Background
Theoretical framework
Methods
Study setting and target population
Study design
Data collection
Quantitative phase
Survey instrument
Qualitative phase
Data analyses
Positionality statement
Ethics
Results
Quantitative phase
Contextual/population characteristics
Variables | Frequency (n) | Percentage (%) |
---|---|---|
Sex
| ||
Males | 170 | 52.6 |
Females | 153 | 47.4 |
Age (years)
| ||
Range: 18 – 80 | ||
Mean ± SD: 33.6, 15.9 | ||
Below 20 | 44 | 13.6 |
20-29 | 138 | 42.7 |
30-39 | 54 | 16.7 |
40-49 | 30 | 9.3 |
50+ | 57 | 17.7 |
Marital status
| ||
Unmarried | 188 | 58.2 |
Ever married | 135 | 41.8 |
Educational level
| ||
Secondary/Senior High School | 112 | 34.7 |
Middle/Junior High School | 95 | 29.4 |
No formal education | 58 | 18.0 |
Primary | 29 | 9.0 |
Tertiary | 29 | 9.0 |
Occupation
| ||
Trading | 99 | 30.7 |
Other Specify (driver, mechanic, shop attendant) | 68 | 21.1 |
Artisan | 62 | 19.2 |
Student | 51 | 15.8 |
Farming | 29 | 9.0 |
Government employee | 14 | 4.3 |
Religion
| ||
Christian | 240 | 74.3 |
Non-Christian (Islam and Traditional) | 83 | 25.7 |
Ethnicity
| ||
Akan | 211 | 65.3 |
Mole Dagbani | 98 | 30.3 |
Ga/Ewe/Guan | 14 | 4.3 |
Geographical location
| ||
Urban (Kumasi metropolis) | 162 | 50.1 |
Rural (Offinso North) | 161 | 49.9 |
Household size
| ||
5 or more | 191 | 59.1 |
Below 5 | 132 | 40.9 |
Household monthly income (GH Cedis)
| ||
0-499 | 148 | 45.8 |
500-999 | 108 | 33.4 |
1000-1499 | 40 | 12.4 |
1500+ | 27 | 8.4 |
Health system accessibility
Frequency (n) | Percentage (%) | |
---|---|---|
Financially accessible medical system
| ||
TM system | 183 | 56.7 |
Orthodox system | 140 | 43.3 |
Total | 323 | 100 |
Geographically accessible medical system
| ||
TM system | 176 | 54.5 |
Orthodox system | 147 | 45.5 |
Total | 323 | 100 |
Culturally acceptable medical system
| ||
TM system | 318 | 98.5 |
Orthodox system | 5 | 1.5 |
Total | 323 | 100 |
Patronage, knowledge, attitude, preference about traditional medicine integration, and engagement with the integrated health system
Variables/Questions | Yes | No | ||
---|---|---|---|---|
n | % | n | % | |
Patronage of TM
| ||||
Have you ever used TM? (By TM, I mean the use of plant seeds, berries, roots, leaves, bark, flowers for medicinal purposes) | 307 | 95.0 | 16 | 5.0 |
Do you seek health advice from TM practitioners? | 183 | 59.6 | 124 | 40.4 |
Do you ask your physician about TM when you want to use them? | 15 | 5.0 | 292 | 95.0 |
Do you ask the pharmacist about TM when you want to use them? | 12 | 3.9 | 295 | 96.1 |
Knowledge about TM integration
| ||||
Do you have knowledge about the incorporation of TM into health system? | 214 | 66.2 | 109 | 33.8 |
Is there a license for TM practice in Ghana health system? | 205 | 95.8 | 9 | 4.2 |
Are there laws to regulate TM in Ghana? | 205 | 95.8 | 9 | 4.2 |
Are you aware of the introduction of TM directorate in some hospitals in Ghana/Ashanti region? | 99 | 46.3 | 115 | 53.7 |
Attitude towards safety of TM practice
| ||||
Should TM container have a warning of possible side effects and interaction with other medications? | 323 | 100.0 | 0 | 0.0 |
Should TM container have a clear note if the medicine is approved by FDA as a safe medication? | 322 | 99.7 | 1 | 0.3 |
Should TM container be labelled with the name of active ingredients, required dose and instruction on when to use? | 321 | 99.4 | 2 | 0.6 |
Should TM container be labelled with the expiry date? | 321 | 99.4 | 2 | 0.6 |
Should TM container have a license and registration number? | 320 | 99.1 | 3 | 0.9 |
Does the production and selling of TM products need to be regulated by Ministry of Health? | 317 | 98.1 | 6 | 1.9 |
Should TM practitioner be certified from the Ministry of Health? | 316 | 97.8 | 7 | 2.2 |
Should TM practitioner have a degree in this profession? | 270 | 83.6 | 53 | 16.4 |
Do you think the pharmacist can give useful advice to you if you want to use TM? | 209 | 64.7 | 114 | 35.3 |
Preference for TM integration
| ||||
Do you prefer TM integration into the formal health system? | 314 | 97.2 | 9 | 2.8 |
Do you want your physician to follow up when you are using TM to avoid any side effect? | 312 | 96.6 | 11 | 3.4 |
Do you want your physician to give you advice about safe use of TM? | 260 | 80.5 | 63 | 19.5 |
Do you think a physician can monitor your health better if he/she knows the kind of TM you are using and who prescribed it? | 256 | 79.3 | 67 | 20.7 |
