Evaluating health service coverage in Ghana’s Volta Region using a modified Tanahashi model

Abstract

Background: The United Nations 2030 Sustainable Development Goals have reaffirmed the international community's commitment to maternal, newborn, and child health, with further investments in achieving quality essential service coverage and financial protection for all. Objective: Using a modified version of the 1978 Tanahashi model as an analytical framework for measuring and assessing health service coverage, this paper aims to examine the system of care at the community level in Ghana's Volta Region to highlight the continued reforms needed to achieve Universal Health Coverage.Methods: The Tanahashi model evaluates health system coverage through five key measures that reflect different stages along the service provision continuum: availability of services; accessibility; initial contact with the health system; continued utilization; and quality coverage. Data from cross-sectional household and health facility surveys were used in this study. Immunization and antenatal care services were selected as tracer interventions to serve as proxies to assess systems bottlenecks. Results: Financial access and quality coverage were identified as the biggest bottlenecks for both tracer indicators. Financial accessibility, measured by enrollment in Ghana's National Health Insurance Scheme was poor with 16.94% presenting valid membership cards. Childhood immunization was high but dropped modestly from 93.8% at initial contact to 76.7% quality coverage. For antenatal care, estimates ranged from 65.9% at initial visit to 25.1% quality coverage. Conclusion: Results highlight the difficulty in achieving high levels of quality service coverage and the large variations that exist within services provided at the primary care level. While vertical investments have been prioritized to benefit specific health services, a comprehensive systems approach to primary health care needs to be further strengthened to reach Ghana's Universal Health Coverage objectives. ARTICLE HISTORY

Trends and correlates of maternal, newborn and child health services utilization in primary healthcare facilities: an explorative ecological study using DHIMSII data from one district in the Volta region of Ghana

“…As demonstrated in this study, facility-based SVDs over the three-year period correlated positively with number of midwives in the pertinent health facility and the cumulative number of ANC visits recorded in the particular health facility. Sheff et al [42] arrived at similar conclusions in their study on maternal and child health services utilization in the Volta Region.…”

District-Level Health Management and Health System Performance: The Ethiopia Primary Healthcare Transformation Initiative

“…First, bottleneck analysis could be used to strengthen our understanding of supply-and demand-side factors that mitigate the relationship between improved management capacity and improved primary care system performance. 29,33,34 Second, although we demonstrate the differential impact of the more intensive intervention, we do not present a cost-effectiveness analysis, which could help inform future investments in leadership and management capacity at scale. 30…”

A rapid systematic review and evidence synthesis of effective coverage measures and cascades for childbirth, newborn and child health in low- and middle-income countries

“…Seventeen studies explicitly defined the measures as effective coverage, three studies referred to measures as effective coverage but reported them according to the adjustments made: input-adjusted coverage [ 50 , 55 ] and structure-adjusted coverage and process-adjusted coverage [ 39 ]. The remaining studies did not use the term effective coverage, instead measures were defined as: adequate contact with high quality care [ 52 ], content coverage [ 36 ], coverage of obstetric services [ 32 ], facility readiness [ 48 ], high quality contacts [ 34 ], missed opportunities [ 37 ], population access to quality care [ 42 ], quality coverage [ 64 ], quality-adjusted contact [ 51 ], quality-adjusted coverage [ 40 ] and treatment pathway [ 56 , 57 ].…”