Research proposal
Utilization of private healthcare facility in a developing country
TABLE OF CONTENTS
Chapter 1: Introduction
Background…………………………………..1
Aims and objective …………………………2
Statement of the problem……………………3
Scope and limitation………………………….4
Significance of study…………………………5
Chapter 2: Literature review……………………………..6
Chapter 3: Study methodology…………………………11
ABSTRACT
In this paper we are going to discuss utilization of private health care facility in a developing country with the help of published articles and available Internet-based sources. This topic is pertinent for the ongoing concern of stakeholders for the last decade.
It was somewhat an arduous task to obtain appropriate references for this piece. This is due to the fact that “utilization of health care” and “developing country” has multiple and loose meaning in the academic and lay literature. There are many variables imparting on the utilization of health care in a developing country and it is difficult to come up with a clearly delineated definition that captures all the prevailing influences. This explains why the focus of this thesis is to have a goal-oriented approach and shed unnecessary verbiage.
Rather than remain embossed in teasing out convoluted linkages in the literature, and the lack of accurate data, we will focus instead on the actual problems and other mitigating factors on utilization of private health care facilities in a developing country.
While above-mentioned factor pertaining to the lack of accurate measurability is true for the entire field of health sector, it is particularly acute in researches directly related on such poorly defined topics. We hope we will be able to provide a better definition as well as uncover issues related to health care utilization in a developing country.
Chapter 1
INTRODUCTION
The utilization of healthcare is an important necessity both in preventing and treating diseases and in promotion of a healthy lifestyle. Third World and developing countries alike implement the use of health care services in selected facilities. This serves as the society’s pro-active and re-active instigator against disease and unhealthy living. However, equity has always been the question in Healthcare (, 1991). It has been well-known that in the Third World, the great majority of people suffer excess mortality and morbidity, while in contrast, the affluent enjoy a health status similar to that of most people in developed countries (, 1991).
The World Health Organization (WHO) pointed out self-reliance, community participation; inter sectoral collaboration, integration of primary health care often including traditional medicine with secondary and tertiary care and provision of services to vulnerable and underserved areas as the key issues in this problem (, 1993). However, poverty in Third World countries is perhaps the most significant issue to be addressed. In 1995, WHO labeled poverty as “the world’s biggest killer and the greatest cause of ill-health and suffering across the globe.” Health care behavior varies considerably in Third World countries (, 1991). With these problems at hand, it is often stressed that services in private healthcare facilities play an important role in Third World countries (, 2003). This research proposal will focus on the healthcare issues that the developing countries are facing and the health issue will be evaluated in terms of advantages and disadvantages to determine if services in the private sector really play an important role in developing countries.
This proposal will focus on the use of private health care facility in Ghana with emphasis on its contribution towards health care delivery in the country. This research proposal includes the presentation of the topic, the background of the study, the proposed objective of the study, statement of the problem, statement of hypothesis, scope and limitation, overview of the methodologies to be used, and the significance of this study.
Aims and Objectives
The government in Ghana provides health care systems through hospitals and health centers. In addition, there are private healthcare sectors and traditional medicine to which the people can choose from. The people in Ghana are forced to rely on private health care sectors, because of the quality of healthcare provided by the government, some even move away completely and utilize traditional medicine as the only source of care.
The aim of this proposal is to describe and access the role of private healthcare facilities in Ghana, as well as implementations of public health practices in Ghana..
Specifically, the study aims to:
-Provide data using the primary – surveys gathered from respondents in Ghana who utilize the private healthcare; the government health care system and those who utilize other types of healthcare including traditional medicine.
– Compare the quality and efficacy of private healthcare facilities over the public healthcare facilities in promoting health service in the Ghanaian community.
-Assess the role of private health care in health improvement, its accessibility and efficiency in providing primary health care to the populace. In addition, access the affordability of the services from the patients’ perspective.
-Describe the government policy on health and other policies that may have impact on health.
Statement of the Problem
Poverty is a key determinant of health. Due to the low life expectancy in Ghana, there is increase in morbidity and premature deaths. Majority of the causes of morbidity and premature deaths are preventable by provision of small but significant healthcare. People in developing countries find themselves relying on the public healthcare system even though it is not adequate, while few are able to afford the private healthcare sector depending on the level of affordability.
Therefore, the researcher of this proposed study finds the necessity to conduct a study regarding the utilization of private healthcare facilities in developing countries like Ghana which plays an important role in improving the health conditions of the nation.
Purpose of the study
Specifically, this proposed study will try to answer the following questions:
a. How much priority does the Ghanaian government give in the utilization of private healthcare utilities in Ghana?
b. Do private healthcare services and facilities in developing countries such as Ghana function well or are better equipped than public healthcare services and facilities?
c. Do Ghanaians prefer treatment in private or in public healthcare facilities? (What are the reasons behind the preference for private vs. public healthcare?)
d. Do private healthcare facilities in Ghana provide fair treatment to Ghanaians regardless of status? Does discrimination or selective treatment occur in these types of facilities in Ghana?
