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Opinions of Wednesday, 29 July 2015

Columnist: Anim-Mensah, Alexander

Assessment of Regional Health Services Accessibility

A developing nation on a progressive ladder requires accessibility to good education, safe drinking water, good communication and transportation and its network, good health and medical services, good housing, balanced diet, improving law and order, good policies and others. These are the necessities for firm foundation of growth.
Of the various sectors mentioned, this article focuses only on the regional health services accessibility. It adopts the methodology, which in simplistic terms, is the ratio used in the article “Assessment of Regional Higher Education Deficits and Strategies to Catch Up” published on Ghana web on June 2, 2015 ( This article is an extension of the application of the said publication and it is to provide a wider bird eyes’ view of the pervasiveness of the issue in many areas as this, for discussion. This ratio is not confirmatory but is used as inference. It can provide, in many cases, an initial or first pass assessment to determine areas which may need extra attention or require next level of detailed analysis.
The ratio as used here for the medical services assessment HPD, considers the number of hospitals in a region (H), region’s land size and population to define the ratio (HPD) of the number of hospitals (H) to population density (PD) as a way to quantitatively rank accessibility of medical services across Ghana. Each region is treated as a separate entity.
This ratio i.e. HPD assumes that all hospitals are operating at full capacity, hospitals are of the same size and equipped equally, population is evenly distributed within each region, availability of good access to roads and access roads, among others which in most cases are not true across Ghana and hence deferred to the next level of details and complexities. However, HPD provides information on distribution on accessibility and can be applied both on “macro” and/or “micro” levels. The “micro” for more details while “macro” for less details like a bird’s view which is being addressed in this article.
Regional number of hospitals, regional land size and population distribution in Ghana can be found at the Wikipedia links and A summary of the various regional population and land size, regional number of hospitals (H), calculated population density (PD i.e. pollution to land size) and ratio (HPD i.e. number of hospitals (H) to population density (PD)) and number of bordering regions are as follows.
• Ashanti: population - 4,780,380, land size - 24,889 km2; population density - 192/km2, number of hospitals (H) - 51; calculated HPD ratio i.e. hospitals (H) to population density ratio of 0.266 (i.e. 0.266 = 51/192) and number of bordering regions 4
• Brong Ahafo: population - 2,310,983, land size - 39,557 km2, population density - 58/km2, number of hospitals (H) - 24; calculated HPD ratio of 0.414 and number of bordering regions 5
• Greater Accra: population - 4,010,054, land size - 3,245 km2, population density -1236/km2, number of hospitals (H) - 81; calculated HPD ratio of 0.066 and number of bordering regions 3
• Central: population - 2, 376,021; land size - 9,826 km2, population density - 242/ km2, number of hospitals (H) -18; calculated HPD ratio of 0.074 and number of bordering regions 4
• Eastern: population - 2,633,154, land size - 19,323 km2, population density - 136/ km2, number of hospitals (H) -19; calculated HPD ratio of 0.140 and number of bordering regions 5
• Northern: population - 2,479,461, land size - 70,384 km2, population density - 35/km2, number of hospitals (H) -15; calculated HPD ratio of 0.429 and number of bordering regions 4
• Western: population - 2,376,021, land size - 23,921km2, population density - 99/km2, number of hospitals (H) - 11; calculated HPD ratio of 0.111 and number of bordering regions 3.
• Upper East: population - 1,046,545, land size - 8,842 km2, population density - 118/km2, number of hospitals (H) - 6; calculated HPD ratio of 0.051 and number of bordering regions 2.
• Upper West: population - 702,110, land size - 18,476 km2, population density - 38/km2, number of hospitals (H) - 10; calculated HPD ratio of 0.263 and number of bordering regions 2.
• Volta: population - 2,118,252, land size - 20,570 km2, population density - 103/km2, number of hospitals (H) - 22; calculated HPD ratio of 0.214 and number of bordering regions 4.
The higher the calculated HPD value the higher the medical services accessibility. Regional accessibility rankings based on HPD in descending order goes from Northern (0.429), Brong-Ahafo (0.414), Ashanti (0.266), Upper West (0.263), Volta (0.214), Eastern (0.140), Western (0.111), Central (0.074), Greater Accra (0.066) and Upper East (0.051). Northern (0.429) has the highest accessibility while Upper East (0.051) has the lowest with Greater Accra (0.066) just above the lowest.
The mean and standard deviation of the various regional HPD is 0.203 and 0.139, respectively. The mean segments Ghana into two (2) with the top half in descending order comprised of Northern (0.429), Brong-Ahafo (0.414), Ashanti (0.266), Upper West (0.263), and Volta (0.214). The lower half comprised of Eastern (0.140), Western (0.111), Central (0.074), Greater Accra (0.066) and Upper East (0.051). The range based on one standard deviation from the mean i.e. 0.064 to 0.342 puts Northern (0.429), Brong-Ahafo (0.414), and Upper East (0.051) outside this range.
Nonetheless, the above analysis reveals that Northern and Brong-Ahafo may have more medical facilities per person while Upper East and Greater Accra may have less per person. This is contrary to our perception that the Northern has fewer facilities per person than Greater Accra. In reality as revealed by this method, Northern has more.
The question now becomes where are the medical facilities locations compared to the locations or residences of the public. The proximity and accessibility as well as the quality of the services patient receive are as critical as the availability.
Having access to health and medical services but of low quality also brings along its own repercussion that was not analyzed here. Therefore, Accra having about the least because of the high population density, however, could have higher quality medical facilities compared with other regions could boost up its overall healthcare ranking.
In any case, the above shows how distributed the healthcare structures are available at the various regions to meet the needs and for further expansion to improve on quality. Also, it sets the platform to look into the various constituents of the health care structure and the various factors to make them operational and beneficial to all.
God bless.
Alexander Anim-Mensah, PhD
Dayton Ohio