Institutions and Structural Quality of Care in the Ghanaian Health System

ABSTRACT

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