Would integrating TM practice into health system make you feel safer to use TM? | 249 | 77.1 | 74 | 22.9 |
Engagement with the integrated health system
| ||||
Have you ever been referred by a medical doctor to a TM practitioner? | 23 | 7.1 | 300 | 92.9 |
Have TM ever been prescribed for you at the hospital/clinic by a medical doctor? | 10 | 3.1 | 313 | 96.9 |
Have you ever been referred by a TM practitioner to a medical doctor/hospital/clinic? | 7 | 2.2 | 316 | 97.8 |
Have orthodox medicines ever been prescribed for you by a TM practitioner? | 4 | 1.24 | 319 | 98.8 |
Patronage of and knowledge about traditional medicine integration
Attitude towards safe traditional medicine practice
Preference for traditional medicine integration
Engagement with the integrated health system
Satisfaction from health systems
Effectiveness of health systems | ||
---|---|---|
Frequency (n) | Percentage (%) | |
TM system | 263 | 81.4 |
Orthodox system | 31 | 9.6 |
Indifferent | 29 | 9.0 |
Total | 323 | 100 |
Socio-demographic characteristics and knowledge about TM integration
Variables | Yes | No |
p-value | ||
---|---|---|---|---|---|
n | % | n | % | ||
Sex
|
< 0.001
| ||||
Male | 130 | 76.5 | 40 | 23.5 | |
Female | 84 | 54.9 | 69 | 45.1 | |
Age
|
0.731
| ||||
Below 20 | 30 | 68.2 | 14 | 31.8 | |
20-29 | 96 | 69.9 | 42 | 30.4 | |
30-39 | 35 | 64.8 | 19 | 35.2 | |
40-49 | 19 | 63.3 | 11 | 36.7 | |
50+ | 34 | 59.6 | 23 | 40.4 | |
Marital status
|
0.013
| ||||
Unmarried | 135 | 71.8 | 53 | 28.2 | |
Ever married | 79 | 58.5 | 56 | 41.5 | |
Educational level
|
0.378
| ||||
Secondary/Senior High School | 78 | 69.6 | 34 | 30.4 | |
Middle/Junior High School (JHS) | 66 | 69.5 | 29 | 30.5 | |
No formal education | 34 | 58.6 | 24 | 41.4 | |
Tertiary | 20 | 69.0 | 9 | 31.0 | |
Primary | 16 | 55.2 | 13 | 44.8 | |
Occupationa |
0.901
| ||||
Trading | 63 | 63.6 | 36 | 36.4 | |
Other Specify | 47 | 69.1 | 21 | 30.9 | |
Artisan | 42 | 67.7 | 20 | 32.3 | |
Student | 35 | 68.6 | 16 | 31.4 | |
Farming | 17 | 58.6 | 12 | 41.4 | |
Government employee | 10 | 71.4 | 4 | 28.6 | |
Geographical location
|
0.001
| ||||
Urban (Kumasi metropolis) | 122 | 75.3 | 40 | 24.7 | |
Rural (Offinso north) | 92 | 57.1 | 69 | 42.9 | |
Religiona | 0.055 | ||||
Christianity | 167 | 69.9 | 73 | 30.4 | |
Islam | 46 | 57.5 | 34 | 42.5 | |
Traditional | 1 | 33.3 | 2 | 66.7 | |
Ethnicity
|
0.126
| ||||
Akan | 148 | 70.1 | 63 | 29.9 | |
Mole Dagbani | 58 | 59.2 | 40 | 40.8 | |
Ga/Ewe/Guan | 8 | 57.1 | 6 | 42.9 | |
Household size
|
< 0.001
| ||||
5 or more | 110 | 57.6 | 81 | 42.4 | |
Below 5 | 104 | 78.8 | 28 | 21.2 | |
HH monthly Income (GH Cedis)a
|
0.119
| ||||
0-499 | 99 | 66.9 | 49 | 33.1 | |
500-999 | 66 | 61.1 | 42 | 38.9 | |
1000-1499 | 26 | 65.0 | 14 | 35.0 | |
1500+ | 23 | 85.2 | 4 | 14.8 |
Predictors of preference for traditional medicine integration into formal health system
Multivariable analysis | |||
---|---|---|---|
Variable | AOR | [95%CI] |
p-value |
Sex
| |||
Male | 1.81 | [0.96-3.41] | 0.067 |
Age
| |||
Age | 0.98 | [0.96-1.00] | 0.222 |
Marital status
| |||
Unmarried | 2.06 | [0.85-5.02] | 1.112 |
Household size
| |||
5+ | 0.47 | [0.23-0.95] | 0.034 |
Income (GHC)
| |||
500-999 | 0.37 | [0.18-0.75] | 0.006 |
1000-1499 | 0.44 | [0.17-1.18] | 0.104 |
1500+ | 0.67 | [0.20-2.31] | 0.528 |
Qualitative phase
Psychosocial factors
Trust in TM use
“I trust TM a lot because they are natural, it does not give side effects and it cures our sickness completely.”[Participant 3, Akumadan, Female, 45 years]
“The TM are the best and they are natural. I trust the usage. They help in total healing from a disease a person might be suffering from without any side effects.”[Participant 15, Kwadaso, Male, 64 years]
Modernised TM products/services
“TM these days are not like what it used to be in the olden days. We are now in modern Ghana and everything has been modernised. Things have changed. When you look at some TM, the way they have packaged them tells you that things have really changed. It is not like the time that they only put it in a pot for you and you have to just boil it and be taking it every day. Now, they make some like capsules and when you go to the traditional herbal clinics, they have machines that they use to check you before they even give you drugs. Pre Nkwa herbal centre for instance has a lot of machines there. They treat you just like you have been to an orthodox hospital.”[Participant 14, Kobreso, Male, 38 years]
