How are child health services structured to reach the poor? A qualitative case study of Community Growth Promotion in Ghana

Abstract

In many countries across sub-Saharan Africa, health inequities are widely prevalent, particularly for poor children who are at higher risk of ill-health and death, if critical child survival interventions are not accessible. Although there has been previous research carried out on the existence of health inequities and the possible strategies required to address them, there is relatively limited research that has specifically focused on the implementation of these policies and programmes (Scott et al., 2012). The purpose of this study is to explore how preventive health care services have been structured for reaching the poor. The specific aim is to understand the extent to which equity issues have been considered in the planning and implementation of a key programme of the Ministry of Health of Ghana, the Community Growth Promotion (CGP) Programme. A qualitative case study of CGP was carried out using health policy analysis. In-depth interviews were conducted with stakeholders involved in CGP at the national, sub-national and community levels, and focus group discussions were undertaken with caregivers of children less than five years of age. The sub-national data were collected from the Central Region of Ghana. The interviews were transcribed and analysed using the framework approach (Ritchie & Spencer, 1994). The key findings of the study focused on three themes: philosophy of equity; analysis of equity issues in CGP, and uptake of health interventions amongst the poor. Health inequities were widely recognised by stakeholders; however there were different drivers and different responses to equity issues at the national and sub-national levels. Although equity was not the foremost consideration in planning and formulating the CGP, it was indirectly addressed in content, focus and structure of the programme. The study further revealed that there are household, community, health service provision and health policy implementation factors that affect the delivery and uptake of services among the poor. In doing so, this thesis contributes to the literature on health equity and provides guidance for developing countries on implementation of strategies to improve health outcomes for the poor.

Date of Award	17 May 2017
Original language	English
Awarding Institution	University of Bath
Supervisor	Roy Maconachie (Supervisor)