Background
Methods
Study design
Research setting
Indicator | Ashanti | Volta | Central | National |
---|---|---|---|---|
a. Socio-demographics (GSS 2013) | ||||
Percentage polpulation (2010 PHC) | 19.4 | 8.6 | 8.9 | 24,658,823 |
Economically active population (2010) | 19.1 | 8.4 | 8.6 | 43.9 |
Percentage population employed (2010) | 18.6 | 8.6 | 8.5 | |
Percentage self-employed of the employed | 65.5 | 75.3 | 69.2 | 64.9 |
Population density (km2) (2010) | 196 | 103 | 224.1 | 103 |
Percentage urban population (2010) | 60.6 | 33.7 | 47.1 | 50.9 |
Sex ratio (males/100 females) (2010) | 94 | 92.8 | 91 | 95.2 |
Households (2010) | 1,126,216 | 495,603 | 526,764 | 5,467,136 |
Average household size (2010) | 4.1 | 4.2 | 4.0 | 4.4 |
Percentage population literate (2010) | 82.6 | 73.5 | 78.2 | 74.1 |
b. NHIS service availability (NHIA, 2013) | ||||
NHIA District Offices | 25 | 15 | 13 | 166 |
Active NHIS card-bearing members | 1,715,174 | 910,559 | 866,831 | 10,145,196 |
Percentage active to regional population | 34 | 28 | 23 | |
NHIS-credentialed service providers (2013) | 619 | 321 | 334 | 3832 |
c. Health personnel availability (GHS 2013) | ||||
Percentage share of health professionals | 18.2 | 8.5 | 8.6 | |
Percentage share of nurses (Professional) | 45.5 | 53.4 | 39.3 | |
Percentage share of nurses (Enlrolled) | 54.5 | 46.6 | 60.7 | |
Number of Doctors | 96 | 36 | 26 | n/a |
Number of Community Health Nurses | 157 | 264 | 130 | n/a |
Population and sampling
Subscriber sampling
Provider sampling
Data collection method
Data analysis
Results
Relationship between subscribers’ characteristics and perceived good quality of care
Characteristic | N | % | X2 | p-value |
---|---|---|---|---|
Age | 5.9785 | 0.014 | ||
< 44 | 332 | 52.3 | ||
44+ | 278 | 59.8 | ||
Gender | 1.5658 | 0.211 | ||
Male | 144 | 59.0 | ||
Female | 466 | 54.5 | ||
Region | 9.8067 | 0.007 | ||
Ashanti | 201 | 52.5 | ||
Volta | 181 | 51.2 | ||
Central | 228 | 62.1 | ||
Setting | 3.7906 | 0.052 | ||
Urban | 261 | 52.3 | ||
Rural | 349 | 58.2 | ||
Marital status | 4.6840 | 0.456 | ||
Married | 380 | 55.3 | ||
Separated | 21 | 56.8 | ||
Divorced | 20 | 42.6 | ||
Widowed | 91 | 58.0 | ||
Cohabitation | 14 | 66.7 | ||
Never married | 84 | 56.0 | ||
Education level | 2.8357 | 0.586 | ||
Primary | 114 | 59.1 | ||
Middle/JHS | 240 | 54.7 | ||
Secondary/SSS | 78 | 57.0 | ||
Higher/Tertiary | 31 | 47.8 | ||
Never attended school | 147 | 55.5 | ||
Occupation | 22.7185 | 0.002 | ||
Senior officer/manager | 11 | 73.3 | ||
Professional | 19 | 42.2 | ||
Technician | 6 | 40.0 | ||
Services/sales worker | 92 | 51.1 | ||
Agriculture | 141 | 60.5 | ||
Plant/machine | 1 | 25.0 | ||
Elementary worker | 91 | 46.4 | ||
Other | 249 | 60.6 | ||
Length of NHIS | 14.3779 | 0.006 | ||
membership (yrs) | ||||
< 1 | 259 | 62.1 | ||
1 | 45 | 54.9 | ||
2 | 79 | 54.1 | ||
3 | 103 | 53.1 | ||
> =4 | 124 | 47.7 | ||
Card used in past | 2.1702 | 0.141 | ||
2 years | 66 | 62.3 | ||
No | 544 | 54.5 | ||
Yes | ||||
Total | 610 | 55.5 |
Characteristic | OR | Std. Err. | z | P > z | [95% C.I] |
---|---|---|---|---|---|
Age (yrs) | |||||
< 44 | 1.00 | ||||
44+ | 1.45 | 0.23 | 2.33 | 0.020 | 1.06–1.99 |
Gender | |||||
Male | 1.00 | ||||
Female | 0.85 | 0.14 | −0.89 | 0.371 | 0.60–1.20 |
