Analysis Of Gender And Healthcare Services Utilization In Rural Ghana

Researchjournali’s Journal of Public Health

Vol. 2 | No. 2 February | 2016 1

www.researchjournali.com

Osei Asibey Benedict

Department of Geography and Rural Development,

Kwame Nkrumah University of Science and

Technology, Kumasi, Ghana

Acheampong Frank

Department of Sociology and Social Work, Kwame

Nkrumah University of Science and Technology,

Kumasi, Ghana

Adusei-Nkrumah Josephine

Department of Community Health, Kwame Nkrumah

University of Science and Technology, Kumasi,

Ghana

Analysis Of Gender

And Healthcare

Services Utilization

In Rural Ghana




ABSTRACT

There has been issue of gender and gender equality emerging as a major concern in international forums due

to general assertion that females are more vulnerable to health disadvantages than males. Gender concerns

regarding health issues include the issue of gender inequality in terms of access and use of healthcare, since

males and females, particularly in developing countries differ in their access and use of healthcare and health

outcomes. This research therefore examines the gender difference in the uptake of healthcare in rural Ghana.

A population-based cross-sectional and quantitative survey using a total of 286 systematically sampled

households from four rural communities was employed for the study. Formal face-to-face household level

structured interview was used to collect data. Data were analysed using Pearson’s Chi square and multiple

regression from the SPSS version 20. Overall, 74% (n=117) of females and 63.3% (n=81) of males had

utilized healthcare for at least once in their last four illnesses preceding the survey. Also, the factors that

influence the use of healthcare by the rural people include age, education, household size, staff attitude and

insurance status. However, there were some differences between males and females in terms of the extent of

influence of factors on utilisation. Age, education and service quality greatly influenced service utilisation for

males than females, whereas insurance status, household size and staff attitude had greater influence on

utilisation for females than males. The study therefore recommends equitable distribution of health facilities,

improvement of educational opportunities and health insurance services, and effective supervision of

healthcare providers as measures to promote gender equity in the use of healthcare in rural areas in Ghana.

Keywords: Gender, Healthcare Utilization, Rural Areas, Health Status, Education, Service Quality, Health

Insurance

1. INTRODUCTION

Healthcare utilisation is a vital determinant of health (Girma et al., 2011; Saeed et al., 2013; Owusu, 2014)

and has particular significance as a public health and development issue in developing countries (Obrist et al.,

2007). Indeed the World Health Organisation (WHO) recommends the accessibility and uptake of healthcare

for the most vulnerable (including women, children and the poor) and the underprivileged people as a

necessary primary healthcare concept (WHO, 1978). Increased utilisation of healthcare has therefore become

a major target of governments of developing countries (Sepehri et al, 2008).

Recently, the world has witnessed issues of gender and gender equality emerging as prominent concerns in

international forums. It is asserted that females are commonly more susceptible to economic, social and health

disadvantages than their male counterparts (United Nations, 2005). Though females generally have longer live

expectancy than males, they have poorer health conditions than males since they report higher rates of

morbidity and disability than males. Also, males and females differ in their use of healthcare and health




outcomes, and explanations on the differences often highlight factors such as socioeconomic inequality as

well as difference in health status as fundamental causes of variations (Saeed et al, 2012; Buor, 2004;

Huisman et al, 2003). Previous studies on gender and healthcare utilisation and health outcome have however

mostly focused in developed countries. Studies on gender disparities in healthcare utilisation and health

outcomes in developing countries are limited, and few ones focus on developing countries in Asia and South

America, leaving countries in sub-Saharan Africa. Given this background, this research paper makes attempt

to address the scarcity of developing country studies by examining the role of gender in the uptake of health

care in rural Ghana.