Scope and Limitation
This proposed study will be limited to the Ghanaian community. The respondents will be limited to Accra, capital city of Ghana. Both public and private healthcare facilities will be reviewed and compared. As stated in the objective, the main focus of the study will be the utilization of private healthcare facilities in Ghana, therefore, the data on the public healthcare will only be gathered based on the secondary data that will be collected from the Ministry of Health, Department of Public of Health and the Universities in the Accra region, as well as the Census bureau.
The outcome of this study will be limited only to the data gathered from the Health Ministry’s records, books and journals and from the primary data gathered from the result of the questionnaire survey and interviews that will be conducted by the researcher. Furthermore, timeline in conducting this study will be limited to the duration of the visit to Accra, Ghana. Conclusions and recommendations will only apply on the proposed topic, and will stay limited to that topic. Other results that would arise outside the topic will not be considered, but will be stored for future use on other research.
Significance of the Study
This study will be significant to the nation of Ghana, particularly to its government because this study might uncover problems and attempt at providing feasible solutions regarding the utilization of healthcare facilities in Ghana. This study can be significant in a way that it might provide education to the Ghanaians in choosing and seeking treatment wisely on private healthcare facilities. The study can pinpoint other areas of concern that are beyond the focus of the topic that would inspire future researchers to explore. This study could be of reference to future studies regarding the utilization of private healthcare in developing nations such as Ghana.
Chapter 2
LITERATURE REVIEW
Introduction
All of the sources that will be cited are important because they provide a definite background of the main variable of the topic proposed. Recommendations provided by previous studies are significant. Moreover, the results that would be gathered in this study could either strengthen or weaken the arguments and recommendations that have been concluded in the previously cited studies.
The cited literatures will provide a fair description of the private healthcare sector or facilities in developing countries. This is imperative and would enable the researcher to have a fair and unbiased idea on the topic. This will also enhance the development of the research and facilitate the attainment of the objectives.
This chapter of the paper will be divided into two major parts. The first part will be discussing literatures and researches pertaining to the general state of healthcare in Ghana. This will be done by providing the background of the subject country; this will allow the researcher to be familiar with the widely-accepted concept and importance of health in Ghana. In the process of discussing subject of the first part, it will be observed that there is a need to establish and utilize private health care services to improve the conditions of Ghanaians. And this is where the second part begins. This part will be discussing the obstacles of establishing and utilizing private health services. These hindrances affect not just the state of health care in Ghana but the state of health of the population. The two parts in general are proofs that the review that the chapter is related to the objectives of the study since comparison of the quality and efficacy of private healthcare facilities over the public healthcare facilities in promoting health service in the Ghanaian community.
Health Care in Ghana
Ghana is one of the five African nations along the northern coastline of the Gulf of Guinea. As its pride, the country possesses one of the best game reserves in West Africa, a large number of good beaches, and plethora of hospitality (, 2000). However, it is also one of the nations in the world that is plagued with poverty. Ghana has been attempting to decrease the amount of poverty in the nation for many decades (, 2004).Ghanaians confront problems such as illiteracy, low life expectancy, AIDS, and the lack of daily necessities such as food and water. (, 2004). Each and every one of these factors increases the likelihood for low-income levels. Some reports have shown that up to 75% of the people in the country live below the poverty line (, 2004). This condition badly affects the development of the country. Moreover, improvement in education, production, and healthcare are hampered.
According to (2004), lack of, or limited healthcare is one of the major problems of Third World countries such as Ghana. Rural areas have suffered deeply with regards to health .Those who have been trained medically have been reluctant to move to rural areas and there are many facilities that have insufficient staff, which means that little help can be given to those in need (, 2004). In Ghana, high mortality, prevalent infectious disease, and related social concerns represent the most commonly discussed health conditions (, 1995). The leading causes of death are well known to Ghanaians living in poverty areas: acute respiratory infections, malaria, measles, diarrhea, and cerebrospinal meningitis, in that order. These risks are compounded by seasonal hunger, nutritional adversity, and widespread poverty, and are all viewed as contributing to the risks associated with infectious disease (, 1995). Ironically, the Navrongo Demographic Surveillance System (NDSS) provided evidence that existing public health services in Ghana have done little to mitigate these concerns (, 1995). Urban communities continue to rely upon traditional healers, traditional birth attendants, and soothsayers for health services, rather than upon allopathic medical practitioners. Modern health care is something provided at distant places by people who are culturally removed from the urban or village health systems at prices that the poor members cannot afford. As a result, use of the formal healthcare system is rare in villages, and limited and expensive in cities and urban areas (, 1995). The consequences of poor health care in Ghana are not only shown in the lessened production due to lack of energy, but also time and money spent by individuals to receive medical attention (, 2004).
