AFRICAN

3
Institutions and structural
quality of care in the
Ghanaian health system
Eugenia Amporfu, i Justice Nonvignon ii
Corresponding author: Eugenia Amporfu, e-mail: eamporfu@gmail.com
SUMMARY—Structural quality in the provision
of health care refers to the availability of physical
and human resources. The undersupply of such
resources in health facilities leads to understaffing,
outpatient and inpatient overcrowding and
undersupply of tools needed for the provision
of adequate health care. The provision of these
resources is very much correlated with institutional
factors, specifically governance and agent
incentives. The aim of this study is to explore the
effect of institutional factors on structural quality
in public health facilities in the Ghanaian health
system. New survey data on 62 public health
facilities across three regions in Ghana were used.
Principal component analysis was used to create
three indices for structural quality: overcrowding,
personnel and equipment. Three regressions
were run for the quality indices on institutional
factors. The results showed that regional hospitals
were the most overcrowded and had the worst
personnel shortages, but had the best performing
equipment. Internal governance was found to be
more important in reducing overcrowding than
external governance. The opposite was the case
for the equipment index. Personnel shortage
was mild in facilities with opportunities for
professional development. The study highlighted
the importance of good coordination of facility
administration with workers as well as with
government in improving quality.
Structural quality of health care
refers to the availability of the
physical and human resources
required for the provision of care. 1
Measures of structural quality include
health facilities’ physical equipment, and
measures related to staff expertise and
staff coordination and organization. 1
Even though this type of quality may
not by itself ensure improved outcomes, 2
it is important because it focuses on the
availability of all inputs necessary for the
provision of care, without which better
health outcomes may not exist. The
definition of structural quality used in
this study focused on the adequate supply
and functional state of resources used for
the provision of health care. Structural
quality, then, ensures access to health care,
which is necessary for the achievement of
universal health coverage.
Universal health coverage is achieved
for a given economy when all residents,
regardless of income, are able to have
access to adequate health care without
suffering financial hardship. 3 One of the
important factors for achieving universal
health coverage is access to technologies
for the diagnoses and treatment of
illness. The availability of these inputs
for the provision of health care
represents structural quality. Government
intervention in the health-care market
affects structural quality. In Ghana, for
example, the government owns more
than 50% all the health facilities in the
country. 4 The government is responsible
Voir page 69 pour le résumé en version française.
Ver a página 69 para o sumário em versão portuguese.
i Department of Economics, Kwame Nkrumah University of Science and Technology, Ghana
ii School of Public Health, University of Ghana
ISSUE 20 • SPECIAL ISSUE ON UNIVERSAL HEALTH COVERAGE 15