An assessment of utilization of clinical services at the La Polyclinic
In pursuance of its goal of improving the health of all Ghanaians, the Government has invested in resourcing and expanding the health sector. The Ministry of Health has realised that despite these efforts, utilization of health facilities has been low across the country. The Five-year Programme of Work objectives for the period 1997-2001 therefore focused, among others, on means to optimise utilization of health services to improve the Ghanaian health status. The La Polyclinic has undergone changes in terms of massive rehabilitation, resourcing, and growth with regard to the mix of services offered since its inception. With this, it was expected that the La Polyclinic would play a competent role in reducing the flow of patients to the Regional and Teaching Hospitals. However, a preliminary comparison of OPD attendance per capita for 1999 (0.18) of the La Polyclinic with the 1997 national target for per capita OPD attendance (0.30) reveals that attendance is low. This means that notwithstanding all the investment, OPD attendance is still not up to par. This may be an indication of the general level of utilization of clinical services in Ghana. The study was conducted in the Kpeshie sub-district to assess the level and pattern of utilization of clinical services at the La Polyclinic. Specifically, to assess the level of utilization, identify factors and client perceptions that have led to that level and to recommend any necessary ways to optimise utilization levels. Data collected from clients of La Polyclinic on the grounds, adult community members in the Kpeshie sub district and opinion leaders within the Kpeshie sub district and service providers using four instruments: exit poll interview, community survey, focus group discussion and key informant interviews respectively, to gather data. For these instruments, 100, 100, 8 and 6 respondents were selected respectively. These groups were interviewed on issues affecting utilization of clinical services at the La polyclinic. The results of the study gave a view of the level and distribution of use of clinical services, the perception of the clients and providers about the provision of clinical care and factors influencing utilization of clinical care and the major factors influencing decision to use the La Polyclinic for clinical care. Reference was made to related secondary data as well as hospital records. Analysis was undertaken with the aid of the EPI-INFO 2000 software. The findings showed that although the level of OPD attendance at the La Polyclinic was low compared to the national target and had seen a general decline between 1993 and 1999; observed utilization in terms of OPD attendance had not experienced a significant deviation from the expected utilization level of 0.20 per capita OPD attendance and therefore, utilization was presently optimal. However, a longer series of OPD attendance data is required to determine the exact trend. Non-users had significantly higher income than users and were more intolerant to long waiting time and harsh staff attitude. It was recommended that a further study should be done after five to ten years to determine the long-term trend of utilization in order to undertake any corrective measures. Additionally, the SDHMT, DHMT and RHA should collaborate to reduce waiting time and poor staff attitude by ensuring that staffs are in adequate numbers, motivated, well trained to relate better to clients and more efficient in time management. Service charges should also be made more affordable to the poorest section of the communities by putting in place an affordable insurance scheme or making exemptions for paupers easier to access.
A thesis submitted to the Board of Postgraduate Studies,Kwame Nkrumah University of Science and Technology, in partial fulfilment of the requirements for the award of Master of Science in Health Services Planning and Management, 2001