Horizontal Inequity in Healthcare Delivery: A Qualitative Analysis of Perceptions of Locality and Costs of Access in the Jirapa Municipality, North‐western Ghana

Abstract

This article provides evidence of horizontal inequity in the distribution of the burden and benefits of healthcare in north‐western Ghana. A qualitative approach was used to collect and analyse the data on variation in perceptions of affordability of health services to rural and urban populations in the Jirapa Municipality of Ghana. The article argues that costs of transportation, food and lodging associated with seeking healthcare at the municipal referral hospital are disproportionately higher for rural residents. This leads to delayed medical treatment, self‐medication or reliance on traditional medicines, all of which can come with harmful consequences. © 2020 John Wiley & Sons, Ltd.

Adopting localised health financing models for universal health coverage in Low and middle-income countries: lessons from the National Health lnsurance Scheme in Ghana

“…Whereas in theory, all the services in the benefits package are fully covered, in practice, however, significant equity gaps exist both in terms of the costs of enrolling in the NHIS (vertical equity) and costs associated with utilisation of health care (horizontal equity). Domapielle et al (2020) observe that rural residents suffer a higher burden of the costs of enrolling in the NHIS than their urban counterparts. This, they argue, arises in part from flat-rate contributions levied on populations in the informal sector of the economy and inflexible terms of payment of these contributions.…”

“…McClelland (1991) observes in this regard that the consequences of paying flat rate contributions on inflexible terms can be catastrophic for poor households. In rural areas, for instance, where a significant proportion of the population is employed in seasonal subsistence agriculture and flat rate contributions might result in catastrophic spending, the incidences of adverse selection and moral hazards have become common (Domapielle et al, 2020). For some scholars however, the failure to implement Act 852 cannot be blamed squarely on implementers of the NHIS but on the lack of reliable income records for populations that work outside the formal sector (Averill and Marriott, 2013;Borghi, 2011).…”

“…This is observed regarding the cost of transportation and costs associated with food and lodging when rural residents are on referral from primary health facilities within their localities to a district or a municipal hospital for further treatment. Domapielle et al (2020) found in their assessment of horizontal equity in the NHIS that the costs of travelling to the Jirapa Hospital (referral district hospital) for care were perceived to be unaffordable to a large Table 2. List of excluded disease conditions.…”

Vertical equity in access to health insurance services: An exploration of perceptions and enrolment in the Jirapa Municipality, north-western Ghana

“…Vertical equity is concerned with treating individuals or communities who are unequal differently in a way that is seen to be commensurate with their relative disadvantage. This differs from horizontal equity, which focuses on ensuring that people in the same circumstances are treated the same (Domapielle, Akurugu, & Mdee, 2020;Donaldson & Gerard, 1993;Whitehead et al, 2001). Vertical equity has been the focus of some health systems because it serves as a form of positive discrimination to promote equity in health services delivery.…”

Stakeholders’ perspectives on facilitative supervision implementation in north-western Ghana: an exploration of adherence and quality of primary healthcare

“…To effectively deliver this task, the Ghana Health Service recommends that these facilities are staffed at the minimum with a medical or physician assistant, a midwife, nurses, and auxiliary staff. However, it has been documented that a key challenge facing most of these facilities is limited availability of medical or physician assistants and midwives, particularly in rural areas (Domapielle et al, 2020). This results in frequent referral of clients from the sub-district level facilities to the district hospitals, a situation that has consequences for the quality of health care offered at that level.…”