Ghana is a fast growing lower middle income country in sub-Sahara Africa. The country therefore needs a

healthy population as an ingredient for sustained economic growth and development as well as poverty

reduction. Provision and use of healthcare particularly in rural areas is therefore a top priority of various

governments considering contribution of the rural sector to development of the country in several aspects, as

well as the proportion of people residing in rural areas. Generally, 49.1% of Ghanaians live in rural areas, and

in the Bekwai Municipality where the research was done as many as 82.4% of the population reside in rural

areas (Ghana Statistical Service, 2012). However, the consumption of healthcare in Ghana is generally low

but the level in rural areas is worse due to several identified factors such as long distance to access healthcare

(Owusu, 2014; Saeed et al, 2013; Ghana Ministry of Health, 2010; Buor, 2004), unbalanced distribution of

health facilities between the rural and urban areas (Buor, 2004), low incomes (Saeed et al, 2012) etc.

Also, one key problem facing the country in terms of health is the issue of gender inequality in terms of the

access and use of healthcare, with more males than females seeking and using healthcare (Anima et al., 2013;

Saeed et al., 2012; Buor, 2004). Gender as a demographic factor influences the seeking and uptake of health

care in most developing countries including Ghana, especially in rural areas because in these countries the

role of custom and tradition is very important, and also there is discrimination in terms of gender which has

the likelihood of influencing the seeking and use of healthcare. In most rural communities in Ghana, women

should be submissive to men in terms of decision-making including decision on who should take custody of

resources. Therefore, males appear to have control over all the resources, and capacity to access health

resources has mostly depended on the males. This situation, together with conditions such as low incomes,

puts the uptake of health care by females in serious jeopardy.

Also females are less able to seek and utilize health care since they are loaded with a lot of domestic duties.

Females perform domestic duties such as cooking, fetching water and fuel wood, catering for children, and

doing all the domestic cleaning jobs. They therefore have limited time to visit health facilities to seek for

healthcare unless they have emergency cases.




There is also gender bias regarding the level of education, which also affects people’s healthcare use. Studies

conducted in both developed and developing countries relate higher education status with more use of

healthcare services (Buor, 2003; 2004; Kasirye et al, 2004; Girma et al, 2011, Authur, 2012; Saeed et al,

2012). Females’ level of education significantly influences their uptake of health care and health outcomes

(Arthur, 2012; Anima, Ahenkan, Poku, 2013). In most developing countries, level of education for females is

low as compared to their males, though recently females in the younger cohorts are increasingly becoming

educated and are also climbing the occupational ladder. However, the latest population and housing census in

Ghana revealed that about 39% of females above age 15 can neither read nor write and for males, the

illiteracy rate is 26.2 % (Ghana Statistical Service, 2013). In the study municipality, similar to most rural

communities in Ghana, education levels for women are low, since their role, by culture used to be basically

domestic, until recently when females are being sent to school.

Difference in health status between males and females also account for differences in their use of healthcare.

Females generally have poorer health conditions than males since they report higher rates of morbidity and

disability than males, and therefore have to utilise healthcare more than males. Also, because of their

reproductive responsibility, females have to utilise healthcare more than males though males mostly take

decisions whether the women should visit the facility or not (Yakong, 2008). It might therefore be useful to

examine whether existing gender differences in socio-economic status in Ghana and rural areas explain the

level of healthcare utilisation in rural Ghana. The latter effect is vital from a policy perspective since it might

be partly amenable to targeted interventions. This research paper therefore explores the problem of gender

differences in healthcare utilisation by examining two specific questions which include the following:

What is the pattern of healthcare uptake by gender in the municipality?

To what extent do the identified determinants influence utilization by gender?

The research has three objectives including the following:

Examine the difference in healthcare utilisation by gender.

Analyze the extent of influence of significant factors on healthcare utilization by gender.

Recommend proactive measure to enhance gender equity in the utilisation of health care in rural areas in

Ghana.

The study therefore hypothesized that:

H0: There is no significant difference in the influence of health status on utilisation between males and

females

H0: There is no significant difference in the influence of education, service quality and insurance status

on utilisation between males and females.




