AFRICAN

Table 2. Results on structural quality indices
Dependent variables
Overcrowding index Personnel index Equipment index
Independent variables Coefficient P-value Coefficient P-value Coefficient P-value
Constant -16.060 0.005 0.923 0.000 .698 0.000
C i – Patient characteristics
Age -0.01 0.853 0.000 0.587 0.000 0.615
Gender (Female=1) 2.401 0.108 0.033 0.061 0.008 0.253
Primary education 6.071 0.045 -0.036 0.313 -.063 0.000
Junior secondary school -1.298 0.502 0.096 0.000 0.002 0.859
Senior secondary school -0.283 0.909 0.074 0.013 -0.039 0.001
Tertiary education 4.098 0.209 -0.004 0.907 -0.036 0.023
Employed in formal sector 7.520 0.008 0.245 0.000 -0.016 0.229
Informal sector employed 2.661 0.217 0.099 0.000 -0.059 0.000
Farmer -3.883 0.159 0.181 0.000 -0.035 0.007
H i – Health facilities
Greater Accra region 5.182 0.069 -0.508 0.000 0.068 0.000
Ashanti region -10.975 0.000 -0.259 0.000 -0.002 0.886
Teaching hospital -15.948 0.006 -0.295 0.000 0.257 0.000
Regional hospital 22.683 0.000 0.015 0.770 -0.264 0.000
District hospital -13.994 0.000 0.185 0.000 0.074 0.000
Number of nurses -0.076 0.041
Number of doctors 0.252 0.000
S i – Institutional factors
Workers’ view of information
flow
-32.986 0.000 0.129 0.000
Learning on the job 0.000 0.977
Professional development -0.125 0.002
Quality of items procured 18.771 0.000 -.085 0.000
Relevance of procurement 12.265 0.000 -.175 0.000
Hiring procedure 0.386 0.000
Job satisfaction -0.174 0.000
Information between
government and health facility
-0.099 0.968 -0.053 0.000
Information between facility
administration and workers
-9.035 0.005 0.141 0.000 0.119 0.000
the patient. To ensure the results were
unbiased and precise, specification tests
(RESET) as well as the White’s general
heteroskedasticity tests were run and the
results showed no specification problem.
The ordinary least squares estimation
method was used for the estimation of
the structural quality regressions.
Regression results
With the exception of the formal
sector and primary education, patient
characteristics did not affect the
overcrowding index. The results show
that patients with primary education
and/or working in the formal sector
are likely to receive care in overcrowded
facilities. While there was no statistically
significant difference in overcrowding
between the Greater Accra region
and the Northern region (the control
variable), the Ashanti region was the
least overcrowded. Regional hospitals
were highly overcrowded (coefficient:
22.683) relative to health centres, while
teaching and district hospitals were less
overcrowded than the health centres.
The institutional factors were all
significant with the exception of
the flow of information between
government and facilities. The flow of
information between health workers and
administration reduced overcrowding.
Improvement in quality and relevance
of procurement increased overcrowding.
The patient characteristics that affect
the personnel index were, occupation of
patients, level of secondary education. All
were positively correlated with the index.
A t-test for the equality of the coefficients
of the Greater Accra and Ashanti regions
showed that Greater Accra has the least
personnel shortage problem followed by
the Ashanti region and hence personnel
shortage is most serious in the Northern
region. The coefficient of teaching
hospitals was negative implying that
personnel shortage was more serious in
health centres than teaching hospitals.
While there was no statistically significant
difference between health centres and
regional hospitals, district hospitals were
more likely to have personnel shortages
than health centres.
The institutional factors showed that
facilities with good information flow
between administration and health-care
workers were likely to have personnel
shortage problems. As expected,
personnel shortage was higher in facilities
in which understaffing was likely to
result from hiring procedures. However,
facilities that provide opportunities for
personnel development, and/or those
in which health workers have high job
satisfaction were associated with low
personnel shortages.
The results on the equipment index show
that age, gender, secondary education
levels and employment in the formal sector
have no correlation with the equipment
index. The higher education and other
employment coefficients were all negative
and significant implying that patients with
higher education and are employed are
likely to receive care in facilities with good
equipment. The facility characteristics
coefficients show no significant difference
between the functional state of equipment
in the Ashanti and Northern regions but
a significantly poorer functional state of
equipment in the Greater Accra region
relative to those in the Northern region.
The equipment of teaching and district
hospitals was found to be in a poorer
functioning state while that of the
regional hospitals was better than that of
health centres.
The results on institutional factors show
that after controlling for quality and
relevance of procurement, facilities with a
good flow of information were associated
with equipment in a poor functional state.
The functional state of equipment in
facilities that are favoured by government
policies was also good.
Discussion
The results on overcrowding across
regions imply that the problem of
overcrowding is less severe in the
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AFRICAN HEALTH MONITOR • OCTOBER 2015