Abstract:
Slum-dwellers lack several essential amenities (such as water, sanitation, and electricity) which make them more
vulnerable than non-slum dwellers. As there is limited to no access to health and social care services in slums, the
slum environment is expected to be an even more dangerous environment for older adults, negatively impacting
their quality of life (QoL). To provide an overview of the perceived (unmet) health and social care needs and how
it affects the QoL, this study aims to explore the self-perceived health and social needs of older adults in urban
slums in Ghana. Using a phenomenological approach, 25 semi-structured interviews were conducted between May
and June 2021, in the homes of older adults in two slums in Ghana. After coding and analysing the transcripts, five
main themes emerged: (a) perception of health; (b) (de)motivators of health service use; (c) perception of social
care, (d) social needs, and (e) influence of phenomena on QoL. It appeared that older adults believed that spiritual
powers were causing illnesses and influenced their use of formal health services. Other factors such as expired
insurance cards and the attitude of healthcare workers served as demotivators for using health services.
Perceived health needs were mainly current disease conditions (arthritis, diabetes, hypertension, vision/hearing
challenges), challenges with health insurance, the behaviour of some health professionals, the proximity of health
facilities, and unnecessary queues at major health facilities. Unmet social needs identified by this study were
a sense of neglect by family (need for companionship), requiring assistance with activities of daily living, and
the need for financial support. Participants had more health needs than social needs. Health providers do not
usually prioritize the care of slum-dwelling older adults. Most participants still have challenges with the National
Health Insurance Scheme (NHIS). Their social needs were mainly related to financial difficulties and help with
some activities of daily living. Participants expressed that they desired companionship (especially the widowed
or divorced ones) and the lack of it made them feel lonely and neglected. Home visits by health professionals to
older adults should be encouraged to monitor their health condition and advocate for family members to keep
older adults company. Healthcare providers should exhibit positive attitudes and educate older patients on the
advantages of formal health services use, as well as the need to seek early treatment as this will influence their QoL
to a large extent.