“Almost all the TM practitioners are also using the modern method of processing drugs. Now, they have a lot of machines to detect diseases.”[Participant 8, Anloga, Male, 81 years]
Quality of service
“When you go to the TM centres, they will keep calm and listen to you and even ask you to be using the TM the way they have asked you to do. They will pamper you and you will feel very happy. That one alone motivates you to use the medicine they have given you unlike the hospitals where from the nurses to the pharmacies all of them will be shouting at you like you are not a human being.”[Participant 2, Afrancho, Female, 50 years]
“The orthodox health providers don’t care about human beings. When you go and you are dying, they will allow you to die. The nurses especially are not respectful…I told you that I have been visiting a TM centre right; the people there are very good. From the nurses to the doctor and even the security man there. They are all very good and treat clients with much respect.”[Participant 20, Tarkwa Maakro, Male, 65 years]
Consumer experience
Health system accessibility
“Now, we have TM clinics and they are all close. They sell TM products in cars and in every corner.”[Participant 6, Anloga, Female, 40 years]
When discussing the financial accessibility of health systems, participants stressed that, orthodox health services tend to be more economical due to the presence of the National Health Insurance Scheme.“Hospitals can recommend certain medicines for you and you will roam from pharmacy to pharmacy without getting the medicine unless you pick a car to places like Kumasi or Accra. It makes it difficult hence inaccessible. However, a TM doctor can just go to the bush, gather some plants, and prepare for me. Therefore, the TM is more accessible to me.”[Participant 4 Akumadan, Male, 24 years]
In addition, some participants clarified that the cost of TM is dependent on the nature of practice. Thus, TM tends to be cost-effective when delivered within informal settings (community-based practice). However, services are expensive when offered in formalised settings such as clinic because TM products and services are uninsured.“The hospital that is the orthodox system since they are covered by the government (health insurance), I do not have to spend much money. The government have taken care of some of the cost so when I add something small (my money) I get the drugs I need.”[Participant 13, Asuoso, Male, 43 years]
One of the biggest incentives to accessing traditional health system as stated by participants is the faster delivery of service/care. This makes traditional healthcare desirable to the populace.“You see there are TM centres that have been opened like a hospital or clinic…When you go to such places, they take a lot of money from you because of what they do. Their clinics are privately owned and they do not get money from the government (not under health insurance scheme), so they do everything by themselves and that makes their services more expensive but TM that are offered by those in houses are really cheap.”[Participant 12, Asuoso, female 38 years]
“If it is about how quickly you get access to care, then the TM centres are the best. When you get there, they attend to you on time. All the test they have to do they make sure they do it fast for you. The TM clinic that I visited, there was a queue but it is not as long as the one at the hospitals. As for the hospital, when you are going make up your mind that you are going to spend the whole day there. There is always a long queue there and you do not get treatment on time.”[Participant 20, Tarkwa Maakro, Male, 65 years]
“When I go to the TM clinic, I don’t waste time. They attend to me quickly whenever I go there. The queue is not long so you get the chance to meet the doctor on time. This makes accessing care at TM centres very pleasant to me”[Participant 10, Asawase, Female, 80 years]
Preference/perceived benefits of TM integration
“It will help us as a country. It will help to reduce the amount of money we spend on drugs that are imported into the country. If we are using our own TM, then there would not be the need to import a lot of the foreign drug into the country. TM practitioners will also get money because they will be employed to work in the various hospitals. Therefore, both their products and services will be marketed and they will earn money.”[Participant 16, Kwadaso, Male, 43 years]