Region | |||||
Ashanti | 1.00 | ||||
Volta | 0.82 | 0.13 | −1.17 | 0.243 | 0.59–1.14 |
Central | 1.36 | 0.22 | 1.84 | 0.065 | 0.98–1.89 |
Setting | |||||
Urban | 1.00 | ||||
Rural | 1.19 | 0.15 | 1.36 | 0.175 | 0.92–1.55 |
Marital status | |||||
Married | 1.00 | ||||
Separated | 0.96 | 0.33 | −0.10 | 0.917 | 0.48–1.92 |
Divorced | 0.53 | 0.17 | −1.94 | 0.052 | 0.28–1.00 |
Widowed | 0.85 | 0.18 | −0.70 | 0.484 | 0.56–1.31 |
Cohabitation | 1.29 | 0.62 | 0.53 | 0.599 | 0.49–3.34 |
Never married | 1.03 | 0.20 | 0.17 | 0.868 | 0.69–1.52 |
Highest level of education | |||||
Primary | 1.00 | ||||
Middle/JHS | 0.80 | 0.14 | −1.18 | 0.237 | 0.56–1.15 |
Secondary/SHS | 0.85 | 0.21 | −0.62 | 0.534 | 0.52–1.38 |
Higher/Tertiary | 0.55 | 0.18 | −1.78 | 0.074 | 0.28–1.06 |
Never attended school | 0.73 | 0.15 | −1.51 | 0.132 | 0.49–1.09 |
Occupation | |||||
Snr officer/manager | 1.00 | ||||
Professional | 0.27 | 0.18 | −1.92 | 0.055 | 0.07–1.03 |
Technician | 0.20 | 0.16 | −1.98 | 0.048 | 0.04–0.98 |
Services/Sales | 0.33 | 0.20 | −1.76 | 0.078 | 0.09–1.13 |
Agriculture | 0.40 | 0.25 | −1.45 | 0.148 | 0.12–1.37 |
Plant/Machine | 0.12 | 0.16 | −1.59 | 0.111 | 0.01–1.62 |
Elementary worker | 0.27 | 0.17 | −2.08 | 0.037 | 0.08–0.92 |
Other | 0.40 | 0.24 | −1.47 | 0.143 | 0.12–1.35 |
Length of NHIS membership (yrs) | |||||
< 1 | 1.00 | ||||
1 | 0.72 | 0.19 | −1.20 | 0.230 | 0.43–1.22 |
2 | 0.79 | 0.17 | −1.07 | 0.283 | 0.52–121 |
3 | 0.78 | 0.15 | −1.23 | 0.218 | 0.53–1.15 |
> =4 | 0.68 | 0.13 | −2.00 | 0.046 | 0.46–0.99 |
Card used in past two years | |||||
No | 1.00 | ||||
Yes | 0.80 | 0.17 | −0.97 | 0.331 | 0.52–1.24 |
No. of obs | 1099 | ||||
LR chi2 (15) | 55.17 | ||||
Prob > chi2 | 0.0007 | ||||
Log likelihood | − 727.51048 | ||||
Pseudo R2 | 0.03665 |
Relationship between healthcare providers’ characteristics and perceived good quality of care
Characteristic | N | % | X2 | p-value |
---|---|---|---|---|
Age | 0.0143 | 0.905 | ||
< 44 | 67 | 8072 | ||
44+ | 72 | 80.0 | ||
Gender | 2.2292 | 0.135 | ||
Male | 73 | 84.9 | ||
Female | 66 | 75.9 | ||
Region | 13.5273 | 0.001 | ||
Ashanti | 62 | 86.1 | ||
Volta | 30 | 62.5 | ||
Central | 47 | 88.7 | ||
Setting | 0.8579 | 0.354 | ||
Urban | 95 | 78.5 | ||
Rural | 44 | 84.6 | ||
Primary status at facility | 3.7071 | 0.447 | ||
Medical officer | 26 | 78.8 | ||
Medical assistant | 14 | 66.7 | ||
Nurse-in-charge | 42 | 85.7 | ||
Other | 57 | 81.2 | ||
Years in practice | 1.2596 | 0.262 | ||
< 11 | 88 | 77.9 | ||
11+ | 51 | 85.0 | ||
Facility ownership | 1.8567 | 0.395 | ||
Quasi-government | 50 | 76.9 | ||
Mission | 44 | 78.6 | ||
Private | 45 | 86.5 | ||
Facility type | 4.9394 | 0.294 | ||
Health centre | 4 | 66.7 | ||
Clinic | 17 | 80.9 | ||
Maternity home | 3 | 60.0 | ||
Hospital | 111 | 82.8 | ||
CHPS | 4 | 57.1 | ||
Total | 139 | 80.4 |
Characteristic | OR | Std. Err. | z | P > z | [95% C.I |
---|---|---|---|---|---|
Age (yrs) | |||||
< 44 | 1.00 | ||||
44+ | 0.90 | 0.48 | −0.19 | 0.846 | 0.31–2.56 |
Gender | |||||
Male | 1.00 | ||||
Female | 0.46 | 0.24 | −1.48 | 0.138 | 0.16–1027 |
Region | |||||
Ashanti | 1.00 | ||||
Volta | 0.14 | 0.10 | −2.70 | 0.007 | 0.03–0.58 |
Central | 1.27 | 0.82 | 0.37 | 0.709 | 0.35–4.55 |
