Introduction
Statement of the problem
Main objective of the study
Literature review
Theoretical review
Andersen’s model of health service use
Empirical review
The state of Ghana’s healthcare delivery system
Research process
Population and sample size
Data collection
Data analysis
Results
Number of patients in the study
Types of medicines with high frequency of stock-outs
Patients’ experiences of non-available commodities in health facilities | Private facility patients | Public facility patients | ||||
---|---|---|---|---|---|---|
strongly disagree/disagree | neutral | strongly agree/agree | strongly disagree/disagree | neutral | Strongly agree/agree | |
Experience incidence of stock outs of anti-malarias whenever I visit this facility | 40.7% | 16.1% | 43.2% | 34.7% | 17.0% | 48.3% |
Experience incidences of stock outs of contraceptives whenever I visit this facility | 41.4% | 29.5% | 29.1% | 23.6% | 20.0% | 56.4.% |
Experience incidences of stock outs of vaccines whenever I visit this facility | 35.3% | 9.8% | 54.9% | 27.6% | 18.7% | 53.7% |
Do not always get all my required medical commodities due to high stock out rate | 18.5% | 24.7% | 56.8% | 16.2% | 28.2% | 55.6% |
We [GHS] recognise the sporadic unavailability of commodities in some of our facilities but you would also acknowledge the pressures on our facilities by the ever-increasing demands posed by the NHIS coupled with weak internally generated funds... [RD-UER, 2018].
Frequency of medicine stock-outs
Exploratory factor analysis (EFA)
Kaiser–Meyer–Olkin measure of sampling adequacy | .755 |
Bartlett’s Test of Sphericity | |
Approx. Chi-Square | 7271.194 |
Df | 136 |
Sig | .000 |
Cronbach’s Alpha | |
---|---|
Availability of commodities (AMC) | .863 |
Frequency of medicine stock-outs (FMS) | .772 |
Seasonality of medicine stock-outs (SMS) | .703 |
Reaction to medicine stock-outs’ (RMS) | .504 |
Communication about the medicine stock-outs to patients (CMS) | .770 |
Loaded factors
Component | Initial eigenvalues | Extraction sums of squared loadings | Rotation sums of squared loadings | ||||||
---|---|---|---|---|---|---|---|---|---|
Total | % of Variance | Cumulative % | Total | % of Variance | Cumulative % | Total | % of Variance | Cumulative % | |
1 | 3.161 | 18.592 | 18.592 | 3.161 | 18.592 | 18.592 | 2.946 | 17.330 | 17.330 |
2 | 2.849 | 16.761 | 35.353 | 2.849 | 16.761 | 35.353 | 2.477 | 14.570 | 31.900 |
3 | 2.256 | 13.270 | 48.623 | 2.256 | 13.270 | 48.623 | 2.395 | 14.090 | 45.990 |
4 | 1.427 | 8.397 | 57.020 | 1.427 | 8.397 | 57.020 | 1.611 | 9.474 | 55.464 |
5 | 1.171 | 6.889 | 63.909 | 1.171 | 6.889 | 63.909 | 1.436 | 8.445 | 63.909 |
6 | .873 | 5.138 | 69.047 | ||||||
7 | .806 | 4.743 | 73.790 | ||||||
8 | .661 | 3.889 | 77.679 | ||||||
9 | .637 | 3.748 | 81.427 | ||||||
10 | .526 | 3.093 | 84.520 | ||||||
11 | .503 | 2.958 | 87.478 | ||||||
12 | .475 | 2.794 | 90.272 | ||||||
13 | .424 | 2.493 | 92.764 | ||||||
14 | .378 | 2.224 | 94.988 | ||||||
15 | .343 | 2.016 | 97.005 | ||||||
16 | .279 | 1.644 | 98.648 | ||||||
17 | .230 | 1.352 | 100.000 |
Component | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | KMO | Bartlett’s Test of Sig | Eigen Values | % of Variance | Reliability | |
AMC1 | .881 | -.076 | .068 | -.094 | .125 | |||||
AMC4 | .877 | -.049 | -.064 | -.027 | .152 | |||||
AMC2 | .770 | .005 | -.328 | .126 | -.010 | 3.161 | 18.592 | 0.863 | ||
AMC3 | .767 | -.109 | .222 | -.050 | -.016 | |||||
FCS 3 | -.037 | .826 | .075 | .012 | .076 | |||||
FCS 2 | .061 | .795 | .227 | -.097 | .108 | |||||
FCS 1 | -.155 | .750 | .050 | .010 | -.020 | 2.849 | 16.761 | 0.772 | ||
FCS 4 | -.059 | .664 | .021 | .217 | -.044 | |||||
SCS 4 | .038 | .035 | .790 | -.024 | -.092 | 0.775 | 0.000 | |||
SCS 1 | -.104 | .146 | .751 | -.165 | .101 | 2.256 | 13.270 | 0.703 | ||
SCS 3 | .254 | .185 | .668 | -.090 | -.070 | |||||
SCS 2 | -.152 | .028 | .614 | .072 | .166 | |||||
RCS2 | -.001 | .004 | .089 | .770 | -.011 | |||||
RCS1 | -.102 | .011 | -.179 | .691 | .296 | 1.427 | 8.397 | 0.504 | ||
RCS4 | .022 | .092 | -.091 | .612 | -.108 | |||||
CMS 3 | .047 | -.079 | .266 | -.082 | .832 | 1.171 | 6.889 | 0.770 | ||
CMS 2 | .272 | .259 | -.197 | .176 | .730 | |||||
Total Explained Variance | 63.909 |
Comparing factors affecting commodity availability between patients of private and public healthcare facilities
Availability of medical commodities
… commodities are definitely more available in private compared to public health facilities in this region … sale agents of pharmaceutical manufacturing companies are available in their branded minivans and ready to supply as and when they are requested to. Whilst public facilities cannot just buy at will due to public procurement requirements, private care facilities can buy medicines as and when needed … . a reason for which commodity availability will always be higher in private facilities … … .. [RD-UER, 2018].