2. DATA AND METHODS

2.1 STUDY DESIGN AND SAMPLING

This research was part of a larger research to investigate the determinants of healthcare utilization in rural

areas in Ghana with Bekwai Municipal as example. The research adopted a population-based cross-sectional

and quantitative survey design to investigate the influence of gender on healthcare utilization in rural Ghana,

using four (4) selected communities in Bekwai Municipality as study areas. The Bekwai Municipality was

selected because of its rural character and also has fewer health facilities. Convenient sampling technique was

used to select the four communities, including Senfi, Sehwi, Chiransah, and Humtado. These rural

communities were selected because of their nearness to health facilities. Systematic random sampling was

used to select the houses from which members were selected as respondents. In houses where there were more

than one household, only one household was randomly selected. The target population consisted of diverse

social, economic, and cultural groups, including persons of 18 years and above who could willfully decide for

themselves regarding the seeking and use of healthcare. A total of 286 households were selected from 1,003

households in the four communities, and the selection was based on the total number of households in each

community.

2.2 DATA COLLECTION

Primary data were collected using formal face-to-face household level structured interview. The interview

schedule consisted of both close and open ended questions. Some of the closed-ended items were ranked for

ease of coding and quantitative analysis. Data collection was done by the researcher with the help of

Postgraduate students from the Department of Geography and Rural Development, Kwame Nkrumah

University of Science and Technology, Kumasi. The interview done in the local language of the study areas (

Asante Twi) and translated back into English to ensure content validity and reliability of the interview

schedule. Participation of each respondent was voluntary. The researcher obtained an informed consent

obtained from every respondent who agreed to participate. All the 286 respondents sampled participated in

the survey.

2.3 VARIABLES AND THEIR OPERATIONALISATION

The dependent variable was healthcare utilisation, operationalised as the number of times a respondent visited

a health facility in the last four (4) times of illness spells. Healthcare utilisation in this study includes total

doctor visits, general practitioner visits as well as specialist visits. Utilisation was ranked in consistence with

Buor (2004) from "0" for non-attendance of health centre and described as rarely, to "4" for attending for all

four and described as very regular. The study also had 8 predictor variables including health status, insurance

status, age, education, household size, employment status, attitude of staff and service quality. Coding of

predictor variables included both continuous and ranked. Insurance status and employment status were

entered as dichotomous variables. The insurance status was defined as insured = 1 and uninsured = 0, and also




employment status was defined as employed = 1 and unemployed = 0. Health status was measured using the

self-assed measure, rated on a scale from 1 to 5 and described from very bad to very good respectively.

Quality of service and attitude of staff were also rated on a scale from 1 to 5 and described from very poor to

very good respectively. However, during the ranking, respondents were guided by some criteria such as

availability of physicians on regular basis, consultation time, availability of drugs, and affective behaviour of

medical and other staff. Variables such as age, years of education, and household size were entered as

continuous variables.

2.4 DATA ANALYSES

Continuous and ranked data were used in the quantitative analysis and multiple regression analysis was used.

Multiple regression was run for each gender group (males and females) to determine the relative influence of

the predictor variables on utilization for males and females. Variables with .05 or less probability (p≤.05)

were considered significant. The confidence in the multiple regression data for the gender categories is

determined using the adjusted co-efficient of determination (Adjusted R2). Before the multiple regression

analysis, descriptive statistics were conducted to describe the background characteristics of the respondents.

Also, Pearson’s Chi square (χ2) tests was used to compare the independent variables and healthcare utilisation

in terms of gender. All the data analyses were done using the Statistical Product for Service Solution (SPSS)

version 20.

3. STUDY RESULTS

3.1 CHARACTERISTICS OF SAMPLE

Respondents’ background characteristics by gender are presented in table 1. The sample size of 286

respondents were all adults (≥18 years) selected from the four rural communities in the Bekwai Municipal.

There were more females (158) than males (128). Also, the level of education was higher for males than

females since there were more males than females who had attained higher education. Concerning the

difference between the gender groups by age, females were on average older than males, and the difference is

significant. Reasons may include lower life expectancy for males than females in Ghana, and also rural-urban

migration which mostly involves the economically active people, mostly males. Males (89.1%) were also

more employed than the females (75.3%), and the difference is significant.

Table 2 also presents the health status and insurance status of the respondents by gender. Regarding the health

status, females were found to be significantly weaker than males based on perceived health status. Reasons

for weaker health status for females include complications in pregnancy and child birth. Difference in

perceived health status between males and females is however not significant. On insurance of the

respondents, males (46.9%) were more insured than females (46.2%), though females were found to have

weaker health status and vulnerable than males, and the difference was significant. This may be due to higher




financial ability of males to pay for the premium. In general however, majority of the respondents were

uninsured, probably as a result of lower financial ability to pay for the premium and the cost of renewal.