Setting | |||||
Urban | 1.00 | ||||
Rural | 2.90 | 1.61 | 1.91 | 0.057 | 0.97–8.66 |
Primary Status at facility | |||||
Medical Officer | 1.00 | ||||
Medical Assistant | 1.01 | 0.81 | 0.02 | 0.987 | 0.20–4.92 |
Nurse in-charge | 2.53 | 1.95 | 1.21 | 0.228 | 0.55–11.4 |
Other | 0.65 | 0.49 | −0.55 | 0.579 | 0.15–2.88 |
Years in practice | |||||
< 11 | 1.00 | ||||
11+ | 1.40 | 0.75 | 0.62 | 0.534 | 0.48–4.04 |
Facility ownership | |||||
Quasi-government | 1.00 | ||||
Mission | 0.61 | 0.33 | −0.88 | 0.378 | 0.21–1.80 |
Private | 1.90 | 1.17 | 1.05 | 0.294 | 0.57–6.36 |
Facility type | |||||
Health centre | 1.00 | ||||
Clinic | 2.69 | 3.13 | 0.85 | 0.394 | 0.27–26.33 |
Maternity home | 0.82 | 1.27 | −0.13 | 0.899 | 0.03–17.13 |
Hospital | 8.11 | 8.42 | 2.02 | 0.044 | 1.05–62.07 |
CHPS | .59 | .87 | −0.35 | 0.725 | 0.03–10.48 |
No. of obs | 172 | ||||
LR chi2 (15) | 32.71 | ||||
Prob > chi2 | 0.0052 | ||||
Log likelihood | −69.158398 | ||||
Pseudo R2 | 0.1912 |
Perception of quality of care components and factor loadings
Item no. | Statement | Component | ||||
---|---|---|---|---|---|---|
Communication | Dignity and respect | Service quality | Accommodation and cleanliness | Confidentiality | ||
1 | He/she spent time to advise me on preventive care | .870 | ||||
2 | Prescriber made time to discuss my health condition and treatment | .853 | ||||
3 | He/she explained everything about treatment | .797 | ||||
4 | Medicines prescribed were very good | .776 | ||||
5 | He/she opened up to me for statements about treatment | .757 | ||||
6 | Nurses treated me with dignity | .943 | ||||
7 | Prescriber gave me option to accept or refuse treatment | .933 | ||||
8 | Nurses were cautious towards me | .907 | ||||
9 | Prescriber made a good diagnosis | .812 | ||||
10 | Treatment was effective for recovery and cure | .777 | ||||
11 | I was able to see prescriber within 30 min | .586 | ||||
12 | There was a prescriber available to attend to me | .551 | ||||
13 | No congestion at facility during last visit | .738 | ||||
14 | Seats were enough at facility during last visit | .606 | ||||
15 | During last visit at facility, environment was clean | .594 | ||||
16 | During last visit, waiting area was well ventilated | .559 | ||||
17 | Confidentiality in consulting room | .848 | ||||
18 | Health information is kept secret and confidential | .729 |
Item no | Statement | Component | ||
---|---|---|---|---|
Communication | Availability and promptness | Accommodation and cleanliness | ||
1 | We explain to clients how to take their medication | .855 | ||
2 | We do proper diagnosis | .812 | .345 | |
3 | We make time to advise clients on disease prevention | .805 | ||
4 | Clients can ask statements about treatment | .726 | ||
5 | Consulting rooms good enough to give privacy | .677 | ||
6 | Environment at facility is neat | .675 | .350 | .396 |
7 | Nurses show interest in clients and makes them feel comfortable | .549 | ||
8 | Enough prescribers to look at clients | .877 | ||
9 | There is always a prescriber at post | .845 | ||
10 | Doctors show interest in clients and makes them feel comfortable | .342 | .353 | |
11 | Waiting area is well ventilated | .912 | ||
12 | Facility has enough seats in waiting area | .454 | .632 |