University of Ghana, http://ugspace.ug.edu.gh SCHOOL OF PUBLIC REALT H COLLEGE OF REALT H SCIENCES UNIVERSITY OF GHANA FACTORS INFLUENCING SAVINGS FOR HEALTH CARE TOWARDS OLDS AGE AMONG NURSES IN THE LA-NKWANTANANG MUNICIPALITY (ID:I0447999) THIS DISSERTATION IS SUBMITTED TO TIlE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULflLLMENT OF THE REQUIREMENT FOR THE AWARD OF MASTER OF PUBLIC HEALTH DEGREE JULY, 2011 University of Ghana, http://ugspace.ug.edu.gh I, FELICIA KOLEKANG, hereby declare that with the exception of the duly acknowledged references, this research is the result of my own original work at the Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences. University of Ghana under supervision. and hence. has not been presented for any other degree in this universityorelsewhereeitherinwholeorpart.lamresponsibleforthe views expressed and the factual accuracyofils contents ... ~ Felicia Kolekang Dr. Augustine Adomah-Afari (Student) (Supervisor) University of Ghana, http://ugspace.ug.edu.gh This work is dedicated to my husband Mr. Frederick Yuorkuu and my children Frank, Favour and Fn:da for theirsuppon University of Ghana, http://ugspace.ug.edu.gh ACKNOWLEDGEMENT First. I thank the Almighty God for his grace and mercy that has brought me this far. Lord I am grateful. I wish to extend my heart felt gratitude to my supervisor Dr. Augustine Adomah-Afari, for his consistent support and guidance throughout this work. You have been with me every step to the completion of the project. God bless you 1 would also like to thank the Head of Department of Health Policy, Planning and Management, Dr. Reuben Esena, and all the leclurers of the department for the expo sure they gave us in c]ass and the field practice experience we obtained . I thank Madam Priscilla Siaw. the Municipal Director of Health Service of the La-Nkwantanang MadinaMunicipal Health Directorate for her support ] thank the management of Pantang Hospital. Pentecost Hospital and Madina Polyclinics _ Kekeleand Rawlings circle for their support. Jamverygrateful University of Ghana, http://ugspace.ug.edu.gh TABLE OF CONTENTS DECLARATION .. ...... . i .. ............ iii LIST OF TABLES LIST OF FIGURES . DEFINITION OF TERMS . ......... )ui J.O. Background 10 Ihe study .... 1.1. Problem Statement .. .. 1.2. Significance oflhe Study 1.3. SludyObjeclives 1.3.1 . General Objectives 1.3.2. Specific Objectives 1.3.3. Research Questions .... 1.3.4. Hypolhesis . IA. OullineoflheDissertalion .. CHAPTER TWO .... LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK ... 2.0. Introduction . 2.1. Savings Towards Health Care ... .. ···· ............ 11 University of Ghana, http://ugspace.ug.edu.gh 2.2. Factors Influencing Savings For Health Care Towards Old Age ...... 2.2.1. The influence of socio.-demographicJeconomic factors on savings for health care towards old age .......... 13 2.2.2. Influence of social factors on savings for health care toward soldage ....... . 2.3 . Theo~ticaIFramework .... 2.4. Conceptual Framework .... 2.5. Chapter Summary CHAPTER THREE .... 3.I.SrudyDesign .... 3.2. Study Area ... .. ... 30 3.3. Study Population 3.3. 1. lnciusioncrileria ... . ....... 32 3.3.2.bclusioncrileria .... 3.4.SlllTlplingMelhods. 3.4.1. Sample Size lli:lennination .... . ....................... 33 3.5. Variables o(the Study .... 3.5.1. Dependent variable 3.5.2 Independent variables .... . .... 34 3.6. Data Collection 3.6.1. Data Quality Assurance ... 3.6.2. Validity and Reliability of Data ... 3.6.3. Data Managemenl .... . .... ·····. ..... 36 University of Ghana, http://ugspace.ug.edu.gh ..... 36 3.6.4. Dlta Analysis ..... 37 3.7. Ethical Consideration ...... 37 3.7.1. Ethicalc1earance 3.7.2.Approvllfromstudyarel .... . .... 37 J.7.J. Descriptionofsubjecis inlhe study ...... 3.7.4. PIlr1icipants' Consent .... 3.7.5. Priv8cyfConfidentiality 3.7.6. Voluntary Participation 3.7.7. Potential RiskiBenefit.. ... 3.7.8.Compensalion .. 3.7.9. Data Siorage and usage 3.7.10. Declaration of conflict of interest 3.7 .11 . Funding information ).7.12. Prolocol amendmenIS .. 3.8.ChapterSummary ... CHAPTER FOUR RESULTS .... ..... 40 4.1. Socio-demographicleconomic characteristics ofPanicipan ts 4.1.1. Ovcrall savings for health care towards old age .... 4.2. Rc:lation~hip between socio-demographic/economic factors and saving for health care lowardS old age ... 4.3. Relalionshipbetweenjob·rtlatedfactorsandsavingsforhealthcare .... .46 4.4. Rc:lationship between social faclorsand savings for healthcare .... . .... 48 University of Ghana, http://ugspace.ug.edu.gh 4.5. Logistic Regression: Soeio-demographicleconomie factors and savings for health care .... 50 towards old age .. 4.6. Logistic Regression: Job related factors and savi ngs for health care.... . ...... 52 4.7. Logistic Regression: Social factors and savings for health care .... 4.8. Multiple Re~"Tession: Association between socio·demographicJeconomic characteristics, jobrelatcdfactors,soeialfactorandsavingforhealthcaretowardsold age...... . .. 55 4.9.Summaryoflhechapter.... . .... 58 ...... 59 DISCUSSION OF FINDINGS 5.0.lntroduclion .... 5.1. Socio-demographic/economic characteristics and saving for he altheare .. 5.2. Influence of job-related factors on savings for health care .... 5.3. Social factors influencing savings for heahh care lowards .... 5.4. Summary of the chapter .......... 65 CONCLUSIONS AND RECOMMENDATIONS .... . .......... 65 6.0. Introduction .... 6.I.Summaryofthesludy 6.2.Conclusionsofthesludy 6.2.1. Socio-demographic/economic characteristics and savingfor health care .... 6.2.2. Influence of job-related factors on savings for health care to wards old age 6.2.3. Social factors influencing savings for health eare towards 0 Idage ..................... 67 6.3. Contributions to Knowledge University of Ghana, http://ugspace.ug.edu.gh 6.3. I.Contributionto policyandpractice ..... ...... 67 6.3.2. Contribution to management of health care institutions 6.3.3. Contribution to methodology 6.4. Recommendations of the study 6.5. Limitations 10 the study ... 6.6. Future Research .... Appendix A: Participants ' Consent and InformationSheel .. .. AppendixB: StudyQueSlionnaire University of Ghana, http://ugspace.ug.edu.gh Table4. I; Socio-demographic/economiccharacleristicsofparticipants . Table 4.2 : Relationship between socio-demographideconomic factors and savings for health care towards old age .... Table 4.3: Relalionshipbetweenjob-related faclorsand savings for health care .... Table 4.4: Relationship between cultural factors and savings forh ealthcare ...... . Table 4.5: Logistic Regression: Socio-demographic/economic factors and savings for health care Table 4.6: Logistic Regression: lob related facto rs and savings for health care Table 4.7: Logistic Regression: Social factors and savingsforh ealth care towards old age ... Table 4.8: Multiple Regressions: Association between socio-demographic/economic characteristics, job related faclors, social factors and saving f or healthcare towards old age ... .. . 56 University of Ghana, http://ugspace.ug.edu.gh LIST OF fiGURES Figurr l : Conceptual frame\\ork of the factors influencing savings for health care towards old Figurc4.2: 0verallsavingsforhealthcarctowardsoldage ... University of Ghana, http://ugspace.ug.edu.gh LIST Of ACRONY;\IS Christian Health Association of Ghana Ghana School Feeding Programme Health Savings La-Nkwantanang Madina Municipal Assembly Livelihood Empowerment Against Poverty Lower and Middle-Income Countries Ministry of Health National HeahhlnsuranceAulhority World HeahhOrganization Social Security and National Insurance Trust University of Ghana, http://ugspace.ug.edu.gh DEFINITI ON Of TER MS Old age: The United Nations has agreed thai 60+ years may be usually denoted as old age. and Ihis is the first anempt al an international definition of old age Cultu re: Cultural syndrome is II pattern of shared attitudes, beliefs. categorizations. self- definitions, noons. role definitions. and values that is organized around a theme that can be identified among those who speak a language. during a specific historic period. and in a definablegeognlphicregion. Savings: Savings means the act of refraining from spending one's income on consumption. The pan of the income. which is unspent. is called savings. From the economist' s perspective, people allocate disposable income between consumption and savings and at various levels of income; there will be a corresponding level of consumption and savings. According to classical definition. savings is income minus consumption Hea lth saviogs(HS): Health savings is money put aside for health care, usua lly contributions areputimoanaccounlthatmayeaminlerestandponableevenaner workersleavetheir joband forlhe purpose oflhis study, it must be emphasized that "health saving" refers to deposits (money) in savings account which will be used for health care inoldage . Sorio-demographic/economic faclors: The leon "socio·demographic" refers to a group defined by its sociological and demographic characterislics. Jt refe rsto: of, relating to, or involving a combination of social and demographic factors . Socio-demographic/economic University of Ghana, http://ugspace.ug.edu.gh factors : age. sex. marital status. and level of education, have influence on health. including savings for health care towards old age. Socio-economic factors are lifestyle components and measurement of both financial viability and social standings. They directly influence social privileges and level of financial independence. Examples include National Health Insurance Status(NHIS),healthstatusandlevelofeducation University of Ghana, http://ugspace.ug.edu.gh Background: Globally, the ageing population is expected to triple from the current estimate of 700milliont02 billion by the year 2050. In Ghana, the ageing populat ion as at 2010 was 6.T1' o ofthetotaJpopuJationand it is projected that by the year 2050, the aged population would have increased to 11 .9. Unfortunately, these people have limited knowledge of how to manage their health conditions and whereto seek appropriate help resulting in untim ely deaths. The National Health Insurance Scheme (N HIS), a fonn of health financing regime instituted by the govemmentofGhana to improve financ ial access to basic heahh care , currentlydoes not inctude most age~related diseases. This makes it necessary for workers to make savings for health care IOwards their old age. Obj«live: The general objective of the study was to detennine factors in fluencing savings for health care towards old age among nurses in the La~Nkwantanang Madina Municipality, Greater Accra Region. Methods: A cross-sectional study using quanti tative methods was appJied to collect data. Multi - stage sampling technique was used to select 227 nurses from three (3) health fac ili ties in the La~ Nkwantanang Madina Municipality in the Greater Accra Region. A structured questionnaire was used to collect data on the socio-demographic/economic factors, jOb-related factors and social factors on savings for health care towards old age among nurses. STATA software version 15.1 was used to analyse the data. Basic descriptive statistics were run, a nd the results presented using tables depicting frequencies, percentages, and proportions. The relationship between variables University of Ghana, http://ugspace.ug.edu.gh was further analysed using simple and mUltiple logistic regression; and 95% confidence level (a=O.05) was used as a level of slat is tical significancl! Results: The prevalence of saving for heallh care among nurses was 80%. Socio- demographic/economic factors, that is. NHIS status and number of dependents were statistically significant at the bivariate level (p-O.OOI.p=O.027). Job related factors such as number of years in service, number of years left for retirement, ranks in nursing and savings account and incentives were significant in influencing savings for health care towards old age (p=O.002) Additionally, family financial expectations, t/le need for the aged to be given proper health CBre and spouse having a paid job were significant among the social factors (p=O.OI3. p=O.046, p=O.005)respectivcly. Conclusion I Recommendation: The study recommended that the National Health Insurance Authority (NHlA) should expand the coverage ofNH IS to include age re latedhealthconditions common to the aged. Ghana Health Service should include incentive packages, in the form of increased salaries, improved human resources policies; and sen ior manageml!nt of health institutions should introduce early comprehensive pre-retirement education for all nurses 10 enable them save for health care towards old age. Pension reforms should be reviewed in consultation with all relevant stakeholders 10 meet current financial needs, hence. providing financial protection to the aged to prevent poverty; and the Ministry 0 fHealth and Ghana Health Service should educate nurses to buy more private health insurance to complemem thc NHIS University of Ghana, http://ugspace.ug.edu.gh INTROD UCTION 1.0. Background 10 Ibesludy Globally, the ageing population is expected to triple from thecurrenl e Slimate of 700 million t02 billion by Ihe year 2050 (Mba. 2010). In Europe, it is projecled that by the year 2050, the ageing population would have reached 33.6%; and 8.3% in sub-Saharan African countries (WHO. 2014). The World Health Organizalion (WHO) indicated that this growth would even be more rapid in lower and middle-income countries (LMICs). including Ghana and that there was the need to give attention 10 their health needs since most LMICs are still fighting communicable diseases: and ageing is associated with non-communicable dise ases, hence, the double burden of diseases (WHO. 2014) In Ghana, the ageing population as at 2010 was 6.7% of the total popUlation and il isprojecled that by the year 2050, it would have increased to 11.9% (WHO, 2014). According to Fonta (2015), non-communicable diseases arc common among the aged due 10 weakness in the immune system; and also the reduction in sensory ability makes it very difficu lt to function on their own and therefore, depend on other family members for support, including health care. In Ghana, Nigeria and Cameroon, diseases such as hypertension, stroke, dementia, arthritis. diabetes, cancers, which are common among the aged account for most adult morbidity and mortality (Aikins, 2010). Unfortunately, these people have limited knowledge of how 10 manage these conditions and where 10 seek appropriate help due 10 poveny resulting in untimely deaths (Aikins,201O). University of Ghana, http://ugspace.ug.edu.gh Research shows that. the health conditions of the aged are mostly non-communicable diseases, which may require long term management but most of the health systems in LMICs are financially challenged and are sti ll focused on the management of in feetious diseases (Araujo de Carvalho t!fal.,2015). Araujo de Carvalho efal. (2015),argue tha t this can atfectthe health of Ihe aged since there will nOI be enough services available to meet their he alth needs and even the cost of these services will nOlbe atfordable to many and Ghana's heahh sys tem is no exception Available evidence suggests the n~d for policies that will inform health systems on the current and future distribution of morbidity, mortality and dependence to ensure adequate planning to meet the changing dimension of disease occurrence (WHO, 2014). Research shows that, the strong Ghanaian family system, which provided support for the aged is broken due to the migration of younger people from rural to urban centres for greener pas tures making the aged more vulnerable, especially in meeling theirheahh care needs (Aboagye ,2012). The World Health Organization (WHO, 2014). suggests that, older people often have unmc! expectation leaving them isolated and at risk of illness because of the changes in the Ghanaian traditionalnonnsthatensurerespcct,supportandreciprocity,indicating the influence o f culture on savings for health care towards old age. Arguably, pI.'Ople in low income countries like Ghana,ofienhaveJimiledaccesstohealthcareduetopoverty,unavaiJabilityoftheservices,and lackofquaJifiedpersonnelloprovidccareascompared with the dc:veloped counlries (Peterset al .