Abstract:
Background: The United Nations 2030 Sustainable Development Goals have reaffirmed the
international community’s commitment to maternal, newborn, and child health, with further
investments in achieving quality essential service coverage and financial protection for all.
Objective: Using a modified version of the 1978 Tanahashi model as an analytical framework
for measuring and assessing health service coverage, this paper aims to examine the system
of care at the community level in Ghana’s Volta Region to highlight the continued reforms
needed to achieve Universal Health Coverage.
Methods: The Tanahashi model evaluates health system coverage through five key measures
that reflect different stages along the service provision continuum: availability of services;
accessibility; initial contact with the health system; continued utilization; and quality coverage.
Data from cross-sectional household and health facility surveys were used in this study.
Immunization and antenatal care services were selected as tracer interventions to serve as
proxies to assess systems bottlenecks.
Results: Financial access and quality coverage were identified as the biggest bottlenecks for
both tracer indicators. Financial accessibility, measured by enrollment in Ghana’s National
Health Insurance Scheme was poor with 16.94% presenting valid membership cards.
Childhood immunization was high but dropped modestly from 93.8% at initial contact to
76.7% quality coverage. For antenatal care, estimates ranged from 65.9% at initial visit to
25.1% quality coverage.
Conclusion: Results highlight the difficulty in achieving high levels of quality service coverage
and the large variations that exist within services provided at the primary care level.
While vertical investments have been prioritized to benefit specific health services,
a comprehensive systems approach to primary health care needs to be further strengthened
to reach Ghana’s Universal Health Coverage objectives.
