Strengthening the Referral System through Social Capital: A Qualitative Inquiry in Ghana

Abstract

The referral system in health care has been noted as very influential in determining which services are accessed and when. Nonetheless, existing studies have relied on specific measurable factors relating to health personnel, transportation and communication infrastructure, and finance to explain the challenges facing the referral policy in developing countries. While this is understandable, the role of social capital remains mostly uncharted even though it is implicit in the well-known lay referral system. Using various facets of the social capital concept, this paper empirically examines how the resources embedded in both structural and cognitive aspects of social relationships influence knowledge of, and adherence to, referral policy. This study is based on semi-structured in-depth interviews conducted with 79 adults in the Ashanti Region of Ghana in 2015. Of the 79 participants, 28 lived in urban areas and 51 in rural localities. Eight health personnel and eight community leaders also contributed to the study. Additionally, six focus group discussions were held. The findings indicated that both cognitive and structural forms of social capital considerably underpinned the ability and willingness of people to adhere to the referral process. Moreover, the role of social capital was double-barrelled. It contributed in a significant way to encouraging or dissuading potential patients from rightly embracing the policy. In addition, precepts of social capital reinforced both positive and adverse effects of the other determinants of the policy such as finance and transportation. However, the magnitude of such impact was linked to how ‘resourceful’ and ‘trustworthy’ one’s available social acquaintances were. The paper suggests that a cautious engagement with social capital will make it a potentially powerful tool for understanding the gaps in and improving the effectiveness of referral policy.

Social participation, health literacy, and health and well-being: A cross-sectional study in Ghana

“…Moreover, one could also argue that the indirect negative effect observed between volunteer activities and health through health literacy partly explains why the majority of the participants demonstrated low health literacy. Indeed, it is common for people in the study context to depend on their social relations to acquire critical health-related information informally ( Twumasi, 2005 , Amoah and Phillips, 2017 , Amoah et al, 2017 ). Therefore, in the event that the individuals and groups in a person’s social circle demonstrate low health literacy, it is likely that little would be passed on to them in terms of health-related knowledge.…”

Social Networks and Health: Understanding the Nuances of Healthcare Access between Urban and Rural Populations

“…They are thus generated through interactions such as talking to others within a community or an organisation [ 20 ]. Many people depend on these networks for not only material resources but also knowledge and information to make decisions regarding healthcare access [ 21 , 22 ]. Social networks exude resources—social capital—which both poor and affluent can deploy in times of crisis such as health afflictions [ 23 ].…”

“ Who'll do all these if I'm not around?” : Bonding social capital and health and well-being of inpatients

“…In the context of this study, this partly explains why the relatives were allowed to spend nights within and around hospital premises as they waited to assist health personnel and their relatives. Moreover, reliance on one’s social acquaintances for financial support for health care purposes is common in the study context (Amoah & Phillips, 2017; Moyer et al, 2014). Indeed, scholars argue that people in societies with weak social security systems may have to depend on their social networks for different kinds of material and economic support (Rostila, 2013).…”

“…On the other hand, linking social capital represents a hierarchical relationship or unequal relationship between individuals with differences in power, resources and social status. It can also refer to relationships between people and institutions (Amoah & Phillips, 2017). Bonding, bridging and linking social capital are part of what is termed as structural social capital, which is different from cognitive social capital (Halpern, 2005; Musalia, 2016; Szreter & Woolcock, 2004).…”

“…Bonding, bridging and linking social capital are part of what is termed as structural social capital, which is different from cognitive social capital (Halpern, 2005; Musalia, 2016; Szreter & Woolcock, 2004). Cognitive social capital manifests in the form of abstract elements such as trust, sense of fairness and harmony (Amoah & Phillips, 2017; Musalia, 2016). The paper also attempts to clarify the dilemma about the role of resources embedded in tight-knit associations—like the relationship between informal care and utilization of formal healthcare—either as a substitute or complement to [formal] healthcare delivery for people on clinical admission (Reeves et al, 2014).…”