Social Protection Initiatives and Access to Quality Healthcare among Older Persons in Ghana – Evidence from Mampong Municipality

Abstract

Background: Population ageing is a major social issue and has become a public health concern which affects both developed and developing countries. Social protection interventions/initiatives (SPIs) that cover older persons have been implemented in many developing countries to improve household food consumption and reduce out-of-pocket payments in accessing healthcare. To reduce the poverty level, promote financial access to healthcare, and improve their health conditions among older populations, SPIs like the Livelihood Empowerment Against Poverty (LEAP) and the National Health Insurance Scheme (NHIS) have been enacted to create an efficient and safety net. Yet, the extent to which older persons' participation in SPIs influence access to quality healthcare is virtually unknown in most developing countries including Ghana. Objective: This thesis investigated the linkage between social protection initiatives and access to quality healthcare among older persons (60 years and above) in the Mampong Municipality in the Ashanti Region of Ghana. This thesis was premised on two (2) main concepts and theories: Andersen Healthcare Services Utilization Behaviour and the Donabedian's Structure, Process and Outcome models. These were integrated with access to care, and quality of care concepts and theories. Methodology: This study employed a triangulation mixed-method research design comprising of both quantitative and qualitative data collection and analysis in addition to the use of community scorecards. For quantitative research, a structured questionnaire embedded in an electronic device was utilized to collect data from 400 non-institutionalized older persons in the study area. Methods of analyses employed for the quantitative research were descriptive statistics, a multivariable reduction (factor analysis) method, and multiple logistic regression modelling with the help of STATA version 14.0 software. For the qualitative research, a total of eight (8) focus group discussions segmented by sex (male and female) and location (rural and urban) among purposively sampled older persons, and thirteen (13) in-depth interviews with key informants (program planners and implementers, and service providers) were carried out. Interview guides were used for data collection and analysed with Atlas-ti version 7.5.7 software using thematic analysis. Results: About 96.0% of study participants were aware of the existence of at least one form of SPIs in their communities. Overall, 64.5% of the participants were beneficiaries of SPIs. The significant predictors of participating in SPIs were: age, household food security, and place of accessing healthcare service. The generated sub-scales on perceived access to quality of care were adequate service delivery, provider attitude, patient/client dignity, easy accessibility to the facility, and patient autonomy. Further, 63.7% had good perception level about the quality of care accessed as against 36.3% with poor perception. The main promoter of quality healthcare was a good attitude of health staff while drugs perceived to be of low quality was the main barrier. Participating in SPIs did not significantly predict the perceived level of access to quality healthcare (quality of care). Rather, the predictors of access to quality healthcare in the context of SPIs participation were age, household food security, household size, and primary caregiver. Other established factors that influenced this linkage emanated from both the community and institutional levels. Conclusion: Addressing access to quality of care among older persons in the context of SPIs participation requires a multidimensional approach, in addition to strengthening the associated promoters to accessing quality health services. This could contribute to model healthcare for older persons in Ghana, especially in the study setting.