.3 PREVALENCE OF MIGRANT FEMALE HEADPORTERS ENROLLMENT IN NHIS ................................................................................................................................. 69 5.3.1 ENROLLMENT IN NHIS AND CHARACTERISTICS OF MIGRANT FEMALE HEADPORTERS
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