Table 1: Background Characteristics of Study Participants by Gender

VARIABLES

CATEGORIES

MALES (n=128) FEMALES (n=158)

χ2 (P-Value) Freq % Freq %

Age

20-29

30-39

40-49

50-59

60 and above

5

36

27

19

41

3.9

28.1

21.1

14.9

32.0

7

38

35

23

55

4.4

24.1

22.1

14.6

34.8

.037

Education

No Education

Basic Education

Secondary

Tertiary Education

32

65

16

15

25.0

50.8

12.5

11.7

76

59

10

13

48.2

37.3

6.3

8.2

.000

Employment

status

Unemployed

Employed

Missing

12

114

2

9.4

89.1

1.5

39

119

24.7

75.3

-

.001

Household

size

1-5

6-10

>10

40

73

15

31.3

57.0

11.7

39

114

5

24.7

72.2

3.2

.006

Table 2: Health and Insurance Status of Study Participants by Gender

VARIABLE CATEGORIES MALES (n=158) FEMALES (n=158)

χ2 sig (p-value) Freq % Freq %

Insurance

status

Uninsured

Insured

Missing

66

60

2

51.6

46.9

1.5

84

73

1

53.2

46.2

0.6

.037

Health

status

Very Bad

Bad

Fair

Good

Very Good

3

10

25

43

47

2.3

7.8

19.5

33.6

36.7

7

15

35

56

45

4.4

9.4

22.1

35.5

28.5

.041




Table 3: Selected questions regarding Healthcare Utilisation by Gender

VARIABLES

CATEGORIES

MALES (n=128) FEMALES (n=158)

χ2 sig (p-value) Freq % Freq %

Healthcare

Utilisation

0 (Rarely)

1(Irregularly)

2 (Moderately)

3 (Regularly)

4 (Very Regularly)

47

49

14

10

9

36.7

38.3

10.9

7.8

6.3

41

76

23

13

5

26.0

48.1

14.6

8.2

3.1

.104

Attitude of

staff

Very Poor

Poor

Satisfactory

Good

Very Good

Missing

7

37

48

11

7

18

5.5

28.9

37.5

8.6

5.5

14.1

5

45

64

17

8

19

3.2

28.5

40.5

10.8

5.1

12.0

.421

Quality of

Service

Very poor

Poor

Satisfactory

Good

Very Good

Missing

3

16

55

28

5

21

2.3

12.5

43.0

21.9

3.9

16.4

4

12

74

40

5

23

2.5

7.6

46.8

25.3

3.2

14.6

.011

Source: Based on Field Data, 2015

Table 3 shows the pattern of healthcare utilisation as well as perceived service quality and attitude of staff

between males and females. The overall finding regarding pattern of utilisation is low rate of healthcare

utilisation, with fewer people attending health facilities for two or more times in their last four illnesses

preceding the survey. However, females with weaker health status, less insured and less educated utilise

healthcare more than males. overall, 74% of the females had visited a health facility for at least once in their

last four illnesses preceding the survey, as compared to 63.3% of males who had visited a health facility for at

least once in their last four illness spells. The different is however not significant. Whereas males utilise

healthcare more rarely, females utilise them more moderately and regularly. Females also significantly

perceived healthcare provided to be quality than males though males were much educated than females. The

difference in attitude of staff by gender is however not significant.

3.2 MULTIPLE REGRESSION ANALYSES

Table 4 presents the results of the multiple regression analyses. Multiple regression analysis was used to

determine the relative influences of the independent variables on utilization (dependent variable). Multiple

regression was run for each gender group to determine the difference between them in terms of relative

influence of the independent variables on utilization.