Subsequently, in certain situations like Ghanaians experience, one might say that the utilization of private health care services would be valuable. According to (2003), the term ‘private sector’ covers a vast array of provider types. They include those who operate on a for-profit basis, and non-profit organizations. Moreover, they vary from highly qualified specialists through to ‘less-than-fully qualified’ practitioners and untrained shopkeepers; and from complex organizations such as inpatient facilities or provider networks, to very simple organizations such as solo-practitioners or itinerant drug peddlers (, 2003). Private healthcare is popular mainly because people seek care from private providers as they are often more accessible, their opening hours more convenient, and their waiting times shorter ( and , 2002). Furthermore, private providers are more responsive to patients. Private sector managers may be better to monitor the performance of their staff, and have greater independence or autonomy in managing their personnel than their public sector counterparts. Nevertheless, it has created an image of convenience and kindness to the patients ( and , 2002).
Private Health Care in Ghana
Establishing a private healthcare facility in Ghana will not be easy. The Private Initiatives for Primary Health Care or shortly, the Initiatives (1997) stated that most clinics in Ghana were established with mainly personal or family finances (83.5%), although some clinic owners also obtained commercial bank loans (39%). The Initiatives (1997) also stated that no provider received any tax incentives or support subsidies when establishing their facilities, and very few received importation privileges (2.5%) or special access to equipment or supplies (3.1%). Also, thirty-four percent of providers surveyed said they encountered problems with high interest rates when establishing their clinics (34.0%) and high business taxes (60%).
Aside from the difficulty in establishing a private healthcare facility, the future of the health care initiative seems to be non existent. First, (1997) stated that private providers are almost exclusively urban based, with less than two percent operating in rural areas. Moreover, half of the providers (51.9%) own the buildings in which their practices are housed. Most facilities are operated with an average of ten staff members which includes both medical and clerical personnel, 62.6 percent have inpatient facilities, and 52.4 percent have their own laboratories. Finally, eighty-two percent of all private practices are ‘solo’ or single physician practices, and a surprising 18 percent operate in group practices (, 1997).
The complication of poverty shows in the survey of the Initiative. The survey reported that “approximately 50 percent of all patients were considered ‘low income’ which was defined in terms of the client’s profession: e.g. housekeeper, security guard, agricultural worker, fisherman, etc” (, 1997). Nevertheless, despite these conditions, (1997) concluded that the sector is able to provide a wide range of preventive and curative services to its clients, many of whom have low incomes. On the contrary, (1997) also concluded that augmentation of the private health sector has been limited by changes in government regulations, prevailing banking practices, and the moribund value of the cedi, the Ghanaian currency. The future of the private health sector in Ghana will depend, in part, on how well it adapts to these conditions. To this end, enhancements, improvements and growth in marketing, business and management practices will be of great significance (, 1997).
A study conducted by (1999) about the private healthcare sector in the Greater Accra Region (GAR) in Ghana revealed that the region is the most densely populated in the nation, and the public and private health investments and economic infrastructure are concentrated in the urban centers. One of the key findings of the study is that about 55 percent of private-sector providers are found in the GAR. The majority of those surveyed (86 percent) were 45 years old and above while only seven percent were below the age of 45. In the older group, 46.5 percent were age 55–64 years and 16.1 percent were 66 years and above. These finding suggests that private practitioners are an aging population and that few new doctors are entering private practice. The study also found that there were fewer women than men in private practice in the region (, 1999). (1999) recommended that policies should be developed to respond to the unique peculiarities of the different types of private health care in the region, since the sector is not homogenous. In addition, they recommended that policies should be developed to support, encourage, and regulate the private sector (, 1999).
The above statements are clear descriptions and assessment of the role of private health care in health improvement, its accessibility and efficiency in providing primary health care to the populace, which also one of the objectives of the research.
The quality of health care provided by private providers in developing countries is poor. (, 1997). This is a big disadvantage for the less fortunate people because they spend greater proportion of their income on health care (private or public) than the rich, often using less qualified or totally untrained private providers (, 2001). (2001) have recommended three objectives in relation to the private provision of care for conditions of public health importance: (a) widening access, (b) improving quality, and (c) ensuring non-exploitative prices. Developing countries should provide community education strategies, because in theory, community education strategies could help people recognize, demand, and obtain higher quality care — and know what they might expect to pay for it (, 2001). Accreditation schemes should also be used for it may monitor the services offered by providers against agreed quality standards (, 2001). Finally, free service for target groups should also be implemented because it may offer mechanisms for limiting costs to service users and could be used to promote quality of care. Free services for specific target groups such as pregnant women, children, and commercial sex workers and for precedence services such as tuberculosis, sexually transmitted infections, and family planning deserve consideration (, 2001).
