Utilisation of public health facilities: a study of community perception in the Kumasi Metropolis, Ghana

There has been overcrowding at the Komfo Anokye Teaching Hospital (KATH) over the years. The teaching hospital which is a tertiary hospital is supposed to function as a referral hospital. The situation has been a burden for the management and staff of the hospital and would want solution to decongest the hospital. Meanwhile, the sub-metro public health facilities are being under-utilised as most of these clients walk into KATH from various parts in Kumasi without referral as non-emergency cases. The study was aimed at reviewing clients’ perception on utilisation of the public health facilities and based on the findings make recommendations to improve their utilisation. The study was a non-interventional descriptive type using both qualitative and quantitative methods. It was conducted in Asokwa, the largest sub-metro in the Kumasi metropolis where Kumasi South Hospital (KSH) the largest public health facility is situated. Three different communities were randomly selected from the Asokwa sub- metro for the study. A total of 150 residents from the communities was selected through systematic sampling and interviewed. In-depth interviews were conducted with management staff of KSH. A total of 200 exit patients who were Kumasi residents were also interviewed at the Polyclinic OPD at KATH. It was found from the study that there is increase utilisation at the KSH as the attendance has seen more than three-fold increase in the period 1999-2003. The OPD attendance in 1999 was 24614. This figure increased between 20-80% over the years till it reached 79961 in 2003. The level of utilisation of KSH is low taking into consideration the resources at its disposal and comparing the trend of its per capita OPD to the national figures. 46.3% of the respondents at KATH and 3 0.4% of those of Asokwa do not trust the sub- metro health facilities because there is a perception that the facilities are not well resourced and for that matter cannot satisfactorily cater for their health needs. 29.3% of the respondents at KATH and 14.8% of those in Asokwa had the perception that the public health facilities have no specialists and do not provide essential services. The people are not aware of the services provided at the sub-metro health facilities. 5.5% of the respondents in Asokwa and 7.3% at KATH cited financial difficulty and long distance from the facility as the reason for not utilising the facility. 78 (52%) of the respondents in Asokwa usually buy from druggist and visit the hospital when they perceive that the illness is serious. 70 (46.7%) of them visit hospital as the first call when ill. Only 1.3% of the respondents in the Asokwa sub-metro use traditional medicine when ill. 74(49.3%) of the respondents in Asokwa do not visit the public health facility. Out of this, 36 (54.8%) visit private or mission hospitals. 27 (46%) of these do so because they live close to the facility, it is relatively less expensive and staff are friendly. The OPD attendance at the KATH Polyclinic has not seen any appreciable increase in the last couple of years. There was 15% and 12.3% decrease in the attendance in the year 2000 and 2002 from the previous year’s respectively and 12.3% increase from 2002 to 2003. 146 (72.8%) of the respondents at KATH the facility to the sub-metro health facilities because they perceive that KATH is the facility were all the technology, specialists and essential services can be provided. 128 (66.7%) of the respondents at KATH indicated that the quality of service at KATH has either improved a lot or a little. Conclusion is that there has been an increased utilisation of the public health facilities in the sub-metros in Kumasi. In spite of this observation, managers believe that the level of utilisation can be improved if the residents in Kumasi are made aware of the services provided at the public health facilities through intensive public education using multiple channels. It is recommended that the public health facilities organise educational programmes in the form of health talks in churches and mosques and also the use of the media (both print and electronic) to make the population aware of the services offered at the facilities. It is also recommended that the fees at KATH be increased at least two folds to discourage people from by-passing the lower level health facilities and visiting KATH without referral.

Source: KNUST