Table 4: Multiple Regression factors for Males and Females

VARIABLES

Males Females

Beta Coefficients Sig (P-values) Beta Coefficients Sig (P-values)

Age .030 .000 .029 .000

Education .040 .000 .019 .010

Household Size -.119 .000 -.183 .001

Health Status -.160 .064 -.095 .011

Service Quality .109 .104 .078 .004

Staff’s Attitude .123 .020 .145 .032

Insurance Status .250 .025 .326 .001

Employment Status -.066 .718 .130 .217

ADJUSTED R2 .835 .762

Employment status had no significant impact on utilization of healthcare for both males and females. The

factors that have significant influence on utilization for males in descending order of importance are age,

education, household size, staff attitude and insurance status. For females, the factors are age, insurance

status, household size, service quality, education, health status and staff attitude. Factors such as age,

education and service quality have larger influence on utilisation for males than females. On the other hand,

insurance status, household size and staff attitude have greater influence on utilisation for females than males.

Also, whereas health status and service quality had no significant influence on utilisation for males, their

influences on healthcare utilisation for females were significant. The adjusted coefficient of determination

(Adjusted R2) for males is .835 and that for females is .762. This implies that the independent variables

adequately explain the utilisation situation for males more than for females. Both are also averagely high.

4. DISCUSSION

This study analysed the role of gender in the seeking and use of healthcare in rural Ghana, using data obtained

from the Bekwai Municipality. The study demonstrated that female utilize healthcare more than males,

though they were less educated and less insured than males. The results may have been due to females’

greater need for healthcare, considering their worse perceived health status and greater morbidity than males.

The results may also be due to females’ roles of taking care of children that affect their use of healthcare since

they are more likely to accompany their children to health facilities where they seek treatment for themselves

too. This finding validates earlier findings in Kassena- Nankana District, Ghana (Exavery et al, 2013), Jimma

zone in South West Ethiopia (Girma et al, 2011). On the contrary, this finding is not consistent with other

studies that found that females reporting their health concerns and visit health facilities less frequently than

males in Ghana (Buor, 2004; Saeed et al, 2013) and Pakistan (Shaikh and Hatcher, 2007).

Education had greater influence on utilisation for males than females. In general, the level of education for

females in the Municipality was low compared to that of males. Education is also more variable determinant

for males than for females, and this explains the variation in its influence on healthcare utilisation. This


Vol. 2 | No. 2 February | 2016 10


finding validates the findings of previous studies in different countries including Ghana (Buor, 2004; Saeed et

al, 2013), Senegal (Ndaye et al, 2005), rural Kenya (Prosser, 2007) and Vietnam (Giang and Allebeck, 2003)

that the level of education has greater influence on healthcare utilisation for males than females. Also, service

quality influence healthcare utilisation for males than females and this may be explained by the finding that

males were highly educated than females in the municipality. Educated people normally appreciate the quality

of services offered and where to access them more than the uneducated. Therefore, males who are highly

educated are expected to be influenced by quality of healthcare provided more than females. This is consistent

with previous studies that looked at influence of education on healthcare utilisation (Arozullah et al, 2005;

Girma et al, 2011 Saeed et al, 2013). However, insurance status has greater influence on utilisation for

females than males, though males were found to be more insured than females. Also, attitude of staff greatly

influenced utilisation for females than males. Health status also had greater influence on utilisation for

females than for males. The influence of health status on utilisation for males was not significant. This may be

explained by lower perceived health status and higher morbidity for females as well as their role of caring for

their children and therefore seeking healthcare for themselves.

Generally, the key factors that influence healthcare utilisation are age, education, service quality, insurance,

health status, household size and staff attitude. Age, education and service quality tend to favour males than

females whereas health status, staff attitude and insurance tend to favour females than males. Healthcare

utilisation rate for males is lower than females who have weaker health status and are also vulnerable. This

calls for more measures to encourage and improve the use of healthcare by both gender groups especially

females who have lower health status and are also vulnerable in terms of economic and social, in order to

ensure equity.

Both null hypotheses have been rejected. Firstly, the null hypothesis that there is no difference in the

influence of health status on utilisation between males and females has been rejected. The results revealed that

health status influence utilisation for females more than males. Whereas the influence of health status on

healthcare utilisation for females was statistically significant, the influence of health status on utilisation for

males on the other hand was not statistically significant. The second hypothesis that there is no difference in

the influence of education, service quality and insurance status on utilisation between males and females has

also been rejected. The results revealed that whereas education and service quality had greater influence on

healthcare utilisation for males than females, insurance status had greater influence on utilisation for females

than males.