• 2008) In 2010, the Govemment of Ghana approved the national ageing policy, which was to ensure thaI the people age with dignit)' and security and identified many health challenges of the aged University of Ghana, http://ugspace.ug.edu.gh (WHO. 2014). The World Heallh Organization (WHO. 2014). report indicates that these challenges include; dementia, cancers, diabetes, musculoskeletal d iseases, respiratory diseases. hcan disease and related conditions, oral health problems among others ,which require long-tenn treatment, which families are not able to bear the financial cost. In vie woftheabovediscussion. the issue to address is to look at the measures that can be put in place by individuals toward meeting their health needs while awaiting the implementation of the national ageing policy. This sludywastherefore,conducledlodelennine factorslhat influence savings for medical or health care towards old age. The aged population is prone 10 age related diseases mostly, non-communicable diseases, which are usually nol Irc:atable, but supposed to be managed with drugs ov era long period of time and will often require in-palient management, which put pressure on the limited health resources and also on their families (Weiss. 2011). The increasing ageing popu lation in the developed world has been identificd and policies have been put in place to meet their health care needs and also give comfort to Ihe aged (WHO. 2014) According to Blakeley and Ribeiro (2008). literature on how nurses save for health care is limited but suggested Ihat nurses make financial preparations for retirement, but this process does not begin early in their careers and thisaffecls their comfort and health on retirement. These researchers suggested that senior management should introduce early comprehensive pre- retirement education for all nurses. This is because major findings suggest that most nurses. both staff and managers, pay insufficient anention to planning adequately for retirement and this has University of Ghana, http://ugspace.ug.edu.gh important implications for their fUiure health and well-being in post-retirement years and recommended prc-retirement education as a partial solution. According to Sexauer and Siegel (2013). individualssavingforret irement is the best decision to make and this is achievable through setting basic rules. decidin g how much to save and how to invest and then slicking to the rules and suggested that only. 70 % of income should be spent and thenthereslputintosavings. However. il is observed thai in most developing counlries, this is yet 10 be considered as far as planning for the welfare of individuals towards old age is concerned. especially meeting their health needs are concerned (WHO, 2014). This group of people are almost forgonen and are left at the mercy of their families with little or no support from govemments and this has serious implication for their heal thseekingabiJityanditafTects theirheallh outcomes (WHO,2014) The increase in the number of people aged 60 years and above is due to improved health care systems and these have serious economic implications as the aged te nd 10 depend on others for theirneeds.includinghealthcareduetopoverty(Mba,2010).lthas been observed thai health systems in most deveJoping counlries. including Ghana are not de veloped and will not be able to meet the heahh needs of the increasing aged population. hence. Ihe need for individuals to pJan forheahh care towards old age while in active service (Odeyemi & Nixon, 2013) The National Ageing Policy of Ghana (Employment & Welfare, 2010). suggests that the increasing ageing population is challenged with poverty and limited access to health care, hence. the need to identify factors that contribule to poverty and inadequate hea lthcare so as to put in University of Ghana, http://ugspace.ug.edu.gh measures thai will limit these occurrences and enable individuals make saving for health care early in life as a sure way to reducing poverty and improving access 10 health care in old age Other research suggests that socio_demographic/economic faclors. that is. age, sex, marital status, and level of education. NIiIS status. number of dependents and health status have influence on savings for heallh care lowardsold age as women live longer and are exposed to aged related diseases but have limited resources to enable them make savings compared with men (Minicuci et al., 2014). For example. the risk for angina is higher in women than in men and increases with age; and also higher levels among the widowed than the newly married in Ghana (Minicuci etal., 2014) Some researchers suggest that the kind of work people do and the amount of money they earn can influence their propensity to save as low income has a negativeeffe ctonsavingsandthiscan influence the ability to save for health care towards old age (Addai, Gyimah, & Owusu, 2017) Research shows thal the strong Ghanaian family system, which provided support for the aged is broken due 10 Ihe migralion of younger people from rural to urban c entresforgreenerpaslures making the aged more vulnerable. especially in meeling their heahh C are needs (Aboagye. 2012). According 10 Chowa (20 I 0). savings are low due to low income levels, lack of access to banking facilities. lack of education on savings. high dependency rati o.andpostponementofsavingtilla well-paid job is got in developing countries. Research shows that Ghana's health system is well structured and if expanded could meet the health needs of the aged popUlation, hence. the need for adequate data to inform policy, University of Ghana, http://ugspace.ug.edu.gh suengthen the health care system to improve service delivery (Araujo de Carval hoerot., 2015). The health system cannot be improved without the individuals contributing by planning for their own health care since the NHIS does nOI cover all health conditions among the aged and also not all the aged groups are covered by NH IS (Saeed, Xicang, Yawson. Nguah, & Nsowah- Nuamah. 2015). Addai etol., (2015),explain that the reasons for savings include. children's needs, buying of assets, investment. building a house, for retirement and as a security but the issue of health care were on the silent. With the above information, it is obvious that there appears to be limited preparedness of individuals towards meeting their health care needs in old age even though majority of the population in developing countrh:s will live beyond age 60 years (Odeyemi & Nixon, 20 13). This research seeks to address the gap in knowledge as how nurses in Ghana and for that matter in La-Nkwantanang Madina Municipality are making savings for their health care towards old age. If nothing is done: 10 meet the health care needs of the ageing population in Ghana. the health disparities among Ihe group within Ihis population will continue 10 widen. The expertise of these people will be lost because they will die early, and this will affe ctthehealth indicators ofthecoumT)'.Thisresearchtherefore,soughltodeterminethedeterminants/factorsinfluencing savings for health care towards old age among nurses in the La-Nkwantanang Madina Municipality. I.2.SigoificanceoflheStudy The infonnalion generaled from this study will enable the Ministry of He alth in collaboration with other agencies to make policy decisions toward enhancing financia l ac cess to health care for University of Ghana, http://ugspace.ug.edu.gh Iheaged population. It will also encourage individuals to make savings for health care towards old age since the NHIS does not coverall health conditions among the aged and also not all the aged groups are covered by NHIS (Saeed, etal., 2015). Despite this, it appears that limited studies(SaeedelaJ., 2015), haveexamined how nurses' health insurance status innuencetheir savings towards health care in old age It is anticipated that if nothing is done to encourag~ people to make savings for health care towards old age. individuals would be burdened with huge medical bills at the time they are not on salary and their families would be under pressure to provide support, which may not be available. This will affect their health outcomes and could lead to avoidable premature deaths thereby losing their expertise and the health indicators of the country will also be affected Nonetheless. it could be argued that few studies (Chowa & Ansong, 2010). have investigated how social factors, especially the support system could provide the m otivationfornursestosave towards hcalth care inold age. This study fills thc gap in thc Ghanaian c ontex!. Another motivation for the study stemmed from the professional background of the researcher. The researcher has worked in Ghana' s health sector for some years. The experiences acquired over the years helped to bringan in-depth understanding on the topic un derconsideration 1.3.StudyObjeclin's The objectives oftht: study have becn grouped intogeneraJ andspeci ficas indicated below. University of Ghana, http://ugspace.ug.edu.gh 1.3.1. General Q bjecti\'es The general objective of the study was to determine factors innuencingsavings for health care towards old age among nurses in the La·Nkwantanang Madina Municipality, Greater Accra Region 1.3.2. Specific Objectivt's The genernl objective was achieved by addressing the following spe<:ific obj ectives I. To assess the influenceofsocio-demographic/economic factors 0 nsavingsforheahhcare towards old age among nurses 2. To determine the innuenceofjob-related factors on savings for heahh care IOwardsold 3. To assess the influence of social factors on savings for health ca re towards old age among 1.3.3. Research Q uestions The following research questions helped find answers 10 address the objectives of the study' I. What is the innuenceofsocio-demographicleconom ic fac lorson savings forhealthcare lowardsotd age among nurses? 2. Whal is the innuenceofjob-related faclorson savings for health care towards old age among nurses? 3. What is the innuenceofsocial facto rs on savings for health care towards old age among University of Ghana, http://ugspace.ug.edu.gh 1.3.4. H)"pol hesis The hypotheses forlhe slUdy were' H :Thereisnorelationshipbclweensocio-demographic/economicfaclorsandsavingsforheailh o care towards old age HI : There is a relationship between socio-demographic/economic faclors and savings for heallh care lowardS old age. Ho: There is no relalionship between job related factors and savin gsforheahhcarelOwardsold H,: There is a relationship between job related faclOrsand slivings for heallh care towards o ld Ho: There is no relalionship bclween social faelorsand savings for heal th care towards old age HI : There is a relationship bctween social faclorsand savings for hea IIh care towards old age Thedissenalian is presenled in chapters 10 enable the reader to follow the lines of argument The chapter one talks about Ihe background to the sludy, the problem slatement, significance of lhe study and the general and specific objectives of the study and research queslions. This chapter has four sections. In chapter IwO, a review of existing literature on the factors influencing savings for hcalth care towards old age are presented. The chapter is divided into four sections. The first pan reviews literature on heal th savings, the second pan looks at Ihe influence of socio-demographic/economic faclors on savings; the third part talks aboul the influence of job related factors on savings for health care; and the fourt h part talks about lhe influence of social fsctors on savings for health care University of Ghana, http://ugspace.ug.edu.gh Chapt~r three describes the study design. the study population. the sampling method. and the sample size, variables of the study. data collection tool, data management and analysis and elhical consideration that were used for the study. In chapter fou r, the results of data analysiso( the variabl~s and their intcrpl'(:talions arc indicat~d. The results are presented on the test of association and the stn:ngthofassociation between socio·demographiclttonomic facton.job related factors. the social factors and savings for health care In the chapter five. the findings of the study as related 10 previous studies have been outlined The presentation covers the association between socio-demographic/economic factors. job I'(:laled ractors, social factors and saving,s rorhealth care towards old age and the strength or their association. The final chapter six iswherelhesummaryorthestudy.conclusjonsoflh~study, contribution to knowledge. recommendations, limitations to the study and future research 8re University of Ghana, http://ugspace.ug.edu.gh CHAPTER TWO LITERATURE REVIEW AND CONCEPT UAL FRAMEWORK Z.O.lntroduction This chapter presents a review of existing literature on the fact orsinfluencingsavings for health care lowardsold age. The chapter is divided into four sections. The first part reviews literature on health savings, the second part looks at the influenceofsocio-de mographic/economicfactors on savings; the third part talks about the influence of job related facto rsonsavingsforheallh care; and the fourth part talks about the innuenceofsocial factors on sa vings for health care Z. 1. Savings Towards Healtb Care According 10 Achar (2012), savings means the act of refraining from spending one's income on consumption, The part of income, which is not spent is called savings oTthe actofrcfraining from spending all income on consumption (Achar, 2012), Available literature indicates that heallh savings is money put aside forheahh care; usual1ycontribu lions are put into an account that may earn interest and portable even after workers leave their job (Lo Sasso. Shah, & Frogner.20JO). For this study, it must be emphasized that 'health saving'referstomoneyput in a savings accounts, which will be used for health care inold age (Achar, 2012). Achar (2012) suggests that, income levels, exposure 10 information on savings, employment status, and dependency ratio, stage in life cycle, fiscal policy,pen sions, insurance, and banking structure are some of the factors that influence savings, From the economisl's perspective, peopleallocaledisposable income between consumption and savings and Blvarious levels of income. there will be corresponding level of consumption and savi ngs(lssahaku,2011).lssahaku University of Ghana, http://ugspace.ug.edu.gh (2011) explains thai according 10 classical definition. saving is income mim.ls consumption. This analysis indicales that saving is normally considered incconomicsasdisposableincomemmus personal consumption expenditure. Inother ..... ords. it is regarded as in come that is not consumed by immediately buying goods and services (Issahaku. 