Private facilities | Public facilities | ETA squared | Interpretation | |
---|---|---|---|---|
Mean (SD) | Mean (SD) | |||
Availability of medical commodities | 2.99 (0.95) | 2.73 (1.01) | .017 | Small effect |
Frequency of stock outs of essential medicines
… I [patient of Private facility - PPrvtF] have “tasted” both types of health care facilities in this region as a patient and I can say that I experience better access to medical commodities anytime I attend a private health care facility … “Once I have the money to pay, I get all my medical commodity requirement from the private health care facility” Private facilities quickly restock their commodities the moment stocks go low … … [patients of Private facilities - PPrvtF, 2018].
… .I [patient of Public facility - PPuF] have experienced high incidence of medical commodity stock-outs in public health care facilities in this region. Most often, when I attend this public facility for service I do not always get all my consignment of medicines … [patient of Public facility - PPuF, 2018].
Private facilities | Public facilities | ETA squared | Interpretation | |
---|---|---|---|---|
Mean (SD) | Mean (SD) | |||
Incidence of medicine stock-outs | 3.11 (0.81) | 3.27 (0.82) | .011 | Small effect |
Effect of seasonality factors on medicine stock-out of commodities
...as indigenes of this region we [patients of Public facilities – PpuF] … .are aware that May to somewhere September every year is the Malaria season because of the wet season … we [patient of Public facility – PpuF] … therefore expect that the health authorities would know these patterns and act appropriately to ensure more antimalarials are stocked up in order to prevent or at least minimise stock-outs during such periods … .. … [patient of Public facility - PPuF, 2018]....we [patients of Public facilities - PPrvtF, 2018] know Ghana and for that matter the Upper East Region (UER) is a Malaria endemic region and as such private health care facilities usually receive high numbers of patients during the rainy season – May to September each year. We therefore expect managers of these facilities to fully stock-up before the season … … [patient of Public facility - PPrvtF, 2018].
Private Facilities | Public facilities | ETA squared | Interpretation | |
---|---|---|---|---|
Mean (SD) | Mean (SD) | |||
Effect of seasonality factors on medicine stock-outs | 2.90 (0.80) | 3.11 (0.75) | .019 | Small effect |
Reaction to medicine stock-outs
Private facilities | Public facilities | ETA squared | Interpretation | |
---|---|---|---|---|
Mean (SD) | Mean (SD) | |||
Reaction to medicine stock-outs | 1.71 (0.43) | 1.78 (0.62) | .005 | Small effect |
.......we [patients of Public facilities - PPuF] … ”know automatically we have to buy medicines from private drugstores and pharmacies whenever stock-outs of medicines occur from the public health care facilities we attend.. … the next thing is that we receive prescriptions forms to go and buy these medicines from external sources … .” [PPuF 1, 2018].
because these facilities are private.. … we [patients of Private facilities - PPrvF] know that even in times of stock-out, some substitutes drugs (whether good or poor) will be made available by these facilities for us to buy … so we tend to spend more money.. … sometimes on very expensive substitute drugs whose efficacy we are often not too sure of.. [PPrvF - 1, 2018].
Private facilities | Public facilities | ETA squared | Interpretation | |
---|---|---|---|---|
Mean (SD) | Mean (SD) | |||
Communication about the stock-out information | 2.60 (0.96) | 3.24 (0.98) | .100 | Fairly large |
Communication about the medicine stock-outs to patients
.....communication of stock-out information in the public health care facilities is done in a better fashion by the staff compared to their counterparts in the private health care facilities … ..in the case of public facilities the issuance of a prescription form is the first indication of stock-out of one drug or the other. This is followed by an explanation from the concerned health staff to us [patients of Public facilities - PPuF] regarding the circumstances of the stock-out and an indication of where to go and buy the rest of these medicines … in the case of private facilities, the issuance of a prescription form should be enough information for us [patients of Private facilities - PPrvF] to understand that there are stock-out of some drug or the other … .the only other thing private health facilities do better is going the extra mile to prescribe poor substitute drugs for us [patients of Private facilities - PPrvF]- [PPrvtF and PPuF 1, 2018].
Discussion of results
Private facility | Public facility | Levene’s test of equal variances | T-test for equal means | |
---|---|---|---|---|
n (Mean)(SD) | n (Mean)(SD) | p-value | p-value | |
Availability of medical commodities | 750 (2.99)(0.95) | 750 (2.73)(1.01) | .206 | .000 |
Frequency of medicine stock-outs | 725 (3.11)(0.81) | 724 (3.27)(0.82) | .352 | .000 |
Seasonality factors on medicine stock-outs | 725 (2.90)(0.80) | 724 (3.11)(0.75) | .002 | .000 |
Reaction to medicine stock-outs | 725 (1.71)(0.43) | 724 (1.78)(0.62) | .000 | .006 |
Communication about the medicine stock-out | 691 (2.60)(0.96) | 660 (3.24)(0.98) | .371 | .000 |