The results of the study have revealed that in general the rate of healthcare utilisation is low, though females

slightly utilized healthcare more than males. Appropriate government policies are therefore required to

improve the rate of utilisation for both males and females. For example, in Ghana, health facilities

distribution, which is determined by government policy, would show how physically reachable the facilities


Vol. 2 | No. 2 February | 2016 11


are to the people. Most of the government health facilities in Ghana are located in key urban centres such as

regional and district capitals. Government policies should focus on providing more health facilities in the

rural areas in order to boost their access and utilisation. Also, strengthening of the government policy of

universal education would positively influence utilisation for both males and females since education has

been found to be positively associated with the use of health care. Promoting and improving the services of

the National Health Insurance Scheme as well as various mutual health insurance schemes is also a very

effective strategy to improve utilisation, especially, by the females who are mostly vulnerable and poor.

There are also appropriate measures that have to be put in place by the healthcare providers to improve on the

rate of healthcare utilisation by both males and females, since the characteristics of healthcare providers also

have much influence on service utilisation. The survey revealed that poor attitude of staffs of health facilities

has negative influence on utilization by the rural people especially the females. Therefore, positive attitude

towards patients encouraged them to utilize the healthcare particularly by the females who exhibit greater

need for services due to poor health status and vulnerability. This finding supports the findings of Cummings

et al (2006) and Witter et al (2007). The Ghana Ministry of Health ensures that quality healthcare is offered to

the people, and also ensures affective behavior of staff of health facilities to motivate and enhance service

utilisation. This is done through the Ghana Health Service. Adequate and effective supervision should be

carried out by the Municipal Health Directorate on the services rendered by the various health facilities in the

municipality both public and private as well as the behaviours of the staff towards patients, particularly those

in the rural communities and females. Staff of various health facilities should also be well motivated to

encourage them to work effectively. More health care professional should be trained and employed by the

government as well as the private owners of health facilities to reduce the work load.

This research study has identified some relevant issues that demand the right policies in order to improve

utilisation of healthcare as well as equity in service utilisation for males and females. There is the need for

policies to ensure easy access to healthcare for both males and females in the rural areas. In general, there was

low rate of healthcare utilisation as well as inequity in the use of healthcare by gender in slight favour of

females. Females exhibited greater need for healthcare as indicated by their comparatively poor perceived

health status.

Females are more vulnerable and as such need much attention, especially in very important areas such as

healthcare as noted by Buor (2004), Girma et al (2011) and Owusu (2015). In order to ensure adequate access

to healthcare there is the need for regular income sources through employment, as well as insurance services

and formal education. The results of the study has revealed that in the selected rural communities males were

more employed, insured and educated than females, which implies more access to and utilisation of quality

healthcare for males than for females.


Vol. 2 | No. 2 February | 2016 12


The research found a mismatch between males and females regarding educational attainment in the rural

communities, with males attaining higher levels of education than their female counterparts. There is

therefore the need to promote educational opportunities for the rural people, especially for females by way of

providing easy access to formal education. The Municipal Education Service should team up with the Local

Authorities to help improve access to educational opportunities by way of providing educational

infrastructure in the rural communities. Girl-child education must be promoted in the rural communities, and

also the government policy of Free Compulsory Universal Basic Education (FCUBE) must be encouraged and

fully implemented in rural areas. Also, those who are not formally educated should be given some form of

vocational training. This can be achieved partly by way of encouraging the NGOs that are focused on

vocational training, particularly those focused on females. Also, non-formal education should be encouraged

among the rural people who have passed the school-going age, particularly, among the females.