20 1 I). According 10 Chows (20 I 0). savings are low due to low income levels. lack of acct:ss to banking facilities, lack of education on savings, high dependency ratio, and postponemenl of saving till a well-paid job is got in developing countries. This researcher added that socio- dernographicfeconomic factors such as agt:, sex. marital status . level of education, incomc level, employment status and cultural faclors innuence saving habits a mong the youth. Research shows that in Ghana, low income levels, high dcpendency ratio, high expenditure. poor financial management are some of the challenges to savings (Addai, el al. . 2017). Addai el al. (2017),explained that the reasons for savings include, children '5 needs. buying of assets, investment. building a house. for retirement and as a security. Even though in Ghana, 38% of thepopulationin2011 hadsavingaccoums, savings in the country had reduced in the past two decades (Afoal-wah. Annim, & Pep,ah, 2015). Afoal-wah f!1 al. (2015), argue thaI Ihis has serious financial implications for individuals and thc coumry and suggest thai women should be empoweredthrougheducationastheirabililylobargaincanincrease savings among households. A research conducted in Kcnya indicates that teachers have the ability 10 save regularly wilh formal financial inslitulions. but idenlified age, sex, level ofincome,depen dency ratio as some of the factors influencing their savings (KibeI. Mutai, Duma. Duma., & Owuor, 2009). Anolhcr University of Ghana, http://ugspace.ug.edu.gh sludyrc::vealc::dlhal nur.;cS makc:: savings forheallhcal1: in old agc::; and for nurses their health on relirement and general wellbeing infonned their savings (Blakeley & Ribeiro. 2008). Other sllIdiessuggc::st that eKposure 10 infonnation on savings and pension plans are k ey to ensuring that people take steps early as 10 meeling their heallh needs in old age an dsuggestedthalpeoplc cannot make good financial decision wilhoutadequate financial information (Clark, MOfrill, & Allen. 2012) 2,2, Factors Innu encing Saving' For Health Ca re Toward, Old Age This section presents some of the faclors that could have an innlH:oceoo SBv;n gs for heahh care to ..... ardsoldage These are presenled based on socio·demographic/cconomic,job-l1:lated and 2.2,1. The influen ce of sociu-demogra phicJc:conoOlic factors on sa vin gs for hea lth un towll rd,old age The term 'socio-demographic· refers to a group deJinl!dby its sociological and demographic characteristics-il refers to:of,relatingto,or involving a comb inationofsocialanddemographic factors (Minicuci. et ai, 2014). Research suggests thaI socio-demographic fac tors: age, sex, maritalstalus. level of education, have an influence on sav;ngs (orhea hh care towards old age (Minicucietal.,2014) According to Saeed etal. (2015), socio-demographidecollOmic factors as age, sex, education level,occupation, marital status and exposure to education on savings a resomeoflhc:faclors that influence savings among Ghanaians. Some research nott that women universally are University of Ghana, http://ugspace.ug.edu.gh exposed to socio-economic vulnerabilities. which affect their health an d economic outcome and argued that even though women are at high risk forage related diseases bee auseoflongevity. they are nol financially empowered and therefore. cannot make enough savings to meet their heallh needs in old age {Saeed etal. . 2015). Saeed elal. (2015), funhermentioned that increased dependency ratio and age have negative influence on savings. They infonnedthat socio-demographic/economicfac tors have an influence on chronic diseases. health status and health utilization. Thus, 10 overcome the challenges associated with old age, including health. there is the need for adequate savings. Saeed and colieagues(20IS),suggeslthattheolderpopulationshouldbegiven health education on chronic diseases. empowered financially to improve access 10 health care as this would reduce the gap in health outcomes among the aged as compared 10 the rest of the population and this would improve life expectancy in the country. 2.2.1 .1. Age The United Nations has agreed that 60+ years may be usually denoted aso Id age and this is the first attempt at an international definition of old age (Prince et 01., 2015). Some research indicates that one of the numerous challenges of old age is how 10 win the never-ending war against poor health arising panicularly from degenerative and man-made diseases such as diabetes, hean diseases, hypenension. stroke. malignant neo-plasm and trachoma and blindness thai often lead 10 complications and pennanenl incapacity (Tawiah, 2011). Tawiah (2011), explains that age is said 10 have a negative influence on savings as 01 derpeople cannot save enough and this influence Iheir heallh seeking behavior and affect their health outcome and University of Ghana, http://ugspace.ug.edu.gh quality of life in old age. Other research also suggest that people will always plan for old age only when they are gening closer to it and this limits their ability to save e nough to meel their health care needs inoJd age (Noone. Alpass. & Stephens. 2010). In Africa, older women are vulnerable: first, due to the biological proce 55 orageing;second,due to gender-related discrimination; and third. majority or older people are illiterate. which are associated with poor access to public TCsources (Pannarel ai" 20 14). Furthermore. most of the Africa's older people. especially women. have no ronnal employment records and thus no access toronnal social security arrangements like pensions (Parmar el al., 2014). Additionally. some researchers suggest that women with breast cancer seek treatment at very late stages (J and 4) at the Korle·Su Teaching Hospital, due partly to poor knowledge of the disease. the cultural context in which the disease is defined and also the inability to access health care due to inadequate income (Aikins, 2010) Despite the fact that women have a longer life expectancy than men, they experience poorer health consequences as a result of their low level of education, income and social status (Fonta, 2015). Other research suggests that women consistently report more difficulties than men in old age because \\ithin the ageing popUlation, a larger proportion of older adults are women (WHO. 2014). This idea was also supported by Jefferson (2009), with the argument that most of the jobs that women engage in weTC not paid jobs and this limit their income, hence, their inability to enroll on a pension scheme leaving them poorer in old age University of Ghana, http://ugspace.ug.edu.gh Some studies argue that the influence of marital status; being married, divorced, separated, never-married, or widowed on savings have changed significantly over the past several decades. and very little is known about the relationship between marital stat us and health (Lui, 200S). In contrast. self-rated healthofthewidowed, divorced, and sepa rated worsened overtime relative to the married, and the adverse effects of marital dissolution have increased more for women than for men (Lui. 2008). Lui (2008), indicates that marital-status transitions can have important effects on optimal household decision to save. particularly inthe case of widowhood and divorce with women and men at risk. Other researchers have also argued that married women consider planning for the future as the responsibility of their husbands, due to their limited income conlTibulion and could be to their disadvantage in later life (Noone. Alpass, & Stephens, 20 10). Children also playa fundamental role in the allocations of family resource and they also have strong interaction effects with changes in marital stalus,especia lIythetimingandlhenumberof children (Love, 2009) 2.2.1.4.Healthinsuran('estatus According to Aboagye (2012), formal social insurance give the elderly economic and social protection and reduces the burden on family members in seeking health care, especially now that Ihe family system is breaking down. Aboagye (2012), acknowledges that the minimum package offered bytheNHIS does not coverall health services, hence. the need to put money aside 10 meelthosehealthservices. University of Ghana, http://ugspace.ug.edu.gh 2.2.1.5. EducalionalSlatus A study on pension reforms in Italy required individuals to decide whether to participate in pension funds. how much to contribute. and how to invest their wealth - raising concerns about their ability to deal with financial matters (Chowa & Ansong. 2010). Chowa and Ansong (2010), found that men had higher financial literacy. which influenced their saving habits. indicating a relationship between financial literacy and the probability of pension plan participation. These analysts reported that there was a strong association between lower levels of education and poorer health outcome suggesting that improving health literacy might bea useful strategy for reducing disparities in health {Chowa & Ansong,2010). 2.2. J.6. lnnuenceofjobreJaledfactof'Sons8vingsforheallh caretowards oltJ age This part prcsentsliteraturcon thejob.related factors that could influence savings for health care towards old age 2.2.1.7. Workiog conditions The working conditions of nurses in mosl developing countries, including Ghana are poor leading to most nurses travelling to developed countries in search of better conditions of service (Anam, Quartey & Agyei, 2015). It is suggested that if nothing is done about the poor working conditions of nurses. majority of the qualified nurses will be losland this will affeclthe quality of health care delivery in the country (Anarfi el al. • 20 15). Nurses also mentioned Jack of equipment to work with. lack of recognition. housing and transportat ion, delay in promotion. and suppliesassomeofthechallengesthathadanegativeeffectonthemandaffects the quality of care that they provide (Kwansah etuJ .. 20 (2) University of Ghana, http://ugspace.ug.edu.gh In addition, research also suggest that health workers. including nurses fonnan integral part of the health system but they are often times neglected leading to shortage of qualified health workforce as tbe demand for lheir services in the developed world is high and at higher income (Henderson&Tulloch,200S) 2.2.1.8. Salary Kwansah et aJ. (2018). report of how nurses were not satisfied with their wages and the slow paceatwhichtheirsalarieswereprocessed,especiallyfornewlyqualified nurses but added that nurses in rural areas were willingdespile the challenges to remain in rural areas and take care of their clients. The magnitude of work that nurses undertake does not correspond with the wages and that most of the work they do are not clearly defined in their job description (K wansah el al., 2018). This seems to suggest that there is a strong correlation between health care quality and staff motivation. According 10 these researchers. Ghana could not achieve the health-related millennium development goals without instituting a comprehensive motivational package for the health workforce, especially in government health facilities (A lhassan et al., 2013). Other research suggest that there isa relationship between income levels and savings in that lower income limits the ability to save (Chowa & Ansong, 2010). Odoom (2015). indicates that nurses will deliver quality of care ifmoti\'ational packages are provided. The motivation can be in the fonn of financial motivation. creating an enabling environment at the workplace. provision of accommodation, transportation and the establishment of welfare policies that could give financial protection to nurses, especially during these hard. University of Ghana, http://ugspace.ug.edu.gh financial times. To train and retain workers, researchers have begun to inve stigatethefactorsthat are likely to motivate workers in general and especially health workers; and a study on motivation and retention of workers found that financial incentives significantly influenced motivation of .... orken in Ghana (Adzei & Atinga. 2012). Another research suggests that financial incentives such as, higher salaries. salary supplements. benefits and allowance. are the best way of motivating health workers, especially in countries where salaries and wages are low to the extent that they cannot meet the basic needs ofheallh workers and their families. including their health care (Henderson & Tulloch, 2008) 2.2.1.10. Saving tullure Research suggests that people will be willing to make investment if the benefits on the investments are high compared with low benefits and that higher salaries will lead to higher investment (James. 