Although the distance factor has been identified as key in the utilization of health services in rural areas of developing countries, it has been analysed without recourse to related factors of travel time and transport cost. Also, the influence of distance on vulnerable groups in utilization has not been an object of survey by researchers. This paper addresses the impact of distance on utilization, and how distance compares with travel time and transport cost that are related to it in the utilization of health services in the Ahafo-Ano South (rural) district in Ghana. The study, a cross-sectional survey, also identifies the position of distance among other important factors of utilization. A sample of 400, drawn through systematic random technique, was used for the survey. Data were analysed using the regression model and some graphic techniques. The main instruments used in data collection were formal (face-by-face) interview and a questionnaire. The survey finds that distance is the most important factor that influences the utilization of health services in the Ahafo-Ano South district. Other key factors are income, service cost and education. The effect of travel time on utilization reflects that of distance and utilization. Recommendations to reduce distance coverage, improve formal education and reduce poverty have been made.

The availability of skilled delivery personnel, life expectancy, national economic wealth, and health expenditure per capita predict the maternal mortality rate of a country. Based on these findings, it is recommended that structural arrangements be made to train skilled health personnel to take care of maternal health problems. In view of the high cost of training physicians, middle-level health personnel may offer an affordable alternative to handle emergency obstetrical cases to address the shortage of physicians. In addition, the allocation of adequate resources to the health sector could improve maternal mortality. The economic wealth of a country and life expectancy at birth are less modifiable through short-term specific interventions. Additionally, it is recommended that country-specific interventions are needed to correct the problem of lack of critical data for analysis.

The significant extent to which maternal education affects child health has been advanced in several sociodemographic-medical literature, but not much has been done in analysing the spatial dimension of the problem; and also using graphic and linear regression models of representation. In Ghana, very little has been done to relate the two variables and offer pragmatic explanations. The need to correlate the two, using a regression model, which is rarely applied in previous studies, is a methodological necessity. The paper examines the impact of mothers' education on childhood mortality in Ghana using, primarily, Ghana Demographic and Health Survey data of 1998 and World Bank data of 2000. The survey has emphatically established that there is an inverse relationship between mothers' education and child survivorship. The use of basic health facilities that relate to childhood survival shows a direct relationship with mothers' education. Recommendations for policy initiatives to simultaneously emphasise the education of the girl-child, and to ensure adequate access to maternal and child health services, have been made. The need for an experimental project of integrating maternal education and child health services has also been recommended. A linear regression model that illustrates the relationship between maternal education and childhood survival has emerged.

The survey seeks to structure a model for gender-based health services utilisation for the Ashanti Region of Ghana, and in addition, recommend intervention measures to ensure gender equity in the utilisation of health services. A sample size of 650 covered over 3108 houses, and the main research instruments were the questionnaire and formal interview. A multiple regression model is used for the analysis of the relationship between the complex independent variables and utilisation by gender. Results show that although females have a greater need for health services than males, they do not utilise health services as much. Secondly, whereas quality of service, health status, service cost and education have greater effect on male utilisation than females, distance and income have higher impact on female utilisation. It is recommended that, to ensure equity in health care utilisation, females be empowered through increased access to formal education and sustainable income opportunities. The introduction of a national health insurance scheme is also recommended to ensure adequate access by both sexes.

The paper examines the factors that influence the utilisation of health services by women in the rural and urban areas in Ghana. The systematic sampling procedure was used to draw the sample from women aged 18 and above with diverse backgrounds from Ahafo-Ano South district, representing the rural districts and Kumasi metropolis, representing the urban districts. The research instruments used for data collection were the questionnaire and formal interviews. Multiple regression was the main tool for analysis. The research reveals that the key factors that impact significantly on the utilisation of health services by women in the Ahafo-Ano South district are, distance, income and family size (number of children) while for Kumasi metropolis they are education, distance and marital status. Whereas it is clear that distance is a common problem facing women in both rural and urban areas in Ghana in the utilisation of health services, marital status and number of children have emerged as contrasting factors influencing utilisation of health services by women in rural and urban Ghana. Recommendations to improve utilisation include the location of maternal and child health services within easy reach in the rural areas, intensification of family planning education in the rural areas, the empowerment of women through access to formal education and vocational training for income generation activities and the full implementation of the National Health Insurance Scheme (NHIS). A model of utilisation of health services by women in the rural and urban areas has emerged. Introduction and the background

This paper examines the impact of water fetching by women and the quality of water during periods of water scarcity on the health of women in the Kumasi metropolitan area. A sample of 210 women drawn using systematic random procedure is used for the study. Formal interview is the main instrument used. The survey has established that income, quality of water, hours spent fetching water during scarcity and age are the main factors influencing women's health in the metropolis during water scarcity. In both the core and periphery, the water-related problem influencing health is hours spent fetching water during scarcity. An empirical model on water needs and women's health has emerged from the survey. Recommendations have been made on strategies to ensure regular volume of surface water, effective management of scarce water resources with the participation of women, and ensuring gender equity in domestic services.

Ghana's NHIS policy generally increases health services utilisation but at present lacks the capability to improve equitable access to healthcare, especially between poor and non-poor older adults. This may hamper the progress towards universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.

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