The survey also revealed that health insurance status was low for both males and females, though males were

slightly insured than females. Though there is a National Health Insurance Scheme as well as other Mutual

Insurance Schemes, the level of insurance coverage in the rural communities was low due to low incomes and

low level of education on insurance services. The rural people also complained that they were given little

attention and treatment when they visit health facilities with insurance cards, and also not all sicknesses are

being treated under the insurance schemes. However, in order to be able to access and use quality healthcare,

there is the need to be actively registered under insurance scheme. There is therefore the need for the rural

people to be properly educated on the schemes. They should also be given the opportunity to pay the premium

and reactivation fee by installment so as to get them actively registered always. It is also recommended that

the National Health Insurance Authority widen the drugs and treatment coverage to help improve registration

and consequently utilization of health facilities especially by the rural dwellers. Also, the amount spent on

each patient or client under the capitation system should be increased to cover more drugs and treatments.

This will help improve utilization of healthcare, hence the health condition of the people in the rural

communities.

This study has some limitation regarding the methodology and sampling. There is a possibility of a recall bias

in self-reports concerning healthcare utilisation. The sampling techniques employed in this study may lead to

some sampling bias. For instance the purposive sampling technique was used to select the study region,

district and the rural communities which were not statistically representative. Also the systematic random

sampling technique used in selecting the households gives the tendency of losing some vital information from

the target population that was skipped over. The study however used a homogeneous sampling frame and

could therefore report similar cases. Also, the sample size was not sufficiently large enough to guarantee

representativeness.


Vol. 2 | No. 2 February | 2016 13


5. CONCLUSIONS

There is the need to improve access and utilisation of healthcare in the rural communities in the Bekwai

Municipality. In spite of all the improvements that have been made to increase healthcare utilization by both

males and females in Ghana, seeking of healthcare still remains low in rural areas in the Municipality. Though

females who have weaker health status, high vulnerability and greater need utilized healthcare more than

males, the rate of utilisation was generally low.

In spite of the higher rate of healthcare utilisation for females than males, females utilise poorer quality of

healthcare. Males have greater advantage than females in terms of using quality healthcare, probably due to

higher levels of education and higher economic or financial ability. There is therefore the need for policies to

eliminate gender inequality in terms of education and income generating opportunities, as these will go a long

way to generally improve the rate of healthcare utilisation as well as eliminate the inequity in healthcare

utilisation in terms of gender. This will therefore promote good health which is an important indicator of

quality of life and a major contributor to human capital needed to promote poverty reduction and socio-

economic development.

This research has been successful in examining the essential differences in healthcare utilisation by gender.

The survey has used the multiple regression technique to show the relative contribution of various factors

(independent variables) to utilisation of healthcare for both males and females.

The survey has also identified areas to be considered in further studies. Firstly, this study did not look at the

effects of physical distance on the use of healthcare by the rural population. Secondly, the effects of income

on service utilisation by both males and females were not looked at in this survey. Therefore, there is the need

for a further and deeper study on the effects of distance and income on the utilisation of healthcare by both

males and females in rural communities, possibly using larger sample size.

6. REFERENCES

Arozullah, A. M., Lee, S. Y. D., Khan, T., Kurup, S., Ryan, J., Bonner, M., & Yarnold, P. R. (2006). The roles of low literacy and

social support in predicting the preventability of hospital admission. Journal of general internal medicine, 21(2), 140-145.

Arthur, E. (2012). Wealth and antenatal care use: implications for maternal health care utilisation in Ghana. Health economics review,

2(1), 1-8.

Buor, D. (2004). Gender and the utilisation of health services in the Ashanti Region, Ghana. Health policy, 69(3), 375-388.

Cummings, B., Mengistu, M., Negash, W., Bekele, A., & Ghile, T. (2006). Barriers to and facilitators for female participation in an

HIV prevention project in rural Ethiopia: findings from a qualitative evaluation. Culture, health & sexuality, 8(3), 251-266.

Daniels, A. A., Ahenkan, A., & Poku, K. A. (2013). Factors Influencing the Utilisation of Maternal Health Services: The Perspective

of Rural Women in Ghana. Journal of Public Administration and Governance, 3(2), Pages-121.

Girma, F., Jira, C., & Girma, B. (2011). Health services utilization and associated factors in Jimma Zone, South west ethiopia.

Ethiopian journal of health sciences, 21(3).