“Through integration, the TM would not fade out of the system. It will help us to preserve our indigenous medical knowledge.”[Participant 14, Kobreso, Male, 38 years]
Knowledge about TM integration
“Ok it has been going on because when you go to the hospital and you have a disease like Hepatitis B, they (medical doctors) can recommend TM for you”[Participant 4, Akumadan, Male, 24 years]
“I am aware some people are being trained at KNUST to become TM doctors. I got to know about it from a doctor who was on radio. He said it when he was talking about TM practice in Ghana, so for that one I know.”[Participant 17, Kwadaso, Male, 50 years]
Nonetheless, the majority of participants were unfamiliar with the presence of integrated health facilities in Ghana. Despite participants’ exposure to the media, many of them had no clue about the presence of TM clinics in some selected public hospitals in the Ashanti region and the country as a whole.“Oh! I have heard of registration of TM practice on radio and television. I know some of the TM practitioners in Ghana here are working with licenses. The TM practitioners who are working underground are those who do not have licenses.”[Participant 11, Asawase, Male, 24 years]
“I have no news about TM clinics situated at hospitals. I always listen to the radio and television but I have not heard anything like that before.”[Participant 7, Anloga, Female, 44 years]
“I do not know health facilities that have some (TM units). I am not even sure that they have done the integration.”[Participant 18, Nkenkaasu, Female, 24 years]
Satisfaction derived from health systems
“I was happy the medical doctor referred me to a TM provider. The reception alone from the two providers was just great. The initiative of the medical doctor to refer me to the TM doctor and the timely and appropriate treatment from the TM provider were extremely fulfilling to me. You can see that through the proper interaction between the two providers, I am now very healthy again.”[Participant 3, Akumadan, Female, 45 years]
Other participants also gave a positive account regarding the use of the traditional health system. According to them, TM are potent in treating maladies.“The cross referral has helped me a lot. I do not know what would have happened to me if the specialist at Okomfo Anokye did not refer me to the TM doctor. In fact, the way both practitioners came together and offered the best of care was excellent. The specialist did not look down on the abilities of the TM doctor and indeed the TM provider also lived up to expectation. Now, I am healthy again due to communication between these two health providers.”[Participant 20, Tarkwa Maakro, Male, 65 years]
“When I got pregnant to my third child, I was having pressure (hypertension). It was very serious and I did not know what to do. I was always sending it to the hospital and they always gave me drugs that will help me but I was not really seeing any serious changes. I was still in pain until I took a TM…When I took it, I could see a lot of changes in my body. The pressure has stopped.”[Participant 6, Anloga, Female, 40 years]
“I felt sick and I was asked by a friend to see a TM provider so I went to the TM centre. The TM was good….I took it and within the first week, I started seeing improvement. The TM was really good for me and I was healed from that health problem totally.”[Participant 18, Nkenkaasu, Female, 24 years]
Recommendations from participants to promote proper integration of the two health systems
“When you implement an intervention and you advertise it, it makes people aware of the existence of that intervention. When people do not know, they wouldn’t use it so they (policy makers) should make sure the advertisement becomes more through the media particularly radio and television stations.”[Participant 11, Asawase, Male, 24 years]
“When you look at containers of TM products from countries like China, you will notice that they have written the expiring dates of the drugs on containers. Some of the TM here do not have that. Some of them are just packaged in plastic bags…they do not look attractive at all and they do not have any description on them too. No expiring date, nothing! Practitioners just write the names of the drugs, and what they are meant for on pieces of papers and that is it. They will not write the expiring date and even how to take them (dosage). It makes using them a bit dangerous. Therefore, they should package them very well. They should write the expiring dates and even how the drugs should be used. That way, it will meet the standard and can easily fit into the formal health system.”[Participant 3, Akumadan, Female, 45 years]
