Health of Ga-East: Utilization of and Expenditure on Health Services in Madina Township

Abstract

Background: Since independence, Ghana has made several efforts to ensure that its population has access to appropriate health care at an affordable cost. A vital measure to increase affordability is to reduce the out-of-pocket payments for health care which is recognised as one of the barriers to access, especially in poorer countries. The National Health Insurance Scheme was therefore introduced in 2003, to address issues of inequities in financial access to health care. Objective: The general objective of this study is to determine the utilization of and expenditure on health care in Madina township in Ghana. Methods: A community survey of 378 households was carried out in June 2010 using structured questionnaires. The zones/communities in Madina were allotted a proportion of the total sample based on its population. Systematic sampling was used to select houses and the head of the household or an adult above the age of 18years was interviewed. Health care facilities in Madina were also identified and mapped out. Findings: The major findings were that generally, the poor made more out-patient visits than the richer. Private facilities were the most used by all levels of socio- economic classes and self-medication was most common among poorer households. Households in the highest quintile incurred slightly more direct costs than their poorer counterparts. Poorer households tended to incur more indirect costs in terms of productivity losses and carers’ time. Current NHIS registrants incurred less direct costs than the non-insured. NHIS registration was higher among the rich than the poor. Conclusion: Currently the NHIS system does not appear to offer financial protection for the poor and therefore households continue to incur relatively high costs on health care.