Vol. 2 | No. 2 February | 2016 14


Exavery, A., & Klipstein-Grobusch, K. and Debpuur, C. (2013). Self-rated health and healthcare utilization among rural elderly

Ghanaians in Kassena-Nankana district. Working paper. Presented in Session 59: Trends, patterns, and consequences of non-

communicable diseases in Africa. 6th Union for African Population Studies Conference (UAPS). 2011. Ghana: Navrongo Health

Research Centre (NHRC).(diunduh 25 Agustus 2013). Tersedia dari: http://uaps2011. princeton. edu/papers/110332.

Ghana Ministry of Health (2010). Annual Report 2009. Ghana Ministry of Health: Accra, Ghana.

Ghana Statistical Service (2012). Ghana National Population and Housing Census: Summary of Final Results, 2010.

Ghana Statistical Service (2013). 2010 Population & Housing Census Report: Women and Men in Ghana.

Giang, K. B., & Allebeck, P. (2003). Self-reported illness and use of health services in a rural district of Vietnam: findings from an

epidemiological field laboratory. Scandinavian Journal of Public Health, 31(6 suppl), 52-58.

Girma, F., Jira, C., & Girma, B. (2011). Health services utilization and associated factors in jimma zone, South west ethiopia.

Ethiopian journal of health sciences, 21(3).

Huisman, M., Kunst, A. E., & Mackenbach, J. P. (2003). Socioeconomic inequalities in morbidity among the elderly; a European

overview. Social science & medicine, 57(5), 861-873.

Kasirye, I., Ssewanyana, S., Nabyonga, J., & Lawson, D. (2004). Demand for health care services in Uganda: implications for poverty

reduction.

Ndiaye, P., Dia, A. T., Diedgiou, A., Diediou, A., Dieye, E. H., & Dione, D. A. (2005). [Socio-cultural determinants of the lateness of

the first prenatal consultation in a health district in Senegal]. Sante publique (Vandoeuvre-les-Nancy, France), 17(4), 531-538.

Obrist, B., Iteba, N., Lengeler, C., Makemba, A., Mshana, C., Nathan, R., ... & Schulze, A. (2007). Access to health care in contexts of

livelihood insecurity: a framework for analysis and action. PLoS Med, 4(10), 1584-1588.

Owusu, G. (2015). An assessment of Regional and Gender equity in healthcare coverage under different healthcare policies in Ghana.

Ghana Journal of Geography, 6(1), 42-62.

Prosser, T. (2007). Utilization of health and medical services: factors influencing health care seeking behaviour and unmet health

needs in rural areas of Kenya.

Saeed, B. I., Louis, M., Aidoo, E. N., Nsowah-Nuamah, N. N., Yawson, A. E., & Zhao, X. (2013). Socio-economic inequalities and

healthcare utilization in Ghana. International Journal of Business and Social Research, 3(1), 54-63.

Saeed, B. I., Oduro, S. D., Ebenezer, A. M. F. E., & Zhao, X. (2012). Determinants of healthcare utilization among the ageing

population in Ghana. Int. J. Bus. Soc. Sci, 3(24), 6.

Sepehri, A., Moshiri, S., Simpson, W., & Sarma, S. (2008). Taking account of context: how important are household characteristics in

explaining adult health-seeking behaviour? The case of Vietnam. Health policy and planning, 23(6), 397-407.

Shaikh, B. T., & Hatcher, J. (2007). Health seeking behaviour and health services utilization trends in National Health Survey of

Pakistan: what needs to be done?. Journal of the Pakistan Medical Association, 57(8), 411-4.

United Nations. (2005). UN Millennium Project. Taking action: achieving gender equality and empowering women. New York:

United Nations.

Witter, S., Kusi, A., & Aikins, M. (2007). Working practices and incomes of health workers: evidence from an evaluation of a

delivery fee exemption scheme in Ghana. Human resources for health, 5(1), 2.

World Health Organization (1978). Declaration of Alma-Ata. In Intern Conference on Primary Healthcare Alma-Ata, USSR.

Yakong, V. N. (2008). Rural Ghanaian Women’s Experiences of Seeking Reproductive Health Care. Thesis Submitted to the

University Of British Columbia, Canada.