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Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation

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  • Atinga, Roger A.
  • Agyepong, Irene Akua
  • Esena, Reuben K.

Abstract

Policy analysis on why women and children in low- and middle-income settings are still disadvantaged by access to appropriate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street-level bureaucracy theory, we explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana's community-based PHC implementation to the disadvantage of women and children accessing and using health services. This was a qualitative study conducted in 4 communities drawn from rural and urban districts of the Upper West region. Data were collected from 8 focus group discussions with community informants, 73 in-depth interviews with clients, 13 in-depth interviews with district health managers and FLP, and observations. Data were recorded, transcribed and coded deductively and inductively for themes with the aid of Nvivo 11 software. Findings showed that apart from FLP frequent lateness to, and absenteeism from work, that affected care seeking for children, their exercise of discretionary power in determining children who deserve care over others had ripple effects: families experienced financial hardships in seeking alternative care for children, and avoided that by managing symptoms with care provided in non-traditional spaces. FLP adverse behaviours were driven by weak implementation structures embedded in the district health systems. Basic obstetric facilities such as labour room, infusion stand, and beds for deliveries, detention and palpation were lacking prompting FLP to cope by conducting deliveries using a patchwork of improvised delivery methods which worked out to encourage unassisted home deliveries. Perceived poor conditions of service weakened FLP commitment to quality maternal and child care delivery. Findings suggest the need for strategies to induce behaviour change in FLP, strengthen district administrative structures, and improve on the supply chain and logistics system to address gaps in CHPS maternal and child care delivery.

Suggested Citation

  • Atinga, Roger A. & Agyepong, Irene Akua & Esena, Reuben K., 2018. "Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation," Social Science & Medicine, Elsevier, vol. 201(C), pages 27-34.
    • Handle: RePEc:eee:socmed:v:201:y:2018:i:c:p:27-34
    DOI: 10.1016/j.socscimed.2018.02.001
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    References listed on IDEAS

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    1. Ridde, Valéry & Kouanda, Seni & Yameogo, Maurice & Kadio, Kadidiatou & Bado, Aristide, 2013. "Why do women pay more than they should? A mixed methods study of the implementation gap in a policy to subsidize the costs of deliveries in Burkina Faso," Evaluation and Program Planning, Elsevier, vol. 36(1), pages 145-152.
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    5. Rishworth, Andrea & Dixon, Jenna & Luginaah, Isaac & Mkandawire, Paul & Tampah Prince, Caesar, 2016. "“I was on the way to the hospital but delivered in the bush”: Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban," Social Science & Medicine, Elsevier, vol. 148(C), pages 8-17.
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    Cited by:

    1. Neely, Abigail H. & Ponshunmugam, Arunsrinivasan, 2019. "A qualitative approach to examining health care access in rural South Africa," Social Science & Medicine, Elsevier, vol. 230(C), pages 214-221.
    2. Ngwira, Chikosa & Mayhew, Susannah H. & Hutchinson, Eleanor, 2021. "Community-level integration of health services and community health workers’ agency in Malawi," Social Science & Medicine, Elsevier, vol. 291(C).
    3. Nunes, João & Lotta, Gabriela, 2019. "Discretion, power and the reproduction of inequality in health policy implementation: Practices, discursive styles and classifications of Brazil's community health workers," Social Science & Medicine, Elsevier, vol. 242(C).

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