2009). James (2009), notes that investment policies playa major role in influencing people to invest arguing that if governments want to encourage investment,thenthe policies should be to ensure higher benefits. A study in Kenya on household income and savings. among teachers. small scale farmer holders and businessmen found that. occupation, gender,andeducationlevelofhouseholdheadpositivelyinfluenced the saving behaviour (Kibct elo/.,2009).Kibetelo/.(2009),reponthatsmallscalefarmerscouldnot make regular and high savings due 10 irregular income now and Jow income levels whereas businessmen saved regularly and higher due to their high income level (Kibet el 01 .• 20 09). There is evidence of how various individual anribules,job and organizational factors. family factors, and sociOC(:onomic context are related to the retirement process and fi nancialwell-being. University of Ghana, http://ugspace.ug.edu.gh physical well-being, and psychological well-being on retirement (Wang & Shi. 2014). Wang and Shi (2014). sho\\ tharthe kind of exposure at work has an influence on development of disease in later life and could detenninethe amount of savings for health care in oldage. 2.2.2. InOuenceohocial fa('torson savings for hcallh care towards old age This part presents review of available literature on the influence of soc ial factors on savings for health care towards old age. According to Gifford and Nilsson (2014), social factors include religion,urban-rural ditTerences, norms. social class, cultural and et hnic variations and these have an influenceonthe way people behave. Valsiner (2009) explains that culture is the mindset ofapeople. ltisanexplicationofhowcullUreoperatesat thementalistic and social planes of human existence and these have an influence on everything, including savings and health outcomes. Literature explains that cultural syndrome isa panem of shared attitudes, beliefs, categorizations,self-definitions.norms,roledefinitions,andvalues that are organised around a theme that could be identified among lhose who speak a particular language, during a specific historic period. and in a definable geographic region (Cohen & Cohen.20IS) Aboagye (2012). notes that the family was considered as social security for older people in Ghana. where very weak social security institutions exis!. However. the role of the family in the careandsupponofeldersisdeclining.Someresearchersarguethatthedecline in familysuppon is due to the change in focus of people on their nuclear families in stead of the extcnded ones and the growing economic constraint, which makes it difficult for families to support the elderly. meaning many elders sti ll remain poor and dependem (Aboagye, 2012) . University of Ghana, http://ugspace.ug.edu.gh 2.2.2.t.Perceplions Some studies argue lhat most Ghanaians do not plan for the futurc and for that maner health care, due 10 lhe fact lhal planning forheallh care indicates lhat you are planni ngtogel sick. which for them is evil and this could influence savings towards health care in old age (Ackah & Owusu, 2012). Ackah and Owusu (2012), also suggested that most Ghanaians rely on the protection of God and do not plan for unforeseen circumslances. The increasing incidence of superstition and some traditional beliefs and practices have effectively combined to worsen the lot of the elderly (Tawiah, 2011). Tawiah (2011), indicates that in some pans of Ghana, older females are branded witches since these women suffer some aged related diseases. which are perceived by culture to be associated with witchcraft. These women are usuaJly labeled and neglected by even close family members and this has a negative effeci on their health (Tawiah, 2011). A dominant argument made in the regional literalure is thatchronicdiseasesareanributedtospirilualcausesandthatlhesespirilUaJcausaltheories infonn lay engagement wilh traditional healing systems (Aikins. 2010). Some researchers recognise the faelthal care of older adults occurs in a cultural context in which the older members of society arc poorly valued. often referred 10 as ageism (Holroyd, Dahlke. Fehr. Jung, & Hunter, 2009). 2.2.2.2.CulturaI8elicfs Other sludies have notcd that cuhure-innuenced personal beliefs (knowl edge of mental illness and stigmatism) are found to playa substantial role in shaping individuals' attitudes toward mental health services (Jang. Kim. Hansen, & Chiriboga, 2007). Jang el a/., (2007). suggest thaI University of Ghana, http://ugspace.ug.edu.gh there isthe need to investigate how culture influences the response to menta I heahh needs and to develop community education and outreach programmes to close the gaps between mental health needs and service utilization in older ethnic minority popUlations . In a study among students on cervical cancer screening. culture was identified as a barrier· this s uggests that there are cultural and traditional beliefs that are influencing the responses to screeni ng{Abotchie, 2009). 2.2.2.3. Social proteclion Social protection is the base for a secure and acceptable life and the main aim of social protection is to tackle poveny and to protect people from risks and shocks caused by for example, unexpected economic fluclU&tions, mostly used where the majority of the people are living under poveny (Abcbrese. 2011). Abebrese (2011), explain that some of the social protection policies introduced in Ghana include Social Security and National Insurance Trust (SSN In, NHIS, the Ghana School Feeding Programme (GSFP) and the Livelihood Empowennenl Against Poverty (LEAP) but all these are not without challenges. Gobah and Zhang (2011), explain that the NHIS in Ghana was established by the National Health Insurance Act. 2003 (Act 650) and National Heahh Insurance Regulations, 2004 (L. t. 1809). This has been amended 10 NHIS Act 852 of 2012. The aim was to improve financial access of Ghanaians, to quality basic health care services and to Ii mit out-of-pocket payments at Ihe point of service delivery, especially the poor and the vulncrabJe. [t is argued that despitc the benefits of this social intervention, that is financial protection to Ih epoor,indudingtheaged,lhis initiative is challenged with increasing cosl ofeate, multiple attendance., and increased drug prescription, whiehchallenge the survival of the scheme (Gobah & Zhang, 2011). University of Ghana, http://ugspace.ug.edu.gh Some researchers suggest thaI there will be high utilization of health services if people are covered bya heallh insurance scheme and this will improvelhehealth indicators of the country (Blandlet, Fink. & Osei-Akoto, 2012). Social security and pension are methods used in most developing countries like Ghana to reduce poverty but this is not meeting the needs of the people as it covers a small portion of workers who are in the formal sector (Osei. 2011). Osei (2011),arguesthatGhana is one of the few countries in sub-Sahara n Africa that has introduced the LEAP programme, which provides social grants to beneficiaries chosen from extremely poor In some cultures in Ghana, families prefer investing in a boy's education because it is believed that the money a son earns from employment after graduation will remain in the family, whereas a girt's wealth will be given to her in-laws (Chowa & Ansong, 2010). Chowa and Ansong (2010), observe therefore. that the perception is that educating boys ensures that wealth remains in the family. Consequently, the returns from education. such as income, which hopefully translates into savings. may not be the same for both young boys and girls beca use males and fema les are trtated differently (Chowa & Ansong, 2010) All the above are attempts made by the governments to improve the quality of life, mostly financed from taxes bulthese alone cannot reduce poverty and improve quality of life as demands keeps changing and the govemmentpurscis alreadyconstrained, hcnce,lheneed for individuals to make savings forheahh care towards old age. University of Ghana, http://ugspace.ug.edu.gh 2.3.ThtorClicalfnilmcwork Taking into consIderation the objective of this study, a review of theoretical thoughts underpinning savings was needed. The neoclassical economic theory. psychological and sociological theory, and behavioural economic theory are some of the s avings theories (Pollak, 1998). Pollak (1998) explains that neoclassical economic theory assumes that individuals are ralional beings and ,",ould re5pond in predictable ways to changes in incentives. According to this perspective, there are t\\O things that will detemline an individual's behaviour; opportunities!constraintsandindi\,idualpreferences. Other economic analysts are of the view that individuals have adequ8tc knowledge and contact with perfect mario:.ets. lndividual success is usually assumed 10 be the purpose of con sump lion, and economic models treat savings as a residual. the resources Ihal remain after consumption decisions are made. The life cycle hypothesis (LCH) (Modigliani & Brumberg, 1954), and the pemlanent income hypothesis (PI H) (Friedman. 1957), theories accept Ihal individuals and households are concemed about long·teml consumption opportunities and explain saving and consumplion in lennsofexpected fulure income. These theories adopt that saving is a way to level consumption in the face of income variations (Modigliani & Brumberg. 1954; Friedman, 1957;PollaL.I and art often regarded in most societies as male relatedoccup8tions (Ghana Stalislical Service, 2014) Healt h eare provision a nd financing The municipality has 22 health facililiesand various categories of heal th staff that provide health care 10 the people. Out of the twenly-two(22) health flcilities, seventeen (17) are private, four (4) are government owned and one ( Il under the Christian Health Association of Ghana (CHAG). The municipality has three (3) sub-districts namely: Madina. Pantang and Danfa with a population of 95,203, 2S,313 and 9,805 respectively according to the 2010 population census (Ghana Statistical Service, 2014). Both NHIS and out-of-pocket payments are the means of health financing in the area. Forthisstudy,three(3)healthflci litieswercselccted 3.3. Siudy Population The study was conducted among nurses betv.een the ages of 18 and 60 years. Nurses were selected for this study because by their training and work, they were exposed to age related discascsand the chaltenges that the aged encoonter in seeking heallh care. especially financial challenges. hence, the need to know whallhey were doing nOllO be victims of what they already knew. In addition. the nursc5 were chosen because they formed majority of the health workforce in Ghana. This meant that their knowledge of savings forheallh care towards old age could infonn policy that would address challenges identified. Thceatcgoriesof nurses in the selected facilities included: certificatt, diploma, undergraduates, gradualeand postgra duatenurses. The Psychiatry Hospital at Plntang had 141 nurses, MadinaPolyclinic (l,:ekele)had 115 nurses,and Pentecost Hospital had 101 nurses. University of Ghana, http://ugspace.ug.edu.gh 3.3.I.lndusionc:rileria All c:alegories of nurses working in the three (3) selected health facililies.onregularsalary,aged belWeen 18. and 60 years were included in Ihe srudy. 3.3.2. Exdusioncrileria Nu~esbelm\ 18 years and those above 60 years, nurses not on regular salary,othe r health care workers,andnursesnolinlheselecledfacililieswerenolincludedinthestudy. J..I.SamplingMetbods Stratified, and simple random sampling techniques were used to select the participants for the study compared to purposive sampling a nonprobability sampl ing melhod with the objective to produce a sample Ihat can be logically assumed 10 be representative of the population (Hall, 2008). Facilities "ere pul in strata. that is govemment owned, Christian Health Association of Ghana (CHAG) and private then three (3) health facilities were selected. govemment faci lities· Madina Polyclinic (Kekele), Psychiatry Hospital at Panlang and the Pentecost Hospital (CHAG), which serves as the referral hospital inlhe municipality wereselecled Purposive sampling strategy was applied to select the study area an d health facilities because of limited lime and resource; and convcnienlaccessibility and proximity to the researcher (Hall. 2008).Beforclheselectionofstudyparticipanls.fi~t,alislofthe nurses was obtained according 10 Iheircategories. Only nurses who fulfilled the inclusioncriter iawereseleCled A simple random sampling was used in selccling the respondents at the facility. Simple random sampling was used because the time for data collection was limited and the nature oflhe work of nurses made il difficult to get them using other sampling methods. The various facililics were University of Ghana, http://ugspace.ug.edu.gh numbered serially as they were visited. The first facility was numbered as HF/OO I and Ihe second facility numbered HF/002 until the sample size was obtained. 3.4. 1. Sample Size Dete rmiaation Since there was no available prevalence rale specifically related 10 the LANMA , the study adopted the prevalence rate used in a study in Pakistan (Rehman, 2011). That is, a sample size of 206wasgeneratedusingtheprevalenceofS4%at95%confidenceinterval.andO.05marginof error and 10% of non-response (this was to ensure that a sizable number was ob tained in the eventofmanynon-responsesfromthepat1icipantsduetothevoluntarynatureofparticipating) using the Fisher's formula n = Z (pq)/d, Where, n=minimumsamplesize Z '"' confidence interval at 95% p=estimate proportion with condition of interest q=l-p d=marginoferror Additionally, 10% of non-response was added to make up a sample of 227 participants for the study. University of Ghana, http://ugspace.ug.edu.gh 3.5. Variables of the Study The variables measured in the study have been grouped into both depende nland independent as ex.plained. These variables were selected based on information in relation to literature reviewed 3.5.1. Dependent "Iriable The outcome variable for the study was s8vings for health care. 3.S.2 Indepeodentvariablcs Theindependem variables that were measured were: SMio-demognapbic/economic vlllriables: age, sex. educational status, maritalstalus. level of income. health insurance status. existing medical condilion JObrelatedvariablcs: salaries.savingscultureandincenlivepackages Socia lfa clors:perceptionofagedhealthcare. social support,cultural beliefs. A quantitative research method was applied to collect empirical data for subsequent analysis in the study. Data was collected in June 2018. A structured questionnaire with closed-ended questions was designed and self-administered by the study participants answerable within )O minutes at the various work places of the panicipants The questionnaire was divided into University of Ghana, http://ugspace.ug.edu.gh sections covering the key objectives of the research. Section A sought 10 collect data on the socio-demographicleconomic characteristics/factors of the research participants. Section B collated responses on the job-related factors. Section C asked questions on the social factors from the participants. The questionnaires were distributed to participants with the help of two research assistants, who were trained on the objectives of the study and how to check for completeness of the questionnaires. The questionnaire for the study was designed by the investigator based on variables identified in literature and sup ported by theoretical evidence 3.6.1. Data Quali ty Assura nce The two research assistants were trained for two days for them to understand how to use data collection tools and how to collect adequate data, make corrections and ensure completeness They were also trained on the information to be given to respective participants so that they could give the required information . Pretesting of the questionnaire was done at Mad ina Polyclinic (Rawlings circle) a faci lity that was not part of the sludy organizations, to ensure that the data collection tool was valid for the collection of relevant information and ensure reliability of the study results. 