University of Ghana http://ugspace.ug.edu.gh DETERMINANTS OF PRIMARY HEALTHCARE UTILIZATION IN THE GOMOA EAST SUB-DISTRICT MARY KONNEH-ARCHER 10636272 THIS LONG ESSAY IS SUBMITTED TO THE UNIVERSITY OF GHANA BUSINESS SCHOOL IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF MASTER OF BUSINESS ADMINISTRATION DEGREE (HEALTH SERVICES MANAGEMENT OPTION) JULY, 2019 1 University of Ghana http://ugspace.ug.edu.gh DECLARATION I, Mary Konneh-Archer, declare that this work is a product of my own research effort. It has not been presented either in part or whole by anyone for any academic award in this or any other university. All sources cited have been duly referenced; and I bear sole responsibility for any shortcoming herein. ……………………………. …………………... MARY KONNEH-ARCHER DATE (10636272) i University of Ghana http://ugspace.ug.edu.gh CERTIFICATION I certify that this long essay was supervised in accordance with procedures laid down by the University of Ghana. ……………………………………. ………………. DR. LILY YARNEY DATE (SUPERVISOR) ii University of Ghana http://ugspace.ug.edu.gh DEDICATION This work is dedicated to Ernest Nti and Nathan Kwasi Amoakohene Nti- you both give me the reason to push the boundaries every day. iii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT My foremost acknowledgement goes to God Almighty for making the successful completion of this piece of work possible. Profound gratitude to my supervisor, Dr. Lily Yarney- I have learnt a lot from you within this period. Thanks for your insightful comments and supervision of this work. Mrs. Rachael Hanson-Garshon (the able Teaching Assistant) may God richly bless you for being there for me insofar as the progress of this work was concerned. My beloved parents, Mr. and Mrs. Paul and Perpetua Konneh-Archer, words cannot adequately express my gratitude to you. I am forever indebted to your wise parental tutelage all this while. I cannot forget to mention my siblings, Dr. Paul Kwesi Konneh-Archer and Ms. Perpetua Yaaba Konneh-Archer- I will choose you as siblings again if I have the chance to do so in the next world- love you to bits. To my in-laws, Lawyer Peter Nti and Mrs. Esther Nti,- you have both been good counsels to the success of my academic journey. To the people of Gomoa East sub district (Okyereko and Adawukwa), especially to Patricia Otubuah (in charge) and the Okyereko health centre, you are simply awesome- thanks for your instrumentality during the data collection phase of this study. To the management and staff of Sanford, thanks for the being supportive in diverse ways. To all my classmates in the MBA class (2017-2019), especially my MBA family, I am forever grateful for your advice. Though it was a challenging process, you were with me all the time. iv University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS DECLARATION ....................................................................................................................... i CERTIFICATION ................................................................................................................... ii DEDICATION ........................................................................................................................ iii ACKNOWLEDGEMENT ...................................................................................................... iv TABLE OF CONTENTS ..........................................................................................................v LIST OF TABLES ................................................................................................................ viii LIST OF FIGURES ................................................................................................................ ix ABSTRACT...............................................................................................................................x CHAPTER ONE .......................................................................................................................1 GENERAL INTRODUCTION .................................................................................................1 1.0 Chapter Introduction ..........................................................................................................1 1.1 Research Background ........................................................................................................1 1.2 Statement of the Problem ...................................................................................................3 1.3 Research Objectives ...........................................................................................................4 1.4 Research Question .............................................................................................................5 1.5 Scope and Limitation of the study ......................................................................................5 1.6 Significance of the Study ...................................................................................................5 1.7 Definitions of key terms .....................................................................................................6 1.8 Chapter Outline .................................................................................................................6 CHAPTER TWO ......................................................................................................................8 LITERATURE REVIEW .........................................................................................................8 2.0 Introduction .......................................................................................................................8 2.1 Definition of Concepts .......................................................................................................8 2.1.1 Primary Healthcare ......................................................................................................8 2.1.2 Health Seeking Behaviour ...........................................................................................9 v University of Ghana http://ugspace.ug.edu.gh 2.2 Determinants of Primary Healthcare Utilization ............................................................... 11 2.3.0 Theoretical Framework.............................................................................................. 11 2.3.1 Healthcare Utilization Model (Andersen & Newman 1973) ....................................... 11 2.3.2 Theory of Planned Behaviour (Ajzen, 1991) .............................................................. 14 2.4.0 Empirical Literature Review ...................................................................................... 16 2.4.1 Distance as a determinant of primary healthcare utilization........................................ 16 2.4.2 Quality of healthcare as a determinant of utilization of primary healthcare ................ 17 2.4.3 Education as a determinant of primary healthcare utilization ..................................... 18 2.4.4 Access as determinant of primary healthcare utilization ............................................. 18 2.4.5 Age as a determinant of primary healthcare utilization. .............................................. 20 2.4.6 Gender as a determinant of primary healthcare utilization. ......................................... 21 2.4.7 Income as a determinant of primary healthcare utilization. ........................................ 22 2.5.0 Hypotheses ................................................................................................................ 24 CHAPTER THREE ................................................................................................................ 25 METHODOLOGY .................................................................................................................. 25 3.0 Introduction ................................................................................................................... 25 3.1 Research design ............................................................................................................... 25 3.2 Research setting ............................................................................................................... 26 3.3 Research approach ........................................................................................................... 28 3.4 Population ....................................................................................................................... 29 3.5 Sampling technique.......................................................................................................... 29 3.6 Sample size ...................................................................................................................... 30 3.7 Sources of data ................................................................................................................ 30 3.8 Data analysis.................................................................................................................... 31 3.9 Research Limitations ....................................................................................................... 31 3.10 Ethical Considerations ................................................................................................... 32 CHAPTER FOUR ................................................................................................................... 33 DISCUSSION OF STUDY FINDINGS .................................................................................