Currently, Ghana is practicing an inclusive integrated health system. When participants were asked to suggest an appropriate integration approach, most of them opted for full integration/inclusion of TM in the national health insurance scheme. They envisaged that a fully integrated health system has the advantage of making healthcare geographically and financially accessible to all.“They have to train more people in the field of TM and make sure that they are good at what they do. Then, post them to the various hospitals and clinics. Now, TM doctors are not many but if they train more people, there will be more experts in the field and every health facility will have a TM doctor. Therefore, getting access to an integrated health facility/care will be easy.”[Participant 10, Asawase, Female, 80 years]
“Integration should be done as a whole. It should be a nationwide thing….They should not say that let us integrate it at bigger facilities such as Okomfo Anokye teaching hospital and leave the smaller hospitals behind. They should take it to every hospital in the country. If this is done, everyone regardless of place of residence can get access to proper healthcare.”[Participant 5, Akumadan, Male, 57 years]
“TM offered at clinics are very expensive. If you do not have money, you cannot really patronise their services. Therefore, they should make it in such a way that TM products/services will be covered under the national health insurance scheme. That way, insurance will cover some of their charges just like it covers that of the hospitals/orthodox healthcare. If we do that, it will help everybody.”[Participant 7, Anloga, Female, 44 years]
Triangulation of study results
Domain of the framework for TM integration into national health systems | Concept/theme | Concept/theme description | Quantitative findings | Illustrative qualitative response: |
---|---|---|---|---|
Contextual characteristics
(psychosocial factors):
Contextual characteristics/psychosocial factors describe the historic use or trust associated with TM usage in a given society. | Trust in TM use | Significant use of TM among residents of Ashanti region. Key reason cited for high use of TM among participants was trust in TM due to its natural state and negligible side effects. | High usage of TM among participants: Yes = 95.0% No = 5.0% |
I have much confidence in traditional therapies because you do not get any problems after taken them and it heals you completely, so I use them a lot.
[Participant 18, Nkenkaaso, Female, 24 years] |
Consumer experience:
Consumer experience is influenced by health system accessibility – physical, financial, cultural [38] | Physical availability of healthcare | Participants narrated how healthcare is geographically available to them. | The majority of participants considered TM geographically accessible. TM = 54.5% Orthodox = 45.5% |
The TM are very close. They take it around and if you want it, you just buy and use it. As for the orthodox medicine, no one will bring it to your shop or your work place. You have to look for pharmacy shop and buy. [Participant 1, Afrancho, Female, 49 years] |
Culturally acceptable healthcare | Furthermore, TM appeared to be the traditionally acceptable health system among participants. | A considerable percentage of participants deemed TM as a culturally acceptable medical system: TM = 98.5% Orthodox = 1.5% |
In the olden days…there were no hospitals and no clinics. Everything concerning our health was dependent on TM. When you are sick, they tell you that take traditional drugs and we are still using it. So, TM to me is culturally acceptable.
[Participant 20, Tarkwa Maakro, Male, 65 years]
Now, we have TM
| |
Financial accessibility | Cost of care was dependent on nature of services delivered. In that, modernised TM practice was reported to expensive, while local TM services were deemed economical. | More than half of participants recounted TM to be less expensive: TM = 56.7% Orthodox = 43.3% |
clinics and they have made it like the hospitals with their nurses and others…those TM clinics are expensive but if you visit an old woman in the house to prepare some TM for you, that one is less expensive.
