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    Extending health services to rural residents in Jirapa District. Analyses of national health insurance enrolment and access to health care services

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    PhD Thesis (3.105Mb)
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    Publication date
    2015
    Author
    Domapielle, Maximillian K.
    Supervisor
    Jalilian, Hossein
    Mdee (nee Toner), Anna L.
    Lawler, John A.
    Keyword
    Ghana; Jirapa district; Health systems; Health insurance; Access; Barriers; Equity; Rural; Urban
    Rights
    Creative Commons License
    The University of Bradford theses are licenced under a Creative Commons Licence.
    Institution
    University of Bradford
    Department
    Bradford Centre for International Development Faculty of Social Sciences
    Awarded
    2015
    
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    Abstract
    This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit.
    URI
    http://hdl.handle.net/10454/14803
    Type
    Thesis
    Qualification name
    PhD
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