In light of the sets of information provided above, it can be stipulated that the researcher’s view to conduct a research regarding the utilization of private health care in Ghana is valid. This chapter of the proposal should also notice that there are some pieces of the puzzles that are missing such as the degree of importance that the Ghanaian government should give in the utilization of private healthcare in the country and the view of Ghanaians on private and public health care services. Knowing this, the researcher now has the idea as to where previous studies ended and where this study should begin.
OVERVIEW OF THE METHODOLOGY
Research design:
A descriptive research methodology using observation and surveys will be employed in this study. The purpose and importance in this type of research is to describe rather than to judge or to interpret. The aim of descriptive research is to verify formulated hypotheses that refer to the present situation in order to explain it clearly (, , , & , 1993; & , 1991). This research chose to use this kind of method to obtain first hand data from the respondents so as to formulate rational and sound conclusions and recommendation to end the study. In addition, this method will allow the researcher to utilize approaches that are more applicable in understanding a culture.
Additionally, this study will also utilize qualitative research methods because the researcher intends to find and build on theories which will explain the relationship of one variable with another variable through qualitative elements in research. Through this method, qualitative elements that do not have standard measures such as behavior, attitudes, opinions, and beliefs will be analyzed ( and , 1998). Also, qualitative research will be allowed for the study of the target population in their natural setting by combining wide range of interconnected methods while hoping for a better result on the subject matter.
For the research design, this research will use the following steps:
1. Analyze and collect published studies from different local and foreign universities and articles from social science journals, collect data and make a content analysis of the collected documentary and verbal material. Afterwards, the researcher will summarize all the information, make a conclusion based on the null hypotheses posited and provided insightful recommendations on the utilization of private healthcare facilities in a developing country such as Ghana. Sampling will be done randomly, which will include private medical physicians, consumers of private healthcare facilities and consumers who utilize the public healthcare facilities. The consumers who utilize other means for their healthcare needs like Traditional medicine will also be considered.
2. Survey using closed end questionnaires will be utilized in this study. The consumer of private healthcare facilities, private medical physicians and consumers of public health care facilities will be provided with the questionnaire and their responses will be analyzed.
3. Interviews will be conducted with government officials from the Ministry of Health, non governmental organizations (NGO’s) and other health care providers that contribute to the delivery of health care in Ghana.
Instruments and Tools:
Closed end questionnaires will be used for the survey because the answers are easy to analyze and are straightforward as target respondents are mostly busy that they do not have enough time to give attention to open questions. Closed response questions save the respondent having to think of possible replies while making the process easier for the interviewer. In the interview part, the researcher will select two physicians each from the five private healthcare facilities that will be observed, using a purposive sampling method
Target population:
The target population will be composed of consumers of private and public healthcare facilities in Ghana, which will include respondents from 18 years of age to 60 years, who live in Accra which is the capital of Ghana. From this population, the researcher will randomly select five private healthcare facilities that would be observed. The target population will be selected regardless of gender, race, experience or status.
It is important that the researcher will be able to define the target population to determine the sampling method needed to be used. This is the case since sampling methods to be used will be the reflection of the characteristics of the target population defined. Sampling can be classified into probability or non-probability. Probability methods describe the target population as a population where every member has non-zero probability of being chosen as subjects. Non-probability methods describe the target population as a population where members can be selected to be subjects in some random manner (, 2005).
For this particular research, the proposed sampling methods to be used are those from the probability methods since it has been stated earlier that the target population will be chosen regardless of gender, race, experience or status. The utilization of the probability methods can also prove to be advantageous since sampling errors can be calculated. This means that the researcher will be able to determine the degree to which the sample is differed from the population. There are three kinds of sampling under the probability method that can be used – random, systematic and stratified. The three samplings can be used independently or simultaneously.
Data analysis:
After data gathering, it will be edited, coded and keyed into the researchers password secured laptop, in addition, a microcomputer for back up at the Institute of Social Statistical and Economic Research in the University will be used.
Data will be analyzed and will be used to test the hypothesis of the study that the utilization of private healthcare facilities in developing countries like Ghana plays an important role in improving the health conditions of the nation. This study will investigate the success of some healthcare facilities, as well as the failure of the others. To address this objective, this research will examine the different strategies and techniques employed in these facilities. The research will also identify certain issues and discard any issues that would be irrelevant to the main focus of the study.
Furthermore, the study also aims to provide insightful and useful recommendations that should be beneficial to the health sectors of the Ghanaian government, other developing countries, or to future researches relevant to the topic.
-Time frame:
This study is expected to be completed in about three months; depending on the cooperation of the respondents. The cooperation of the respondents will be fervently sought.
REFERENCES:
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