[Participant 19, Nkenkaaso, Male, 20 years] | |
Consumer experience:
Consumer experience is impacted by satisfaction derived from utilising the various health systems as well as motivation for usage [38]. | Satisfaction from health systems | Satisfaction from health systems was based on effectiveness of therapy. | More than three-quarters of the participants reported that they gain satisfaction from accessing TM because it is effective in treating ailments. TM = 81.4% Orthodox = 9.6% Indifferent = 9.0% |
The best medicine I can talk about is TM. If not for TM, I know I would not be alive by now. I was very sick. It was not easy for me at all but TM has saved my life.
[Participant 10, Asawase, Female, 80 years] |
Consumer experience:
Consumer experience is influenced by knowledge about the integration process [38]. | Knowledge about TM integration | Participants demonstrated their familiarity with the integration process. Knowledge about integration varied among sex of participants. | More males (76.5%) than females (54.9%) were aware of TM integration into the Ghanaian health system
p-value < 0.001 |
So yes, I have heard that TM has been integrated into our healthcare system. I am a man so I keep track of issues especially health related issues. Even our current president Nana Addo met some of the experts to find out from them how well they can implement that. So, I am aware of it.
[Participant 17, Kwadaso, Male, 50 years] |
Knowledge about integration differed in terms of marital status of participants. | Participants who were not married (71.8%) exhibited more knowledge about TM integration than their ever married counterparts (58.5%)
p-value = 0.013 |
I know there are some pharmacies that sell TM products. When you visit such a facility, the TM provider will tell you to go to the hospital for the doctors to examine you before he starts treatment. That way, the provider will be sure of what you are suffering from and know the kind of drugs to give to you. I am young and single oo but I know a lot of things about health
[Participant 19, Nkenkaasu, Male, 20 years] | ||
Participants’ residential status influenced their knowledge about TM integration. | A greater proportion of urban dwellers (75.3%) were more knowledgeable about TM integration than the rural residents (57.1%). Hence, being a city dweller was perceived to be advantageous.
p-value = 0.001 |
Oh yes, I have heard about TM integration on the radio, that is Peace FM. My brother, I feel lucky to be in the city because any new intervention starts from the city…They said that, now the hospitals have been made in such a way that when you visit the facility and you prefer TM, they will send you to a TM centre to be treated there. For instance, if you are suffering from malaria, they have some TM at the hospital that can treat malaria and they will prescribe that for you.
[Participant 16, Kwadaso, Male, 43 years] | ||
The size of participants’ households influenced their knowledge about integration. | Participants with less than five household members (78.8%) were familiar with TM integration than those with five or more household members (57.6%).
p-value = < 0.001 |
Currently, there are people at KNUST who are learning TM. That is what they have gone to school to study. We are only two in this house, I told you one of my grandchildren is staying with me and he is the one who told me. He said it when I was sick and receiving care at a TM centre. Therefore, many facilities will have it (TM units) in few years to come.
[Participant 20, Tarkwa Maakro, Male, 65 years] | ||
Consumer experience:
Consumer experience is shaped by people’s preference for integration [38]. | Preference for TM integration | Larger household as a predictor of preference for TM integration. Participants with larger households were more likely to choose TM integration. | In comparison to household size less than 5, the likelihood of service users with household size five and above having preference for integration is [0.47; 0.23-0.95]
p-value = 0.034 |
I support integration with all my heart because with integration people like me who have larger families can have access to good healthcare. I have a large family my sister! In all, we are nine that is wife, seven children and myself. So do you understand why I prefer integration?
[Participant 13, Asuosu, Male, 43 years] |
Participants who had lower household monthly income have a high propensity to prefer integration. | The possibility that a participant who earned between 500 and 999 Ghana Cedis to prefer TM integration was lower than those who earned below GHC 500. 500-999: [0.37; 0.18-0.75]
p-value = 0.006 1000-1499: [0.44; 0.17-1.18]
p-value = 0.104 1500+: [0.67; 0.20-2.31]
p-value = 0.528 |
I prefer integration because if I go to the hospital and they are unable to cure me, then I can get treatment from a qualified TM doctor without having to spend much. I do not earn much; I earn just 300Gh Cedis a month so through TM integration, even with my little income, I will get proper care and can patronise quality TM products and services when the need arises.
[Participant 14, Kobreso, Male, 38 years] |
Discussion
Implication for practice
-
Willingness on the part of policy makers to include some of the approved TM products on the NHIS Drug List.
-
Government legislative and regulatory instruments to increase the number of integrated health facilities in Ghana to promote patronage particularly in the rural areas where TM is widely used.
-
A well-developed and documented partnership building strategy between all stakeholders particularly the health practitioners to strengthen cross referral between the two health systems.