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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2018

Open Access 01-12-2018 | Research

Towards universal health coverage: a mixed-method study mapping the development of the faith-based non-profit sector in the Ghanaian health system

Authors: Annabel Grieve, Jill Olivier

Published in: International Journal for Equity in Health | Issue 1/2018

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Abstract

Background

Faith-based non-profit (FBNP) providers have had a long-standing role as non-state, non-profit providers in the Ghanaian health system. They have historically been considered to be important in addressing the inequitable geographical distribution of health services and towards the achievement of universal health coverage (UHC), but in changing contexts, this contribution is being questioned. However, any assessment of contribution is hampered by the lack of basic information about their comparative presence and coverage in the Ghanaian health system. In response, since the 1950s, there have been repeated calls for the ‘mapping’ of faith-based health assets.

Methods

A historically-focused mixed-methods study was conducted, collecting qualitative and quantitative data and combining geospatial mapping with varied documentary resources (secondary and primary, current and archival). Geospatial maps were developed, providing a visual representation of changes in the spatial footprint of the Ghanaian FBNP health sector.

Results

The geospatial maps show that FBNPs were originally located in rural remote areas of the country but that this service footprint has evolved over time, in line with changing social, political and economic contexts.

Conclusion

FBNPs have had a long-standing role in the provision of health services and remain a valuable asset within national health systems in Ghana and sub-Saharan Africa more broadly. Collaboration between the public sector and such non-state providers, drawing on the comparative strengths and resources of FBNPs and focusing on whole system strengthening, is essential for the achievement of UHC.
Footnotes
1
NSPs are those that operate outside the direct control or oversight of the government and include both for- and non-profit providers.
 
2
The classification of a FBNP is one in which there is terminological discord. In this article, the term FBNP refers to non-state, non-profit health providers who self-identify as being driven by religious values.
 
3
Detailed histories can be found in Arhinful [33] and Bohmig [29].
 
4
Beyond the remit of this paper, this is examined more closely in other papers reporting on this study.
 
5
The geospatial data collated for the SAM report is intended to be publicly accessible but was not – and was provided directly by the Department of Information, Evidence and Research, at the WHO in Geneva.
 
6
Information on the Ahmadiyya Muslim Mission healthcare is scarce and little reliable or substantial data was found to be available on the establishment, location or numbers of facilities within Ghana however, the information that was available from CERSGIS was included in the final database for mapping purposes.
 
7
Multiple attempts were made to acquire the missing CHAG facility establishment data by comparing historical member lists, internet searches, and direct contact – however too many dates remained unconfirmed for a reliable analysis to be conducted on the full database. Information was also collated on the date that facilities became a member of CHAG (which is different to date of establishment), but the data was assessed to be too incomplete to report here with confidence (this will be pursued later). Information was obtained from CHAG for 189 of the facilities, but as 152 of these were listed as joining between 2000 and 2017 there was a time bias in the data that could not be reconciled.
 
8
This research project is a sub-study within a broader WHO - Alliance for Health Policy and Systems Research (AHPSR) funded project conducted by researchers at the University of Cape Town (UCT) and the University of Ghana examining the historical relationship between the Ghana public health system and non-state non-profit providers.
 
9
Member checking was conducted as a form of verification within the main study. Furthermore, within this sub-study, gathered and synthesised data was again checked with key stakeholders.
 
10
Applicable across all of the maps, regional and district boundaries (now increased to 216) have changed over time but by using GPS data rather than address details this is not considered to be a significant issue for this research.
 
11
Quasi-public facilities are institutions owned by government establishments in service industries such as mining and manufacturing as well as educational, military and law enforcement agencies. They are subsidised but not operated by the government. They predominantly serve their target populations but use has been encouraged in times of crisis such as during physician strikes.
 
12
District designated hospitals are the first referral hospital and provide higher levels of clinic care at the district level. They serve populations of approximately 100,000–200,000 people in a clearly defined geographic area [65].
 
13
This point is applicable across all of the maps and is a recognised limitation of the study with challenges in showing changes in ownership and type of facility, as well as the exclusion of facilities that have subsequently closed.
 
14
Establishment data is available for 224 of the 300 CHAG member facilities.
 
15
This estimate is based on limited figures due to the previously mentioned lack of CHAG membership data available. A 2003 CHAG Annual Report shows that 67.5% of total facilities and training institutions were Catholic and the latest figures show that they make up 41% of CHAG members.
 
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Metadata
Title
Towards universal health coverage: a mixed-method study mapping the development of the faith-based non-profit sector in the Ghanaian health system
Authors
Annabel Grieve
Jill Olivier
Publication date
01-12-2018
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2018
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-018-0810-4

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