3.6.2. Validity and Reliability of Da la In conducling a study that applied quantitative methods, it was necessary that efforts were made to ensure the validity and reliabil ity of the data and results. Val idity refers to the degree to which empirical evidences and theoretical rationales support the adequacy and appropriateness of interpretations and actions based on test scores. A lest is seen as being reliable when ilcan be used by several different researchers under stable conditions, with consistent results and the University of Ghana, http://ugspace.ug.edu.gh results not varying. To ensure validity and reliability, the data collection instruments were pretested at the Madina Polyclinic (Rawlings circle) with the nurses, which provided the opponunity for the researcher to reframe the questions to suit the re quirements for the conduct of the main study and appropriate analytical strategies were applied in the analysis of the data. Relevant theories !hat exist on savings were also reviewed and factored into the development of the questionnaire. It is anticipated that the resuhsare valid and reliable . Thus,thestrategycould be replicated byotherresearchcrs in other senings 3.6.3. Data Ma oagement The data collected was edited manually to correct any duplications an d wrongenlries.The edited data was then coded and entered and analysed statistically using Stata software version 15.1. Data was collected on variables identified in literature as having an influence on savings for health care towards old age. Data was collected according to the objectives of the study and 3.6.4. Data Ana lysu Basic descriptive statistics were run using Stata software version 15. 1, and the results were presented using tables depicting frequencies, percentages, and proportions. The relationships between variables were further analysed using simple and mu ltiple logistic regressions. This data analysis strategy was earlier applied by some researchers and was adapted duc to Ihe fac t that this analysis strategy was relevant to Ihis study (Rehman, 2011). T he level of significance of this study was 9So/e (pO.05.Theresullsateshowninlhelable4.3below Table 4.3: Relationship between job-related faclorsall(! savings forhealtb care Variable Fr~ (lucncy Saving for health care Chi- :'Ii ("I. ) Yes-n('"!.) Non(O/.) square =Xl <10 145(67.76) 115(82.14) 25(17.86) 11-20 53(24.77) 39(75.00) 13(25) 2 1-30 5(2.34) 1(20.00) 2(80.00) 3 1+ 11(5 . 14) 77(77.78) 2(22.22) :~~rs left for retirement 3.273 0,352 15(7.01) 11 (73.33) 4(26.67) 11-20 22( 10.28) 15(68.18) 7(3 1.82 ) 21 -30 102(47.66) 79(80.6 1) 19( 19.39) 75(35.05) 60(84.51) 11(15.49) University of Ghana, http://ugspace.ug.edu.gh Salary Regular 205(97.62) 161(80.50) )9(19.50) Not regular 5(2.38) )(75.00) 1(25.00) Su!ury(amount) <1000(low) 6(7.59) 5(83.33) 1(16.67) 0.088 IOOO-1499(middle) 24(30.)8) 15(65.22) 8()4.78) 1500-1999(high) 35(44.)0) 31(88.57) 4( 11 .4) 2000+(highesl) 14(17.72) 13(92.86) 1(7.14) Nur.~i"grullk StafTnurses 4)(27.56) 27(67.50) 13(32.50) SeniorSlaffnurse 54(34 .62) 4)(79.6) 11(20.7) Nursing officer 48(30.77) 41(91.11) 4(8.89) Principal nursing officer 10(6.41) 7(70.00) )()O.OO) Depuly directorofnursing 1(0.64) 1(100) 0(0.00) services Others Do you 1laveolher job incentives Incentives 35(16.91) )0(90.91) )(9.09) No incentives 172(83.09) 134(78.44) )6(21.56) Doyou huve any insurancepoJicy Insurance policy 117(56.52) 94(83.19) 19(16.81) No insurance policy 90(43.48) 67(77.0 1) 20(22.99) DoyouJlfIl'eothusources oJ;""ome Have olhersources of 65(31.10) 48(78.69) 13(21.31) !N:O:O;l:hter sources of income \44(68.90) [\5(82 . 14) 25( 17.86) (Il'count 188(88 .68) 152(83.52) )0(16.48) No account 24(11.32) 13(59.09) 9(40.91) Fref/uellcyoJsaving.f 3.372 Weekly 8(4.12) 6(75.00) 2(25.00) Monthl} 168(86.60) 134(83.2) 27(16.77) Quarterly 14(7.22) 12(85 .710 2(4.29) Yearly 4(2.06) 2(50) 2(50) % o/saving.{Jorheullhcure 0.791 10% 86(46.49) 66(80.49) 16(19.51) 20% 56()0.27) 45(84.91) 8(15.09) 30% 29(15.68) 25(86.21) 4(13.79) 40% 14{7.57) 12(85.71) 2(14 .29) Saving.fenoughlomeet 0.141 0.707 heallhlleetlsonrerirement Enough 58(28 .57) 45(81 .82) 10(18.18) NOlenough 144(70.94) 112(79.43) 29(20.57) University of Ghana, http://ugspace.ug.edu.gh Doyou beiollC 10 credit 1.401 Ul/ion Credit union 40(18.87) 33(86.84) 5(13.16) No credit union 172(81.13) 130(78.31) 36(21.69) Doyou~/ongtoa welfQre club WelfarecJub 84(39.62) 69(85.19) 12(14.81) No welfare club 128(60.38) 94(76.42) 29(23.58) t!o:~eYOUIQkenUIOQII 0.058 73(34.60) 56(78.87) 15(2 1.13) No loan 138(65.40) 106(80.30) 26(19.70) t::;hQ'!:: ing sa~jJlgs for 0.061 Affecting 60(69.77) 46(79.31) 12(20.69) Not affecting 26(30.32) 20(76.93) 6(23.08) 4.4. Relalionship belween social faClorsaodsa,ings forheahhcare From thechi.square lest results, there was a relationship between savings for health care and working status of spouse with {PO.OOS. There was also an association between family financial expectations and savings for health eare.p=O.013. There was an as soeiation between proper aged health care and savings for health care.p-O.046. Detailsofthisa reshown in table 4.4 below. University of Ghana, http://ugspace.ug.edu.gh I'-value Spousal consent IOI{51.27) 75(76.53) 23(23 .14) Nuconsenl 96(48.73) 75(82.42 16(17.58 Spouse working status Working 156(87.15) 124(81.05) 29( 18.95) Not working 23(12.85) 12(54.55) 10(45.45) ~umb ... rojchifdrl.'n 40(21.86) 31(79.49) 8(20.5 1) I 39(21.31) 33(86.84) 5(13. 18) Z 54(29.51) 43(83.69) 9(17.3 1) 3 34(18.58) 24(70.59) 10(29.41) 4+ 16(8.74) 12(75.89) 4(25.00) Fumilyexpec'lfllion,' AlTectingsavings 145(69.38) 122(84.72) 22(15.28) Not affecting savings 64(30.62) 41(69.49) 18(30.51) Does 11,1.' aged need proper corejoraged Need proper care 204(99.51) 158(80.20) 39(19.80) Donol need proper care 1(0.49) 1( 100) 0(0.00) Will jamily be willing 10 sappurt medictll bills Willing 104(49.06) 79(79.00) 21(21.00) NDlwi lling 21(9.91) 17(80.95) 4(19.05) Not sure 87(41.04) 69(81.18) 16(18.82) DO}'nu contribute /o SSN1T 199(94.31) 157(80.93) 37( 19.07) Don'teonlribule 12(5 .69) 7(63 .64) 4(36.36) MeetlU'etil' ollreli,,'melll 0.549 Enough 45(22.50) 38(84.44) 7(15.56) Not enough 155(77.50) 120(79.47) 31(20.53) Do you M-'Onl NHIS to 0.062 cOI'eragedileolthcflre Conr 201(95.71) 158(81.56) 37(18.97) Noteonr 9(4.29} 5(55.56) 4(44.44} University of Ghana, http://ugspace.ug.edu.gh 4.5. Logisfic Regression: Socio_dcmographic/economic factors and savin gs forhealfh carc towards old age The study findings by binary logislic regression revealed that the odd s of saving for health care among those insured was 3.75 limes Ihan that of those who were nOI insured (p~.030, CI""=I.18- 11.84). Respondenls who save for health care within the age range 30·39 years was 0.81 times than that of those aged <30 years (,F0.439, CI"'0.36· 1.79). When other socio- demographicJeconomicfactorswereadjustedfor.theoddsofsavingforhealth carc towards old age among age range 30-39 was about 0.7 times than those aged <30 0.279. See University of Ghana, http://ugspace.ug.edu.gh ::;ber of dependence 3.4(0.74,15.18) 0.116 8.6(1.07,68.48) 0.042·· 1.6(0.33,5.19) 0.704 2.1(0.37,12.02) 0.405 1.1(0.22,5.12) 1.4(0.23.8.76) 0.710 0.3(0.07,1.58) 0.5(0.07,3.90) 0.531 4.6. Logistic Regression: Job rela ted factors and savings for heahh ca re At the logistic regression level, the study further explored the extent oflhe influence of job related factors on savings for health care towards old age among nur ses in the La-Nkwantanang Madina Municipality in the Greater Accra Region. The results revealed that the odds of saving for health care among senior staff nurses was 1.88 times compared with staff nurses (p '="D. 185, CI=D.74-4.79). After adjusting for all other job-related factors. the odds of saving for health care towards old age among senior nursing officers increased by 10 times than that of staff nurses p=O.OI I, CI=1.7-59.22). Furthermore. the odds of saving for health care among nursing officers was 4.9 times compared with staff nurses (p=O.OIO, CI= 1.45-16.74). When all other job factors were held constant, the odds of saving for health care among nursing officers increased 51 times than that of the staff nurses (p=O.OOI,CI""5.43-484). Moreover, the odds of saving for health care among those with savings accounts was 3.51 times compared with those without savings accounts (p=O.O I2. CI= 1.38-8.94). The overall module comparing job related factors and saving for health care towards old age wasp=O.OOO2 (p<0.05). The details of the results are shown in table 4.6 below University of Ghana, http://ugspace.ug.edu.gh Table 4.6: Logisli~ Rtgression: Job relaled ra~lon andAs~~i(~;~;~t~allb ~~;:Iue COR (95o/,cl) P·value :;:::' oj yean; in R,f 11·20 0.7(0.30.1.40) 0.272 0.1(0.01.0.37) 0.002·· 21·30 0.7(0.1.8.11) 0.902 0.1(0.00.15.35) 0.322 31+ 0.8(0.1,).9) 0.742 0.5(0.07.4 .14) 0.553 NumbuojyearJ/ejt forretiremenr R,f 11 ·20 0.8(0.18.3.34) 19.1(0.66.555) 1.5(0.43.5.27) 0.517 10.3(0.56.189 0.116 1.9(0.53.7.37) 0.306 22.9(1.20.436) 0.037·· R,f Have incentives 2.7(0.79,9.52) 2.1(0.34.12.90) Nursing rank R,f Senior staff nurse 1.88(0.74,4.79) 0.185 10.0(1.70,59.21) Nursing officer 4.94(1.45.16.74) 0.010" 51.32(5.43.484) Principal nursing 1.12(0.24,5.06) 0.880 72.1(4.01.1295) 0.004"- officer Deputy director of nursmgseTVlces In suronc:epolicy R,f With policy 1.47(0.73,2.98) 0.276 2.1(0.58.7.76) Savings account R,f With accounts 3.51(1.38.8.94) 9.3(1.57.55.5 1) Orllersourcesoj Rof Have other income 0.8(0.38.1.70) 06(0.16.2.21) sources University of Ghana, http://ugspace.ug.edu.gh 4.7. Logistic Regressioo: Socia l factor5and saviogs for health care The study also revealed that the odds of saving for health care amon g nurses whose spouses had a paid job was 3.6 times than that of those without a paid job (p=0.009. CI=I.40 - 9.01) . After adjustingfora[[othersocial factors. the odds of saving for health care towards old age among Ihose whose spouses had paid jobs increased 10 3.9 times compared wilh those whose spouses had no paid jobs (p=O.Oll , CJ=1.37 _ 11.05) which was statistical1y significant. Additionally, the odds of saving for health care among nurses with family financial expectations was 2.43 limes than that of those without family financial expectation (p=O.OI6, CI=I .19-4.98). In addition, the odds of saving for health care among nurses who said NHIS should cover all health care services was 3.13 times than that of those who said itsho uld not cover all health care services (p=O.09, CI=O.87-1J .34). The relation between social factors and savings for health care towards old age was p >0. 113. Details of the resu lts are shown in table 4.7 below. University of Ghana, http://ugspace.ug.edu.gh J::;uuworking!ilUIUS Working 3.56(1.40.9.04) 3.9(1.37.11.05) ~:rilY lXPl('/(/fi(mS Affecting savings 2.43(1.19.4.98) 1.8(0.75.4.24) ::;:ffamilYbtWilfinXlosUPPOrtmldiculbillS 1.1(0.34.3.72) 1.0(0.26,4.00) 1.1(0.55.2.37) 1.2(0.48.2.80) Do }'ou contribute to SSNIT R,f 2.4(0.61.8.71) 1.2(0.12.12.78) Will SSNIT contribution met/ netdl' on rl';rl mtnl R,f Enough 1.4(0.57,3.44) 1.0(0.37,2.63) NHIS to cover ugl ht ufthcure R,f Takc: care of health cost in 3.1(0.87,13.34) 3,.5(0.61,20.47) otdagc: 4.8. Multiple Regression: Association between socio-demographic/econonlic characleristics, job related factors, social factor anti saving (orhea lthure toward s old age Adjusting forsocio-demographicleconomic factors, job related faclors and social factors, using Ihe p"'O.OO I, showed thaI all individual factors had p 0 .05. The next chapter presents a discussion of the meaning of these associations and compared with existing literature and University of Ghana, http://ugspace.ug.edu.gh CHAPTER FIVE DISCUSSION OF FINDINGS S.O.Introduction This chapter presents the findings of the study as related to previous studies and available theories. The presentation covers the association between socio-demographi c/economicfactors, job related factors , social factor and savings for health care towards old age and the strength 0 f their association. There are four sections. 5.1. Socio-demographic/economic characteris tics and saving ro rhcalthcare The results revealed thai Ihesocio-demographic/economic factor s; age, sex,marilal status, level of income, level of education among olhers played an important role in their ability to save for health care towards old age even though not statistically signifi cant (p=0.279). From the results, nurses aged 30-39 years were less likely to save for health care low ards old age compared with nurses aged <30 years and those aged 50+ were more less likely to make 5 avings for health care towards old age compared with those aged<30 years. Additionally, nurses who were married were also less likely to make savings for health care towards old age compared with those not married and nurses with higher income had higher chances to make savings compared with those with lower income. This is similar 10 a study, which suggested that age had a negative influence on savings-as people age Ihey are less likely to make savings(Ki bel el ai., 2009). The results also indicated that nurses who were enrolled in the NHIS were more likely to save for health care towards old age compared with those not insured fp=O.024) . This demonstrates that nurses were aware of the limitations of the NHIS in health service coverage as evidenced in University of Ghana, http://ugspace.ug.edu.gh 85.2~o of respondents saying they were aware that NH IS was nOI laking care of all health care costs. TheissuPpor1ed by a study which found thattheNHIS provides financia l proteclion In seeking heaJth care and should be expanded to meet health needs of the aged and also reduce burden on other family members 10 bear Ihe health cost of the aged (Aboagye. 