Aim: This article draws on the poverty and access to health care framework to explore the barriers to access and utilization of primary health care among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP) in Ghana. Background: Although many developing countries have made progress in extending primary health care to their populations following the Alma-Ata Declaration of 1978, the establishment of the Millennium Development Goals, and the Sustainable Development Goals (SDGs), barriers remain pervasive, particularly among vulnerable population groups. Previous studies have hardly paid in-depth attention to this important indicator for measuring progress toward achieving SDG 3. Methodology: To this end, we conducted a case study of access to health care services and utilization among aged indigents enrolled on the LEAP programme in the Daffiama Bussie Issa District of the Upper West. We collected and analyzed qualitative data from indigents aged 65 years and above, health care providers, and staff of the LEAP and the National Health Insurance Scheme (NHIS). Findings: Our analysis found geographic inaccessibility of health care, high costs of drugs and related services, exclusion of essential services from NHIS benefits package, and irregular transfer of cash to negatively influence access and utilization of health care among aged LEAP beneficiaries in the district. In addition to the need to strengthen the economy, provide health infrastructure and human resources for health in rural areas, the government needs to review the beneficiaries’ bimonthly stipends to reflect the daily minimum wage, eliminate the delay in payments, and review the benefits package of the NHIS to include essential services and medical devices commonly used by aged people. Yet implementing these recommendations has affordability implications that require innovation to mobilize additional resources and create the desired fiscal space and institutions that can sustainably implement universal coverage programmes such as the LEAP.
This paper examined inequalities in drinking water access among regions and between urban and rural areas in Ghana with a focus on access to safely managed water service, access to safe water, access to water on premises, access to sufficient quantities of water, and access to improved water. Microdata of the 2017/18 Ghana Multiple Indicator Cluster Survey was used and analyzed using descriptive statistics and Gini index. Nationally, access to safely managed water service was low (6.8%) with moderate inequality among regions (Gini index = 0.27) and high inequality between rural and urban areas (Gini index = 0.42). Also, among the 10 administrative regions, moderate inequality was recorded for access to water on premises (Gini index = 0.20), and low inequality for access to safe water (Gini index = 0.117), access to improved water (0.06), and access to sufficient quantities of drinking water (0.02). The results of the study reinforce the call by the United Nations for disaggregation of national data of the Sustainable Development Goals by relevant socio-economic and spatial variables at a subnational level to help in the design and implementation of inclusive and equitable policies.
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