University of Ghana http://ugspace.ug.edu.gh UNIVERSITY OF GHANA UTILISATION OF HEALTH CARE SERVICES IN THE OBUASI MUNICIPALITY BY ODAME DARKWAH EBENEZER (10243432) THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF MPHIL GEOGRAPHY AND RESOURCE DEVELOPMENT DEGREE DECEMBER, 2014 University of Ghana http://ugspace.ug.edu.gh DECLARATION This is to certify that this thesis is the result of research undertaken by Ebenezer Odame Darkwah towards the award of the Master of Philosophy in Geography and Resource Development in the Department of Geography and Resource Development, University of Ghana. ……………………………………. …………………………… (Signature) (Date) Ebenezer Odame Darkwah (Candidates Name) ………………………………….. ………………………………. Dr. Joseph K. Teye (Date) (Principal supervisor) ………………………………….. ………………………………. Dr. Charlotte Wrigley-Asante (Date) (Co-supervisor) i University of Ghana http://ugspace.ug.edu.gh ABSTRACT Globally, attention and investments towards demand-side strategies to enhance health care utilisation have improved over the years. Despite this significant investment in health care, its utilisation is far from adequate. Against this backdrop, this study examined the utilisation of health services in the Obuasi Municipality. Drawing on Kroeger’s (1983) health behavioural model, it specifically examined the incidence of major diseases and people’s perception about disease causation. The study also assessed the kinds of health facilities often utilised by different socio-economic groups and factors influencing the use of these health facilities in the Obuasi Municipality. Lastly, the modes through which people in the study area finance their health care were also examined. A multi-stage cluster sampling method was used in selecting 210 respondents for a household survey whiles a respondents for the qualitative facet of the study were purposively selected. The study reports that malaria is the most prevalent disease among diseases reported by the respondents. Respondents gave much credence to the natural aetiological model and the epidemiological triad of disease causation. The study showed higher utilisation of hospitals and health clinics than health centres and traditional health centres. The proximity of health facilities, quality of health services rendered, adequacy of equipment and personnel, social accessibility are some of the factors that influence utilisation of specific health facilities in the Obuasi Municipality. Nonetheless, the study reports self- medication as a significant intervening health care resource whereas NHIS, out-of-pocket and private insurance are the main modes of health care financing in the study area. The study concludes that there is a direct positive link between perceived morbidity, illness response, access to and use of health care services, as reported by Kroeger (1983). The study therefore recommends a revamp of most of the health facilities and provision of mobile or outreach clinical services to dispersed rural communities, which do not have the threshold population to merit Community-based Health Planning Services (CHPS). ii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENTS I wish to thank all those who have offered assistance and advice in diverse ways during my course of study and in preparation of this Thesis. I am most grateful, first of all to the Almighty God who through His Infinite Love and Grace taught me the principles of life. I have come this far in my pursuit of knowledge just by His abundant grace and mercy. My sincere thanks go to Dr. Joseph K. Teye and Dr. Charlotte Wrigley-Asante for their invaluable comments and constructive suggestions. I am very grateful to my father Mr. Samuel Darkwah for his continuous support, love and valuable suggestions from the beginning of my studies to the end. My sincere gratitude goes to my mother Ms. Comfort Ansomah and siblings: Barbara Odame Darkwah, Jennifer Odame Darkwah and Kwaku Asante Darkwah, for their support. I want to sincerely thank Wendelina Acheampomah Boakye, Faustina Obeng Adoma, Kwabena Asare and all my friends for the significant role they played during the primary data collection. Again, Mr. James Kofi Gyimah, Mrs. Felicia Amofa, Mr Felix Achew, Mr. Vincent Adiamah, Mr Yawson, Mrs. Edna Gyau Baffuor and Mr. Kwabena Kyeremanteng, all deserve words of appreciation for their support during my field work. iii University of Ghana http://ugspace.ug.edu.gh DEDICATION This thesis is dedicated to my parents Mr. Samuel Darkwah, Ms Comfort Ansomah and all parents who strive to make a better life for their children. iv University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS DECLARATION .................................................................................................................. i ABSTRACT ......................................................................................................................... ii ACKNOWLEDGEMENTS ................................................................................................ iii DEDICATION .................................................................................................................... iv TABLE OF CONTENTS ..................................................................................................... v LIST OF FIGURES ............................................................................................................ xi LIST OF ABBREVIATIONS ............................................................................................ xii CHAPTER ONE .................................................................................................................. 1 1.1 Introduction .................................................................................................................... 1 1.2 Problem statement .......................................................................................................... 4 1.3 Objectives ....................................................................................................................... 6 1.4 Hypothesis ...................................................................................................................... 7 1.5 Justification of the study ................................................................................................ 7 1.6 Definition of concepts .................................................................................................... 8 1.7 Organisation of chapters ................................................................................................ 9 CHAPTER TWO ............................................................................................................... 11 THEORETICAL PERSPECTIVES AND LITERATURE REVIEW ............................... 11 2.0 Introduction .................................................................................................................. 11 2.1 Theoretical Models....................................................................................................... 11 2.1.1 Andersen’s Health Utilisation Model........................................................................ 12 2.1.2 Kroeger’s health behavioural model ......................................................................... 16 Review of relevant literature in the context of Kroeger’s health behavioural model ........ 20 2.2 Health and its Significance .......................................................................................... 20 2.3 Factors Influencing Utilisation of Health Services ...................................................... 21 2.3.1 Predisposing Factors that Influence Health Service Utilisation ................................ 23 2.3.1.1 Age ......................................................................................................................... 24 v University of Ghana http://ugspace.ug.edu.gh 2.3.1.2 Sex .......................................................................................................................... 25 2.3.1.3 Education................................................................................................................ 27 2.3.1.4 Occupation and income .......................................................................................... 30 2.3.1.5 Household size ....................................................................................................... 32 2.4 Characteristics and Perception of the Disorder ............................................................ 32 2.4.1 Type, severity, and perception of ailment or disorder .............................................. 33 2.5 Characteristics of the Health Service and Enabling Factors ........................................ 36 2.5.1 Accessibility (Distance) ............................................................................................ 37 2.5.2 Acceptability, Trust and Quality of Service .............................................................. 41 2.5.3. Mode of health financing ......................................................................................... 44 2.6 Type and Choice of Health Care Resource .................................................................. 50 2.6.1 Formal (Modern) or Informal (Traditional) Health Care Resource .......................... 50 2.6.2 Private or Public Health Care Services ..................................................................... 51 2.6.3 Factors that Influence Choice of Health Care