20 12). The results also indicated that, number of dependents had an influence on savings for health care towards old age (p=O.029). The odds of saving for heahh care towards old age among those with dependents were 0.6 times compared with those who did not have dcpendents. This means that nurses with dependents were 40% less likely to make savings for health care towards old age This finding is similar to othcrs which found thai dependency rat io had negative influence on savings (Saeed elal. . 2015) The study also revealed that there was a relationshipbctween a spouse having a paid job and savings for health care {p:=O.008}. Nurses who had spouses with a paid job were 3 timcs more likely to make savings for health care towards old age meaning the more income in the household, the higher the chances of making savings for health care. The above is sim ilar to a study, which suggested that increased income in the household would increase the ability to make savings {Issahaku, 201 I). Although olhersiudiessuggcsi thai age, sex, maritalstalus, and level of education have an innuenceon savings (Saeed elol. • 2015: Love,2009),thiswasnot statistically significant in this study. This could be due to the sample size and the fact that the study was done among only nurses who may have very sim i lar characleristics University of Ghana, http://ugspace.ug.edu.gh 5.2. lonueoceofjob-related factors 00 saviogs for bealth care The resuhsalso indicatoothat senior staff nurses had 1.8 times higher ability to save for health carethanthatofstafTnurses(p~ . 18S).butwhenal1otherjob.relaledfactors were controlled for, the odds among senior nurses increased by 10 times than that of staff nurses (p::O.Oll). Moreover. the odds of saving for healthcare towards old age among nursing officers was S times than thai of staff nurses (p=O.OIO). This means that nursing officers had highest chance of saving for health care towards old age among the nursing ranks. Nurses who had olherjobincentives were more likely 10 save for health care than those without job incentives. meaning that incentives had a positive innuence on savings for health care tow ardsold age even though not statistically significant (p=O.lll). Jnaddition. nurses who had savi ngs accoum were more likely to save for health care compared with those without savings accounts (p=0.009). which was statistically significant. This finding is like a study. which suggests that rnotivational pac kagesin the fonnoffinancial motivation give financial protection to nurses (Odoom,20IS) The resuhs also indicated that there was an association between number of years in service and savings for healthcare. Nurses who worked between II and 20 years were about 30% less likely to save for healtheare towards old age compared with those who worked for <10 years (p=O.272). When all other factors were adjusted for, they were 90% less Ii kely to save for health care towards old age (p=O.002). In addition. the results also revealed that there was an association between number of years left for retirement as nurses who were left with more than 30 years to retire were 2 times more likely to make savings for healthcare compared with those less than 10 years to go on retirement (p=0.306). The above flndingsare similar to the evidence documented in the literature (Tawiah, 2011). Tawiah (2011), suggested that older people often University of Ghana, http://ugspace.ug.edu.gh have little money and would not be able 10 access quality health care, which have negative impact on Iheirhealth seeking behaviour, hence. the quality ofthe irhealth The results sho\\ed that majority of nurses were making savings for health. which could be attributed to their awareness of the heahh risks associated with old age, againsl the reality that the NHIS had yet to cover most of the health conditions associated with old age and the SSNIT pension would nol be enough to meet their needs, includingilealthcarefp==O.OOO2). Theabove findings are similar to Ihesuggeslion that nurses would always put their health first and would make savings for health care (Blakeley & Ribeiro. 2008) . II was found that since they had regular fonn of income and their salaries wereplI.id through financial instilUtions, thai is.lhebanksthat manage these savings, it enables Ihem 10 make savings for health care towards old age. The aboveissimilartothefindings,whichsuggestthatwhenincomeis regular it increases the ability to make savings and the higher the income the higher the savings{K ibetel(J/. . 2009). The results revealed that the nurses would need increased salary 10 enable them make savings for health care towards old age. This was evident in a response to a multiple response question when majority (86.S%) of the nurses asked for an increase in salary, 57% as ked for reduced taxation on salaries. 60% asked for transportation allowance, and rent allowance (S 10/,) as some of the ways or incentives that their employers could adopt to assist them in making savings rorheallhcare. This finding is similar to the suggestion that low levels or income would m:lkc it difficult for savings (Addai. et aJ, 2(17). The above findings are similar to findings ofearlicr studies reponed (Henderson & Tulloch, 2008) . They suggested that improved salaries and benefits are major financial incentives for workers to remain in Ihe health sec tor. University of Ghana, http://ugspace.ug.edu.gh 5.3. Social faclOrs iofluencingsavlngs (or health care IOwards The results also revealed that thert was an association between the working status ofa spouse and savings for health care (p-="0.OO8). This means that the nurses whose spouses had paid jobs were likely to make savings forhcahh care towards old age. Furthermo re,financialexpectations from other family members were found to be affecting savings for health care as compared with those that did nOI have such demands (p=0.OI5). However. after adjusting for all Olhercultural factors. this was nOI statistically significant (p=O.186). indicalinglhal. pUllingsl1 social factors logether, spouses who had paid jobs' contribution to savings fo rhealth care was nOI statistically significant. The results also revealed that there was an association between a gedneed for proper health care and savings for health care lowards old age (p-O.046). The above findings are similartoearlierfindings, whichsuggesledthatanincreaseinhouseholdincorne wouldincreasc savings (Kodom, 2013). Furthennore, Ihere was an association belween social proteclion such as SSNIT contribUlions Nurses who contributed to SSNIT pension scheme were more likely to make savings for health care towards old age compared with Ihose who did not contribute to SSN IT {jJ=O. 175). Nonetheless. among Ihose who contributed to SSNIT and said their conlribution was not enough to meet their needs on retirement were 1.4 times more likely 10 make savings for health care compared with Ihose who said il was enough 10 meet their needs on retiremenl (p=0.460). There was also an association between the family willingness to support medical bills on retirement and savings forhealthcare IOwardsold age University of Ghana, http://ugspace.ug.edu.gh Nurses who said they were not s~ of family suppon wert more likel) to make savings for health care towards old age compared with those who said family members were going to suppon bills (/F0.712). This finding is simi lar to earlier findings reported in the literature (Holzmann. 2013). Holzmann (2013). suggested that there was the need for reforms in pension schemes to meet current financial needs and give social protection to the aged. This was ,Iso similar to a su~eslion Ihat the famil y system that gave protection to the aged was breaking down gradually (Aboagye. 2012) Overall. the evidence showed that there were associations between socio-demographic/economic factors and savings for health care towards old age (p-O.279) though not significant; job related factors arni savings for health cart' lowardsold age (p- O.OO2); and social faCIO rs and savings for health care lowards old age (p='0.113). Although there was an association between the above factors. the strength of the association between all the above andsavi ngs for health care was not statistically significant (p>O.OS). The above findings were similar to others reponed in the literature (K ibet el 01 .• 2009; Odoom. 2015; Tawiah. 20 II). 5.4. Summary of t he chaplu Thechapterprcsented findings oflhe study and how they relalcd to current literature. Thene,,' chapter presents the conclusion of the study It discusses the implications of the findings for policy. methodology and management University of Ghana, http://ugspace.ug.edu.gh CHAPTERSlX CONCLUSIONS AND RECOMMENDATIONS 6.0. lutroductiuu This chapter presents the summary of the study, conclusions of the study, contribution to knowledge. recommendations, limitations to the study and future research. This chapler has six (6)seclions. 6.1. Summary oftbesludy This section presents the summary of the study based on the general objective. Despite the increasing number of people aged above 60 years is increasing in de velopingcountries, not much is done to meet the health needs of the ageing population, especia lIyimproving linancial access toheahhcare. This study therefore, was conducted to assess Ihe factors influen cing savings for health care towards old age among nurses in the La-Nkwatanang Madina Municipality in the Greater Accra Region. A cross-sectional study using quantitative methods was conducted among nurses in the La- Nkwatanang Madina Municipality in the Greater Accra Region of Ghana. A sample size of 227 at the prevalence of 84% was used where closed-ended questionnaires were self-administered to solicit responses relating to the influence ofsocio-demographic/economic factors, job related factors and social factors on savings for health care towards old age. There was evidence that, factors influencing savings for health care towards old age inclu desocio-demographic/economic factors, job related factors and social factors with the prevalence of 80%. Even though the prevalence was below the WHO standards. there was evidence of the relationship between the University of Ghana, http://ugspace.ug.edu.gh dependent and independent variables in the study. The low prevalence could be due to limited knowledge of planning for the future as far as heahh care wasconcemed as suggested earlier (Clark erai., 2012). 6.2. Conclusions of the sludy This section presents the conclusions of the study in relation to the specific objectives. The study concludes lhat, there was evidence that nurses were making saving s for health care towards old age with a prevalence of 80%. The conclusions pertaining to the specific objectives have been presented below. 6.2.1. Socio-demographic/economi(' ('hara('tcrisli('s and s3ving for health care There was evidence that socio-demographic/economic factors, including NHIS status and number of dependents had influence on saving for health care towards old age. There was also reliance on NHIS to save for health care towards old age, hence, the need to include age related health conditions (Employment & Welfare, 2010). 6.2.2. Innuenceofjob-rclatcd factors on savings for health nreto wardsoldagc There was evidence of an association between job related factors and savings for health care towards old age. The results revealed that, number of years in service, number of years left for retirement., ranks in nursing and savings account were factors ass ociated with savings forheahh care towards old age at the univariate level. Incentive packages in the form of financial motivation had the ability to increase savings for health care toward sold age, similar to earJier suggestions (Odoom, 2015). University of Ghana, http://ugspace.ug.edu.gh 6.2.3. Social factors ioRuencing ssvings fOl"bealtb CSI'e towsl"ds old a ge There was also evidence of an association between social factors and savings for health care towards old age. The results revealed that. spouses with paid jobs, family financial exp ectations and proper health care for the aged were statistically significant in relation to savings for health care towards old age. The study revealed that SSNIT contributions, not sure of family support in old age and the expectation that NH IS be expanded to coverall common aged-related health conditions had an influence on savings for health care towards old age. This is similar 10 the findings, which suggested that pension reforms should be reviewed to meet current financial needs, hence, providing financial protection to the aged to prev entpoverty(Ho]zman n,2013). 6.3.Contl"ibutioos to Knowledge This finding of the study contributes to policy and practice, management of healthcare institutions and methodology. These have been explained below. 