Social capital, health literacy, and access to healthcare : a study among rural and urban populations in Ghana

Student thesis: PhD Thesis (Lingnan)


There is ample evidence supporting the association between social networks, and health and well-being. However, existing research and policies to address health-related inequalities in Ghana, have largely neglected this critical nexus. To address the knowledge gap, this study uses the concept of social capital (social relationships and the resources embedded in them) to investigate how and to what extent social relationships influence healthcare access and health literacy among selected rural and urban people. The study also examines how the stock of social capital, and the forms it takes, can influence implementation, and sustenance of local level pro-poor health policies. One such policy in Ghana is the Community-based Health Planning and Services (CHPS). The CHPS is an initiative that aims to reduce healthcare barriers for people in deprived and remote areas. Compared to other countries in the sub-region, Ghana is one of the most politically stable and fastest developing, socioeconomically. However, major health goals are yet to be realised owing to numerous systematic bottlenecks.

The study adopts a variety of methods including a cross-sectional survey of 779 individuals; 95 in-depth interviews with rural and urban residents as well as health personnel, community leaders, and six focus group sessions to offer a thorough understanding of the problem. The sample was drawn from eight rural and 36 urban communities/suburbs found in five districts in the Ashanti region. This region has a diverse population profile, which is analogous to that of the country as whole due to its nodal location.

The results showed that social capital functions differently across the two population groups regarding its effects on healthcare access and health literacy. While high level of social capital had positive effects on health and well-being in some instances, it demonstrated negative consequences in other circumstances, leading to different levels of health and well-being among rural and urban people. Surprisingly, low degrees of social capital was sometimes better for health and well-being than high levels. Also, the properties and magnitude of different social capital proxies provided an important explanation for why the CHPS policy was fatally troubled in some localities while succeeding in others according to the study’s findings. These findings situate social capital as a vital component, not only at the policy initiation phase, but also in implementation, and in sustaining pro-poor health policies. The study establishes social capital as a “double-edged” determinant of health and well-being. Instead of being an unequivocally positive factor, as some studies suggest, its effects can be ambiguous. It shapes health by itself and in how health literacy and access to healthcare affect health and well-being particularly among rural people. To address health-related inequalities and consequently, disparities in health and well-being by using social capital as a resource, stronger relationships should be forged between social institutions and the populace Moreover, to strengthen social capital while curbing its adverse effects, pertinent social divisions such as rural and urban disparities must be probed. The study thus makes a significant contribution to the literature on social and public health. It postulates that social capital, while not a panacea, should be adopted strategically to improve health and strengthen health services in low-income countries.
Date of Award1 Sept 2017
Original languageEnglish
Awarding Institution
  • Lingnan University
SupervisorDavid Rosser PHILLIPS (Supervisor) & Roman DAVID (Supervisor)

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