A multidimensional study of public satisfaction with the healthcare system: a mixed-method inquiry in Ghana

Padmore Adusei AMOAH*, Kingsley Atta NYAMEKYE, Ebenezer OWUSU-ADDO

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

3 Citations (Scopus)


Many governments in sub-Saharan Africa have recently sought to improve their health systems by increasing investment in healthcare facilities and introducing social insurance programmes. However, little is known about the impact of these intended improvements on public perceptions about the healthcare systems. This article examines whether and why people of different socioeconomic and ideological backgrounds are satisfied (or not) with the current healthcare system in Ghana from a social ecological perspective.

Data were elicited from a cross-sectional mixed-method study conducted in four regions in Ghana in 2018. We used ordinal logistic regression and thematic analysis techniques to analyse the data.

Satisfaction with the healthcare system was generally low. From our quantitative study, intrapersonal factors (e.g., being older and having good health and well-being status); interpersonal factors (e.g., linking social capital); community factors (e.g., living in rural areas); and organisational and public policy factors (e.g., trust in the health system, favouring welfare policies, and being interested in politics) were positively associated with satisfaction with the healthcare system. These were corroborated by the qualitative study, which showed that poor attitudes of health personnel, financial constraints, perceived poor health facilities, and perceived inefficacy of services contribute to dissatisfaction with the healthcare system.

Strategies to improve satisfaction with the healthcare system in Ghana should incorporate ecological perspectives by considering factors such as demographic profile, health needs, political orientation, issues of trust in the healthcare system, and the dynamics and impact of social relationships of populations concerned.
Original languageEnglish
Article number1320
JournalBMC Health Services Research
Issue number1
Early online date9 Dec 2021
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
In the qualitative study, we used the interpretivist paradigm to ensure that the views of participants were at the centre of data collection, analyses, and the interpretation of findings. This paradigm provides an opportunity to explore a research question from the perspective of people who have experienced the situation []. A semi-structured in-depth interview approach was used to gather data from 39 participants. Preliminary analysis was done after each interview, and by the 20th interview, data saturation was reached for almost all aspects of the study, but we carried out more interviews to ensure a balanced sample in terms of the characteristics of participants []. About 12 of these participants also took part in the quantitative study, and they were purposively selected as with all other participants. We used a maximum variation purposive sampling technique to select participants from Ashanti, Brong Ahafo, Upper East, and Greater Accra regions based on age, sex, educational attainment, and rural-urban residence, as shown in Table . The interview guides were pre-tested, and corrections were made based on the test. The interviews were conducted in-person at the homes and workplaces of participants by the first and second authors with support from (trained) research assistants who were fluent in the local languages of participants. Contents of the interviews included how people felt about the public healthcare system, the challenges they faced in accessing the health services, and the positive aspects of the system (Additional file : Appendix I shows the complete interview guide). Each interview lasted approximately 45 min, which were audio-recorded. Further details of the methods employed in this study have been reported elsewhere [] and in Additional file : Appendix II. The Council for Scientific and Industrial Research (CSIR) (RPN 006/CSIR-IRB/2018) and Lingnan University Research Ethics Committee (EC-052/1718) approved the research protocol.

Funding Information:
The Council for Scientific and Industrial Research (CSIR) (RPN 006/CSIR-IRB/2018), and Lingnan University Research Ethics Committee (EC-052/1718) approved the research protocol. Written and verbal consents were obtained from participants depending on their literacy levels.

Funding Information:
This study was funded through Lingnan University Seed Grant (Grant code: 102338). The study also received funding support from Lingnan University through the Lam Woo Research Fund-Individual Grant (Grant code: LWI20014). Both fundings were offered to the first author. The funders played no role in the study design; data collection, analyses, and interpretation; in the writing of the manuscript, or in the decision to publish the results.

Publisher Copyright:
© 2021, The Author(s).


  • Public satisfaction
  • Healthcare system
  • Social ecology
  • Social Capital
  • Ghana
  • Social capital


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