6.3.1. Contl"ibution to policy and pl"aclice There is the need for policy makers (Ministry of Employment, Labour and Social We lfare) to considerthevariablesidentifiedinthisstudyforinclusioninthe formation and reformulation of the national ageing policy. There is the need for the introduction of early pension health care plans education preferably at the point of appointment to enable nurses start early and save adequately for health care towards old age since older age have negative influence on savings. The National Health Insurance Authority (N H1 A) in collaboration with the relevant stakeholders should strengthen and expand the NHI S to be more relevant to the heal th needs of the aged since the NHIS, currently, does not cover all health care costs, especially those common among the University of Ghana, http://ugspace.ug.edu.gh aged as acknowledged in the Ghana National Ageing policy of2010 (Employment & Welfare, 2010). This can be achieved through engagement with the yariouS lTade union groups to come up with suggeslions on the role Ihe yarious stakeholders will play tha t will infonnpolicy in meeting theirhealthneedson~tirement The NHIS AC12003 (AcI650) amended 10 NHlS Act 852 of2012, recommends the provision of private health insurance schemes to complement the NH1S, this should be pursued without further delay. This could be achieved Ihrough sensitisation led by the Government of Ghana on the need to buy private health insurance since the NH IS isnOlwell resourced to meet the hClllth needs of all its citizenry and regulate the actiyities of private ins urancecompaniestoensurethat they providelheneededfinancialproleclion The SSNIT pension plan should be revised by the Ministry of Employment, Labour and Soc ial Welfare to meet the current linancial needsofitscontributors,re duce poyertyand increasethcir linancial abilirylo seek health care at the time that they are most vulnerable, thus, improving their health outcomes. There is also the need for families and communities to engage in income generalion actiyitiesthat will make them less dependent on others and make savings for health eare towards their old age to reduce the burden on spouses and other family members. This can be done by the Government of Ghana through the creation of II conducive business environment coupled withactiye priyate sector involvement. University of Ghana, http://ugspace.ug.edu.gh 6.3.2. COilIribution to managemenlorbeaUhcare instifutions The management of health institulions should organise periodic sensitisation workshops on pensions and insurance asa way of encouraging their workers to start planning forrelirement early enough to be able to save enough for health care towards old age. There is the need for the management of health institutions to provide incentive packages for nurses, especia llyfinancial incentives, which will increase their disposable income and hence, their ability 10 make savings for health care towards old age. Nurses should be encouraged to engage in other income generation activities that will increase their sources of income since their salary alone is not enough to enable them make savings for health care towards old age . There is the need for the management of health institution to provide a conducive working environment for nurses. This will help them to be free from stress and reduce the risk for infections,which lead to reduced spending on current health to save for health care towards old age. Compulsory regular medical checkup should be instituted as part of the conditions of service of all employees, especially nurses at least, once every year. Th is will aid early identification of health problems for proper management before old a ge;hence,helps reducethe costs of health care. 6.3.3. Contribution to methodology The use of quantitative methods in data collection and analysis e nabledtheresearchertoquantity the data that was collected and interpreted the results with figures, whi chgaveaclearpictureof the findings compared with qualitative data that is not able to quantify the findings. It also enabled the researcher to measure and quantity the association between the dependent and University of Ghana, http://ugspace.ug.edu.gh independent variables. which could not have been possible with using qualitative methods. Consequently, the findings of this study could be generalised to the po pulationofinterest. 6.4. Recommeodatioolloflbe sludy In view oflhe findings oflhe study, the following recommendations are made for policy makers and management of health care institutions. Policy makers [t is recommended that policy makers. especially in the Ministry of Health, Ghana Health Service, Ghana Education Service, and Ministry of Employment, Labour and Social Welfare Ihese key findings to ensure that appropriate actions are taken t o address the deficiencies while improving on the achievements accordingly: J. Age was identified to have a negative innuenceon savings for health care. The Ghana Education Service should consider introducing financial management in schools starting from the basic level to enable children cultivate the habit of savin gand start saving early to have enough money that will meet their health care needs in old age . 2 Sensitise nurses on the existence of private health insurance. This could be achieved throughsensitisationledbytheGovemmentofGhanaontheneedto buy privale health insurance since the NHIS is not weJl resourced to meet the health nee dsofallilscitizcnry and regulate the activilies ofprivale insurance companies 10 ensu relhat Ihey provide the needed financial protection University of Ghana, http://ugspace.ug.edu.gh 3. The SSNIT pension plan should be revised by the Ministry of Employment. Labour and Social Welfare to meet the current financial needs of its conlribUlor s. Managcmentofbeahbcareinstitutions The management of health care institutions that supervise and mana ge these nurses should ensure I. Nurses are sensitised on savings, pensions and insurancepolicies early to ensure adequate preparation towards health care in old age 2. Incentives in the form of financial motivation such as increase in salaries, benefits and allowances should be introduced to increase their ability to make sa vings for health care towards old age. 3. A conducive work environment is created 10 reduce stress, which will limit present spending on health care to make savings for health care in old age. 4. Regular medical check-ups for nurses to detect diseases early fo r proper management to prevent complications inold age. 6.5. Limilations to the study The study had some limitations. The target population of the study bylhe nature of their work is busy and this could be seen in the incompleteness of the questionnaires. It was observed that administering the questionnaires at Ihe hospital environment in fluencedtheresponsesasnurses were busy anendingto their clients. This might have affected the quality of the information that was given. This was also because a lot of students were conducting their research at the same time and there was research fatigue among the respondents University of Ghana, http://ugspace.ug.edu.gh Another limitation was the facl that the questionnaires were self-administered. and the researcher did not have control over the responses to the questions and this co uldhaveafTectedlheresulls. The study population that consisted of all categories of nurses might have had similar characleriSlics and this could also have afTected the studyresul ts. Another limitation was the fact that deposits made in saving accounts was used to measure savings for healthcare towards old age as there could be other ways nurses were making savings for health care. Due to limited lime within which the research was conducted. other avenues could not be explored Furthermore. mosloftherespondentsconsidered infonnation about salary and saving culture as personal infonnation. This was evident while checking for completeness and accuracy of lhe responses to the questionnaires and during analysis where it was found that out of 214 respondents. only 78 of them indicated their salary level. In view of the limitations encountered in the conduct of this study. it is recommended that more studies should be conducted to identify the investment opportunities available for nurses in Ghana and other developing countries. The sample size and the sites of the study should be increased in future studies considering people from different professional backgrounds 10 improve on the findings and ensure comparative analysis. University of Ghana, http://ugspace.ug.edu.gh REF E.RENCES Abebrese, J. (2011). Social protection in Ghana. An (h'en>iew ofE xisting P~ogrammes and their Prospects and Challel/ge~·. Friedrich Ebert Stiftung, 10-23. Retneved 20 December. 2017,from:hnp:lllibrary.fes.de/pdf-fileslbueros/ghanalI0497.pdr. Aboagye, E. (2012). Old age dependence on family support: the effect of health insurance Intervemion.Master'sthesis,UniversityofOslo. Abotchie, P. N., & Shokar, N. K. (2009). Cervical cancer screening among college students in Ghana: knowledge and health beliefs. International journal of gynecological cancer: officio/journal of the International Gynecological Cancer Society, /9(3). 412-416. and Investment Behaviour of teachers-An empirical study Ackah, C., & Owusu. A. (2012, March). Assessing the knowledge of and attitude towards insurance in Ghana. In Research Conference on Micro-Inmrance. University of Twente. Retrieved 12 November2017, from: https:llwww.utwente.nl/enlbmsJ Addai, B., Gyimah, A. G., & Owusu, W. K. B. (2017). Savings Habit among Individuals in the lnfonnal Sector: A Case Study of Gbegbeyishie Fish ing Community in Ghana. International Journal of Economics and Finance. 9(4),262-272. Adzei, F. A., & Atinga, R. A. (2012). Motivation and retention of health workers in Ghana's district hospitals: addressing the critical issues. Journal ofheallh organization and management, 26(4). 467-485 Afoakwah, c., Annim, S. A., & Peprah, 1. A. (2015). i-Iousehold Savings and Women's Bargaining Power in Ghana. Journal of Global Economics, 3( 139), 2. hnp:/ldx.doi.orglI0.4172J237S-4389.1000139. Aikins, A. D. G., Boynton, P., & Atanga, L. L. (2010). Developing effective chronic d isease interventions in Africa: insights from Ghana and Cameroon. Globalization and health,6(l),6.https:lldoi.oruI10.118611744-8603-6-6. Alhassan, R. K., Spieker, N., van OSlenberg, P., Ogink, A., Nketiah-Amponsah. E., & de Wit, T. F. R. (20 13). Association between health worker motivation and healthcare quality efTorts in Ghana. Human resollrce~Ior heulth, ll( I), 37. hnps:l/doi.orWI 0.1 18611478-449 1- 11 - n· Anarfi. 1., Quartey, P., & Agyei, J. (2010). Key detenni nants of migration among health professionals in Ghana. Development Research Centre on Migration, Globalisation and Poverty. Retrieved II October, 2017, from: https:11 researchgate.netiprofi lelPeter Quaney/publicationl273438573 download;d March 1I/Iinks/55006f020cf2d6 1f820d86baJdownloaded_March_ll.pdf. 73 University of Ghana, http://ugspace.ug.edu.gh Araujo de Carvalho. I.. Byles, J., Aquah, c., Amofah, G .. Biritwum. R., Panissel, U., & ~eard. J. (2015).lnfonningevidence_basedpoliciesforageingandhealthinGhana.Blllletlnojthe World Heulth Organization. 93(l). 47-51. Blakeley, 1., & Ribeiro, V. (2008). Are nurses prepared for retirement? Journal of lJursing management,J6(6),744-752. Blanchet, N. J.. Fink. G., & Osei-Akoto. I. (2012). The effect of Ghana's National Health Insurance Scheme on health care utilisation. Ghanamedicaljollrnal ,46(2).76-84. Banks, J. • Blundell, R .. & Tanner, S. (1998). Is there a retirement-savings puzzle? American Economic Review, 88(4). 769-88 Chowa, G., & Ansong, D. (2010). Youth and savings in AssetsAfrica. Children and YOllth Services Review, 32(1 I), 1591-1596 Clark, R. L. . Morrill, M.S., & Allen, S. G. (2012). The role of financia l literacy in detennining retirement plans. Economic/nqllily. 50(4). 851-S66 Cohen, A. B. (2009). Many fonns of culture . American psychologist, 64(3), 194-204. Fonta, L. C. (2015). Assessing Health Inequality among the Elderly in Ghana. Doctoral Dissenation,UniversityofGhana Friedman, M (1957). A Theory of the Consumption Function. National Bureau oj Emnomie Research. Princeton UniversilyPress. 57 (1),20-37. Hall, J .. & Lavrakas, P. (200S). Cross-sectional survey design. Encyclopedia ojsurvey research methods, 173-174. Henderson, L. N., & Tulloch, J . (2008). Incentives for retaining and motivating health workers in Pacific and Asian countries. Human resources jar health, 6(1), IS. https:lldoLorgIlO.11861l47S-4491-6-18 Holroyd, A., Dahlke, S., Fehr, C., Jung, P., & Hunter, A. (2009). Anitudes toward aging implications for a caring profession. Journal ojNursing Education, 48(7), 374-380 Holzmann, R. (2013). Global pension systems and their reform: Worldwide drivers. trends and challenges. Internationaf Social Security Review, 66(2), 1-29. University of Ghana, http://ugspace.ug.edu.gh ISSahak~h~~a~~~' s~~~:;i~:~~w~~ i:~:gu:;:r =;~S;:g~:~ ~f ~~:~:~~O~:;i~~~/:Iaji~~:i: Sciences 4 (I): 1-12 James, S. (2009). Incentives and invesnnents: Evidence and policy implications. World Bank. hnps:lldoLorgJI0.1596/27875. Jang, Y .. Kim, G., Hansen. L. & Chirihoga, O. A. (2007). Anitudes of older Korean Americans toward mental health services. Journal offhe American Geriatrics Society, 55(4). 616· 620. Jefferson, T. (2009). Women and retirement pensions: A research review. Feminist Economics, 15(4),115.145. Kibet, L K., Mutai. B. K., Duma, D. E., Duma. S. A .. & Dwuor, G. (2009). Detenninants of household saving: Case study of smallholder fanners, entrepreneu rs and teachers in rural areas of Kenya. Journal ofD evelopment and Agricultural Economics, 1(7). 137·J43. Habit and Use of Savings among Households in Ga·East M""k;p,I;~, Do'lo"I'h,,,ru,';oo.Uo;v<~;~,,rGh,", Lo Sasso, A. T., Shah, M., & Frogner. B. K. (2010). Health savings accounts and health care spending. HealrhServices Research,45(4). 1041·1060 Love, D. A. (2009). The effects of marital status and children on savings and portfolio choice. The Review ofF inancial Sludies. 23(1). 385·432 Minicuci. N., Biritwum, R. B. . Mensah, G., Yawson, A. E .. Naidoo, N., Chatterji. S .. & Kowal, P.(2014). Sociodemographicand socioeconomic patterns of chronic non-communicable disease among the older adult population in Ghana. Global heallh aClion, 7(1), 21292. Retrived26November2017,hnps:/ldoi.orglI0.3402/gha.v7.21292 Modigliani, F .. & Brumberg, R. (1954). Utility Analysis and Aggregate Consumption Functions: An Attempt at Integration. Post Keynesian Economics. New Brunswick. Rutgers University Press. University of Ghana, http://ugspace.ug.edu.gh Ghana Districts. (2017). La-Nkwanlollong-Madina Municipal ..osembly. Retrieved 27 November. 2017, http:// .ghanadistricts.com/HomelDistrictlI15. Ministry of Employment. Labour and Social Welfare. Ghana. (2010). Nalional Ageing Policy Ageing with Security alld Dignity,'. Accra, Ghana: MoELSW Noone. 1. . Alpass. F. • & Stephens, C. (2010). Do men and women differ in their ret~rement planning? Testing a theoretical model of gendered pathways to retirement preparation. Research on Aging. 32(6), 715-738. Odeyemi. I., & Nixon. 1. (2013). Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis. Imernotionaljournalfor equiry in health. 12(1),9, https:lldoi.orglI0,U.