Health Literacy and Health: Rethinking the Strategies for Universal Health Coverage in Ghana

Health literacy is generally thought to be associated with positive health behaviour, appropriate health service utilisation and acceptance of interventions to maximise health outcomes. It is therefore increasingly suggested that evidence-based research should investigate how health literacy may operate in the context of universal health coverage (UHC). However, the role of health literacy in the relationships between elements of UHC such as access to healthcare and health insurance has not been widely explored. This applies in particular in sub-Saharan Africa although service coverage and health outcomes vary hugely between and within many countries. This paper addresses this lacuna through a cross-sectional empirical inquiry in Ghana, today one of Africa’s most promising health systems. The study employed structured interviews to gather data from 779 rural and urban adults using a multistage cluster sampling approach. Health literacy, and health insurance subscription were found to be inversely associated with poor health-related quality of life (HRQoL). Access to healthcare did not predict HRQoL. However, the interaction between access to healthcare and health literacy produced a negative effect on poor HRQoL. The interaction between health literacy and health insurance subscription also showed a similar effect on HRQoL. Simple slope analysis depicted that access to healthcare and health insurance subscription related positively to HRQoL only when health literacy was high. The paper argues that where health literacy is low, even favourable policies for UHC are likely to miss set targets. While not losing sight of relevant sociocultural elements, enhancing health literacy should be a central strategy for policies aimed at bridging health inequalities and improving UHC.