Access to Health Care in Old Fadama

An Urban Informal Settlement in Ghana

Master’s Thesis

Department of Society and Globalisation (ISG), Roskilde University (RUC)

 Submitted 6th of July, 2015

By

Sofie Yung Mitschke

Research area

Old Fadama is one of the largest urban informal settlements in West Africa

Grown into a local community with numerous of shops, private schools, mosques and public toilets and baths.

Estimated 80.000 residents who have migrated from other parts of country mainly Northern Ghana

Electronic dumpsite causing a significant health threat to the people

Problem statement

How do economic, social and cultural characteristics of the local residents, living in the urban informal settlement in Ghana, influence their access to health care services? And, how are medical care providers able to address the local residents’ health needs?

Sub-research questions

1. How do the local resident’s health knowledge, attitude and beliefs influence their willingness to seek health care?

2. How do social and financial conditions of the local residents influence their ability to use health services?

3. What types of services do conventional health care practitioners provide for the local residents?

Theoretical FrameworkRonald Andersen and LuAnn Aday (1974): Access components (own illustration)

Preparations before fieldwork in Ghana

Research on study area

Applied for travel grants (Danida Travel Grant, Africa Nordic, Oticon Fond, Dansk Tennis Fond)

Developed a plan/schedule for field work (time-period, interviews, deadlines etc. ) and budget

Contacted relevant organisations and people in my network, announcing my arrival

Contacted local translator

Contacted journalist at Globalnyt (ulandsnyt.dk)

Data collection in Old Fadama

Meeting with local translator before going to the field

Consulted with community chiefs and other local authorities

Walk around and got an overview of the area

Focus Group Discussions

10 focus group interviews (five male groups and five female groups)

Selection of participants

Introduced myself in the local language

Ethical considerations

Class exerciseIn the three scenarios below, you are conducting a focus group discussion with local residents in Old Fadama. You want to find out how the residents behave/act when they get sick. What health providers do they seek and why?1. Scenario During the focus group discussion, there is one person who dominate the conversation and the rest are not participating. How would you involve the rest of group in the discussion?2. ScenarioDuring the focus group discussion you ask the questions below, but the participants do not understand your questions. How would you rephrase them? What diseases do you think most people here in your community get infected

by? Are you familiar with any organizations, NGO’s or associations that work with

health issues in your community? 3. ScenarioDuring the focus group discussion one of the participants starts talking about the on-going conflict between traditional tribes in Northern Ghana where he/she has migrated from. You wish to lead the conversation back to your topic about health care in Old Fadama. How would you do that?

Advantages (Successes) Limitations (challenges)

How groups of people think, feel and react about a particular topic

  The group dynamic generated new

perspectives on a topic  

It provide an idea of shared views or not shared views

  I was able to interact directly with

respondents (allows clarification, follow-up questions)

  Reaching more reluctant people who are

often the most vulnerable

Ensuring active participation  Covering in depth perceptions on a

particular issue  Risk of power hierarchies among the

participants 

Social tensions between the participants   Moderator bias

The moderator role

Short and specific questions

Not too many questions – keep it simple!

Make the conversation as ’natural’ as possible

Body language and energetic tone of voice

Memorize the questions and try not to look at the interview guide

A good relation and collaboration with the local translator

Time-line of data collection in Accra, Ghana

11th-18th of February: Focus group interviews with local residents of Old Fadama

19th-20th of February: Interviews with drug store owners in Old Fadama

26th of February: Interview with Medical Doctor

2th of March: Interview with NGO, Housing the Masses

3th of March: Interview with Ministry of Health

12th of March: Interview with Social Service (A.M.A)

16th of March: Observation study of Poly-clinic in James Town

Unpredictability in the data-collection process

The importance of local drugstores also called chemical sellers

Trust in traditional health practitioners

Low tendency to use formal health institutions

Local drugstores are the link between the local residents in Old Fadama and the formal health system

Change in the direction of my research 

More findings…

Illness level is an important factor for the local residents’ willingness to seek health care

“You only go to hospital when you cannot get up... When you can’t do things on your own. For here, you go to hospital when you don’t have any control over your body… Because people here don’t like hospital... Some say the hospitals are not good others say they waste time...“(Annex 6, p. 4)

Social network enables the local residents to gain financial access to health care service

“…as we come to a place like this we are all one...“ (Annex 8, p. 3)

The low tendency to seek health care increase health care expenses

Reflections after the fieldwork and submission of my thesis

Too much data! Data-collection is very time-consuming

A different theoretical framework

More critical towards the local residents in Old Fadama (validity)

Only few focus group interviews were very useful

More focus on gender perspective and traditional medicine

The end… And good luck with your fieldwork