Barriers to accessing healthcare among women in Ghana: a multilevel modelling

Abstract

Background Women’s health remains a global public health concern, as enshrined in the Sustainable Development Goals. This study, therefore, sought to assess the individual and contextual factors associated with barriers to accessing healthcare among women in Ghana. Methods The study was conducted among 9370 women aged 15–49, using data from the 2014 Ghana Demographic and Health Survey. Barrier to healthcare, derived from four questions— whether a woman faced problems in getting money, distance, companionship, and permission to see a doctor—was the outcome variable. Descriptive and multilevel logistic regression analyses were carried out. The fixed effect results of the multilevel logistic regression analyses were reported using adjusted odds ratios at a 95% confidence interval. Results More than half (51%) of the women reported to have at least one form of barrier to accessing healthcare. Women aged 45–49 (AOR = 0.65, CI: 0.49–0.86), married women (AOR = 0.71, CI:0.58–0.87), those with a higher level of education (AOR = 0.51, CI: 0.37–0.69), those engaged in clerical or sales occupation (AOR = 0.855, CI: 0.74–0.99), and those who were covered by health insurance (AOR = 0.59, CI: 0.53–0.66) had lower odds of facing barriers in accessing healthcare. Similarly, those who listened to radio at least once in a week (AOR =0.77, CI: 0.66–0.90), those who watched television at least once a week (AOR = 0.75, CI: 0.64–0.87), and women in the richest wealth quintile (AOR = 0.47, CI: 0.35–0.63) had lower odds of facing barriers in accessing healthcare. However, women who were widowed (AOR = 1.47, CI: 1.03–2.10), those in the Volta Region (AOR 2.20, CI: I.38–3.53), and those in the Upper West Region (AOR =2.22, CI: 1.32–3.74) had the highest odds of facing barriers to healthcare accessibility. Conclusion This study shows that individual and contextual factors are significant in predicting barriers in healthcare access in Ghana. The factors identified include age, marital status, employment, health insurance coverage, frequency of listening to radio, frequency of watching television, wealth status, and region of residence. These findings highlight the need to pay critical attention to these factors in order to achieve the Sustainable Development Goals 3.1, 3.7, and 3.8. It is equally important to strengthen existing strategies to mitigate barriers to accessing healthcare among women in Ghana.

Household Socioeconomic Status and Antenatal Care Utilization Among Women in the Reproductive-Age

“…We found out that women who reported costs of care as barriers to maternal care utilization were less likely to undertake ≥ 4 ANC and the newly recommended ≥ 8 antenatal contacts. This finding conforms to the reports made by past studies both for Nigeria and elsewhere ( 4 , 12 , 20 , 32 ). Despite the free maternal care policy in the state, some women still experience costs as a barrier because of ignorance of the free maternal care policy, and due to the fact that free maternal care policy does not cover all costs, particularly indirect costs relating to transportation charges, waiting time in health facilities, opportunity costs of time in traveling to health centers, and the costs of drugs ( 11 , 38 ).…”

“…Also, educated women are aware of their basic human rights and may have gained higher health literacy. Consequently, they are more likely to overcome any form of barriers to maternal care utilization compared with their counterparts with lower education and lower health literacy, which are keys in determining the utilization of maternal care services ( 32 ).…”

“…The finding is in conformity with studies for Nigeria and Ghana ( 39 – 42 ). According to Seidu et al ( 32 ) health insurance and free maternal care enables women to afford healthcare and freely choose from various providers according to their needs without fear or worry about costs ( 32 ).…”

Big Problem or Not a Big Problem: Problems to Health Care Utilization by Residence in The Gambia Among Women of Reproductive Age. A Cross Sectional Study

“…This could be associated with the expansion of primary health care in The Gambia reaching 97% and 85% of the population living within 5 and 3 kilometres, respectively from a primary health care post (20). This nding is in disagreement with 2014 DHS in Ghana which reported women in rural residence have 41% higher chance of distance being a barrier to health care utilization compared to urban residence (14).…”

“…Companionship or not wanting to go alone during health care seeking provides social support for women in need of care. Not wanting to go alone is reported as a perceived barrier to health care utilization by 10% of women in The Gambia and by 15% of women in Ghana (13,14).…”