~~/1475-9276-12- 2. Odoom, E. (2015). Assessing the Impact of Motivation on the Work Perfonnance of Nurses at the Amasaman Municipal Hospital. Doctoral dissertation, University of Ghana. OseL R. D. (2011). Reducing poverty through a social grants programme: The case of Ghana.ISSER research paper, Ghana Illstill/le of S'ati,!,·tical Social and Economic Research. University of Ghana. Accra, GiIana. Retrieved 16 November 2017 http://african-models.wider.unu.edu Parmar, D., Williams, G .• Dkhimi. F. . Ndiaye. A .• Asante, F. A., Arhinful, D. K .. & Mladovsky. P. (2014). Enrolment of older people in social health protection programs in West Africa-Does social exclusion playa part? Social science & medicine, 119.36-44. Peters, D. H., Garg, A .• Bloom, G .• Walker, D. G., Brieger, W. R., & Hafizur Rahman, M (2008).Poverty and access to health care in developing countries. Annals oflhe New York Academy ofS ciences, 1136(1), 161-171. How Economists Think. Working Paper No.3. Joint Centre for Prince, M. 1.. Wu. F., Guo, V., Robledo, L. M. G., O'Donnell. M. . Sullivan. R., & Yusuf, S (2015). The burden of disease in older people and implications for health policy and practice. TheLancel,385(9967j,549-562 Rehman, H. V., Bashir, F., & Faridi, M. Z. (2011). Savings behavior among different income groups in Pakistan: A micro study. lnternalionol Journal of Humanities and Social Science, 1(10),268-277 Saeed, B. 1.. Xicang, Z., Vawson, A. E .• Nguah, S. B., & Nsowah-Nuamah, N. N. (2015). Impact of socioeconom ic status and medical conditions on health and healthcare utilization among aging Ghanaians. BMC public health, 15(1), 276. hnps:lldoi.org/IO.1186/sI2889- OI5-1603-y. University of Ghana, http://ugspace.ug.edu.gh Sexauer. S. c., & Siegel. L. B. (2013). A pension promise 10 oneself. Financial AnalysIS Joumal,69(6).13-32. Tawiah, E. O. (2011). Population ageing in Ghana: A profile and emerging issues. A/rican Popli/alionStudies, 25(2),623-645 Valsiner,J. (2007). Culture in minds and societies: Foundations 0 fculturalpsychology.Psychol. Slud. (Seplember2009). H. 238-239 Wang, M., & Shi. J. (2014). Psychological research on retirement. Annual review o/plychology. 65.209-233. Weiss, C. O. (20 11 ). Frailty and chronic diseases in older adults. Clinics in gerialric medicine. 27(/).39·52. Williams, C. (2007). Research methods. Journa/ 0/ Bllsi/les~' & Ecol/omics Research JBER, 5(3). 65 ·72 World Health Organization. (2014). Ghana country assessment report on ageing and health ::~~//apps.who.int/iris/bitstreamlhandle/l 0665/12634 1/978924 1507332_eng.pdl'?sequen University of Ghana, http://ugspace.ug.edu.gh Appendix A: Participants' Consent and Inform9lioo Sheet Research Topic: Factors Influencing Savings for Health Care Towards Old Age Among Nurses in the La- Nkwatanang-J\.1adina Municipalit)'. G renter Accra Region. G hana. DearPanicipant, You have been selected to panicipate in this study tit led "Factors influencing savings for health care towards old age among nurses in the La- Nkwatanang-Madina Municipality in the Greater Accra Region, Ghana. This study is being conducted by Ms Felicia Kolekang, a student of the School of Public Health, College of Health Sciences, University of Ghana, in partial fulfillment for the award ofa Master of Public Heahhdegree Your participation in this study is voluntary and you can withdraw in the course of the study (even after you have agreed to panicipate) without any penalty There will not be any compensation for participation apart from the benefits that will come when policies are put in place to improve health care You will be asked questions on the factors that influence you to save and the reasons for making savings. The study does not pose any risk except some questions that may be private. The information you provide will be treated totally confidential and will not be disclosed to anyone University of Ghana, http://ugspace.ug.edu.gh excepl for academic purpose. No response you give will be specifically identified with you bul will be combined with the general responses of the entire population If you have any questions about the study, you are free to ask the follow ingpersons: Ms. Felicia Kolekang (principal investigator) on 0208394498/0541524214 or Dr. Augustine Adomah-Afarion 0265435294 (Supervisor. School of Public Heatt h.Legon) In Case of any concern, you can contact the Ethics Administrator. Ms. Hannah Frimpong. Participant Statement and Signature hereby certify that I willingly agree to fully participate in the study on the topic"Factors influencings avings for health care towards old age among nurses in the La-Nkwatanang-Madina Municipality in the Greater Accra Region. Ghana. All my questions have been addressed satisfactorily. I understand that 1 can freely withdraw from the study if I so desire at any given time Signature of Participant .... Signature of researcher University of Ghana, http://ugspace.ug.edu.gh InvestigatorStatementandSign3ture I. .............................................................. cer1ifythattheparticipanthasbeen given enough time to read aboul the topic understudy. AtI questions and coocems raisedbYlhe participant have been addressed. Signarurt ... University of Ghana, http://ugspace.ug.edu.gh PA RT IC IPANT INFO R;\ IATION SHEET Ti'I ~: Factors Influenci ng Savings for Health Care lowa rds Old Age among Nurses in the La-Nkwan tanaog Munici pali ty. Greater Acc ra Region Institu tion: University of Ghana, School of Public Health, Department of Health Policy, Planning and Management Background Dear participant, my name is FELICIA KOLEKANG. I am a student from the School of Public Health, University of Ghana, Legon. The purpose of the study is to explore the factors innuencing savings for health care towards old age among Nurses in the La-Nkwamanang: Municipality Nurses in the selected facilities will be interviewed and appropriate infomation recorded on factors inn uencingsavings for health care. The procedure will be non-invasive and will nol cause any discomfort to participams. However, anyparticipamwhofeelsuncomfortableaboutthestudyprocesshastheright to stop the process Infonnationobtained wi ll help know and understand your needs. Rigbt to refuse Panicipating in the study is voluntary and you can choose not to participa teo You are at liberty to withdraw from the study 8t any time. Participation iseocouraged since the challenges identified will help infonnpolicy University of Ghana, http://ugspace.ug.edu.gh Oalaslofagl!30du5C Data gathered will be safely kept preventing other people from havingacc ess to it. r ...i vacyandconfidenlia li l)' Any observation made, and information recorded would be respected and kepI confidential. Information recorded would be used purposely for Ihe siudy. NB: Are there any questions you may wish to ask before consenting to the study. If yes, .. , declare that the purpose, procedures. risks and benefits have been explained thoroughly 10 mc. All questions and doubts have been answered and I haveunderslood. I herebyagreetopanicipate (Signature/thumbprinlofparticipant) (Date) I verity that the purpose, procedures. risks and benefits have been expl ainedthoroughlytothe participant. All questions and doubts have been answered and the participant has understood The participant has willingly agreed to part-take intne study University of Ghana, http://ugspace.ug.edu.gh (Signaturcofimcrvic\\er) (Date) Felicia Kolekang School of Public Health, POBoxLG 13, Legon Tel No.0208J9449810541524214 You can also contact the researcher for any further clarification on above address or the Administrator, Ethical Review Committee. Ghana Health Service. Ms. I-Iannah Frimpong (050 704 12 2J/0243235225) University of Ghana, http://ugspace.ug.edu.gh Appendix B: Study Ques'ioooaire SCHOOL OF PUBLIC HEALTH COLLEGE OF HEALTH SCIENCES QUEST IONNA IRE Factors Influencing Savings for Health Care towards Old Age among Nurses in the La- Nkwantanang Municipality in the Greater Accra Region, Ghana This questionnaire is to collect data on the Factors Innuencing Savings for Health Care towards Old Age among Nurses in the La-Nkwantanang Municipality in the Greater Accra Region. Ghana. 1 will be grateful if you could make time to complete it. Every piece of information will beheld in absolute confidence. Thank you . Facility .. Please fill the blanks alld mark r..J] unless' othernise indicated. University of Ghana, http://ugspace.ug.edu.gh ScclionA: Socio-DemographicChllraCle,.istics This seclion seeks to gather infonnation on the socio..demographic factors ofche respondenls which illClude age, selt,and marital status, among others I, Age(incompleteyears) . a. Male [] b.Female( I 3. Level of education. a. Ccrtificatel] b.diploma Ll c.Undergradu8te I I d.Graduate[ J e. Postgraduate [ ] 4 Religion a. Christian (J b. Moslem (J c. Traditionalist [ ] 5. TribelEthn icbackground ... a.Singier 1 b.Co.habiting[ I c. Married [ I d. Divorced [ J e. Widowed ( J 7. Place of residence. a. UrbanI] b. Peri·urbanL] c. Rural[) 8 Have you enrolled in NHIS? Yes [ ] No ( 1 9. Isyour cardactive? Yes I ) No!] 10. Are ages 60·69 years exempted from NH IS premium? Yes [} No [ J II . Does the NH IS cover all health services? Yes ( I No [ J 12. Do you have any known chronic medical condition? Yes ( ] No I I University of Ghana, http://ugspace.ug.edu.gh Section B.Job related facton This section will want to gather infonnationon factors related to your work thai can influence your savings for health care towards old age I. Forhowlonghaveyoubeingworkingasanurse?. 2. Whichnursecategorydoyoubelong? a. CommunityhealthnurselJ Health assislant [ ] c. General Nurse I] d.Publichealthnursel J e. olher specify. 3 What is your present rank? a.StatTnurse [ J b.senior staffnurse[J c.nursingofficer[] d.principalnursingofficer[] e. deputy director of nursing services [] f. others, specify .. 4. Whalisyourpresentsalary? .. 5 Do you haveotherjob incentives? Vest ] No[ ] 6 If yes, what are they? a.Allowance [ ] b.Accommodalion{] c.Fuel [] d. Uniform [ ] e. Transportation. [ ] f. olhers specify .. 7. Do you have any insurance policy? Yes [J No [ ] 8. What type of insurance? ................................................................................................... . 9. Doyou receivesalaryregularly? Yes { 1 No[ J 10. Do you have other sources of income? Yes { ] No [ I II.Doyouhaveasavingsaccount? Yes [ J No[] University of Ghana, http://ugspace.ug.edu.gh 12. Howoftendoyousave? a. weekly [ J b. Monthly [ J c. quarterly [ I d.yearly LJ e.othersspecify .. 1J . Will the savings be enough to meet your health needs in retirement? Yes [ ] No[ I l4.Do youbeiongtoacreditunion? Yes { I No[] 15. Do you belongtoa welfarec1ub? Yes [ 1 No[ I 16. Have you ever taken a loan? Yes[] Noll 17. If yes, how many times? a. One[ ] b. two [ J c. three or more [ I 18. What type ofloan have you taken? a.commercialloan[ J b. housing loan [ ] c. domestic loan [ 1 19. Is it affecting your savings? Yes (1 No[ I 20. Haveyourecentlygoneforfunhertraining? Yes [I No [ ] 21 . Is the cost of training and further training affecting savings? Yes [ ] No] I 22. What can be done by your employer to enable you save adequately? Tick as many as possible. a.increasesalary[l b. Provide accommodation [ I c. reducetaxesonsalary[] d. Transportation allowance [ I e.renta llowance[ I f. reduce interest on loans I 1 g.reducecostoffurthertraining[J h. immediate promotion with salary adjustment[] Lriskallowance ( ] j . others, specify ... 23. How many years do you have to go on retirement? .... .................. ..... ..... . University of Ghana, http://ugspace.ug.edu.gh 24.Whatpercentag~ofyoursavingisforyourpersonalhea[thca.reonretirementl old age? a. IO%[ J b. 20%[ I c.30%[ I d. 40% [ I e.olhersspecify ..... . SectionC:Cultura l faCIOt5 This section seeks to gather infonnation on the cultural factors that can innuenc~ savings for heallhcare towards old age I If you are married or cohabiting, do you need to inform your partner be fore savi ng? Yes[ I No[ J 2 Is your partner having a paid job? Vest I No [ ] 3. How many children do you have? ............................................. . 4 Doyouhaveotherdependents? Yes( ] No( I S If yes. how many?. 6. What types of dependents do you have? a.Parenu[] b. Siblings [ J laws [] d.grand-children[ ] e.othersspecify ..... 7 What are your reasons for saving? a. buy a house ( ] b. takecareofmynceds() c. take care of my children [ ] d. buyacar[ I e. educate my children ( 1 e.care for my health needs [ I f. othersspecify .. 8. ArefamilyfinancialexpectationsafTectingyoursavings7 Ycs[] No( ) 9 Will family be willing to support your medical bills? Yes [ ) No I Notsure[ ) University of Ghana, http://ugspace.ug.edu.gh 10. lsil necessary 10 give proper heallh care 10 the aged? Yes[) Noll 12. Who will be responsible for your care inold age? a.myself[] b. spouse I J c.childrenll d. olher family members [ J 13. DoyoucontributetoSSNIT? Yes I I No I I 14. Will your SSNIT contribution be enough 10 support you in old age? Yes [J No [ ] 15. Are you saving money for future sicknesses? Yes [ I Nor] 17. Will you wantlhe national health insurance scheme (N HI S) to take care of your health cost in old age? Yes [ J No[] .""",.",,,,,,,,,,,,_,,,UG,n_iIvIe"rNs"iItyI' o'f' 'G1ih;a~n'{a~, ~h~tTt1pI:I/C/uSgR>s:pVaIcEeW.~u~gf.e~~d;u~.gt~h~::""'Oi''''O'' ,-..' ... :.-__ • ~ T~/' +133-301-68/109 ~ __ .~.,;...~.--'-"-- Fax + 233-302-685414 Email ghserc@gmoilcom 9'h Febru!lry,20J8 I~~~~~~~~~~-------------------, Faclors Influencing Savings for Health Care towards Old Age among Nurses intheLa-Nkwantanan Munici alit 8'h Pebruar 2018 __~ :~h~~~~~~~~,~,2~OI~9 ________________________ i n.;~ :'III, .. m:1I '~' I uircs the fo llowing f, 'om th e \' rinci pfli In vesfigfl to l <';1It>lI1is~i(ln of year!)- progress repon of the stlldy 10 the Ethics Review Committee (ERC) l~cl,(.",\,j l 01""'hic;11 IlpprovlIl iflhesludy lnsts for more than 12 months, S"b"l'~~I,)n of :, fill:!1 repClrt :afle l' co mple t io ll of the study 11l1;,nnms EHC i f 5111lly emlllOt be implemented or is discontinued l'lnd reasons \\h~ IIi I OfllHIl~ the ERC rmd your sponsor (where applicable) befofe any publiel'l lion of the fC$(";lIch ri "d lll~~ l'Ira;';-no!c th"l ;lny modification of the study without ERC l'IpprovRI of the amendment is inv,llid n,,'I:RC 111:1) obscrl'c or calise to be observed proccdurcsandrecord sorlhest lldyduringlJlldnfierimplcl11elllllllol' Kuldl:VCJIIOIC the protocol identification number in all futurecolTcspondencc in relation to thisl1ppro\,.:d Plol'l~nl SiGNED .... ,~.~ . DR. CYNT HIA BANNERMAN (GHS-ERC CHAIRPERSON) '111e D;f~CI{'lr, Itesearch & Developmellt Division. Ghana J.leallh Service. Accra