This thesis explores the quality of health care delivery in rural Ghana. In Ghana, the Ministry of Health has been concerned about the quality of health care for sometime, but improvements in quality have been slow to develop and become noticeable: there continue to be complaints about the quality of care given by health workers and received by clients. For their part, health workers have reported the challenges to delivering quality services, while patients describe difficulties of accessibility and technical competence of health workers. It was envisaged that an exploration of the quality of care at the district level would reveal the range of constraints to provision and receipt of quality care, providing an evidence-based analysis incorporating the views of the important stakeholder groups, that could help to contribute to quality improvement in rural Ghanaian health care, especially in primary health care delivery at the local level. The study reported here was carried out in rural Amansie West district in the Ashanti region of Ghana. Using the administrative district as a case study allowed for “multiple sources of evidence gathering”, thus ensuring that the findings are more likely to reflect reality if based on several different sources of information and types of data. The study design was qualitative and involved qualitative data collection methods, including: semi-structured interviews with 66 patients, 25 health workers from seven primary health care facilities and six core members of the district health management team; and focus groups that involved discussions with members from seven communities. These data collection methods explored study participants‟ ideas about the definition of quality of health care, perceptions about the quality of actual health care delivery and feelings about the quality improvement strategy adopted in the primary care facilities studied. Interviews were tape recorded with consent, and translated into English as they were transcribed. Data were analysed manually, using iteration and thematic analysis. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of statements and their meaning to participants. Thematic qualitative analysis of the data suggested that the different provider, recipient and administrative level groups had similar views on what constituted quality of care. In their perceived definitions, all groups tended to emphasise the importance of interpersonal relations, accessibility, technical competence and effectiveness, but these dimensions variously „ranked‟ in importance by stakeholder groups. Perceptions of the quality of actual health care received and the quality improvement process being deployed in Amansie West revealed that many of the obstacles to high quality health care were described as residing within the structure of health care delivery. This study provides new knowledge about perceptions of quality, experience of quality and quality improvement in a rural area of a developing country. It has improved understanding of the differing views held by the different stakeholders. It shows the dimension of understanding about quality added when the views of patients and community members are considered in addition to providers and administrators. Findings suggest improvements could be made to structural aspects of health care provision that could improve quality: for example, appropriate equipment, trained health workers and sufficient numbers of trained workers.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:600046 |
| Date | January 2010 |
| Creators | Danquah, Augustina |
| Publisher | University of Aberdeen |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=203831 |
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