| Popis: |
Rapid ageing of populations globally following reductions in fertility and mortality rates has become one of the most significant demographic features in recent decades. As a low- and middle-income country, Ghana has one of the largest and fastest growing older populations in sub-Saharan Africa, where ageing often occurs ahead of socioeconomic development and provision of health and social care services. Older persons in these contexts often face greater health challenges and various life circumstances including role loss, retirement, irregular incomes and widowhood, which can increase their demand for both formal and informal support. This thesis addresses the effects of the socio-political structure, informal social support and micro-level factors on health and health-seeking behaviour among community-dwelling older persons in Ghana. The theoretical perspectives draw on political economy of ageing, social convoy theory and Andersen5s behavioural model. Using multi-stage stratified cluster cross-sectional survey data of older cohorts (N= 1,200) aged 50 years and older, multivariate generalised Poisson and logit regression models estimated the associations among variables and interaction terms. Although Ghana’s national health insurance scheme (NHIS) enrollment was significantly associated with increased log count of healthcare use (β = 0.237), the relationship was largely a function of health status. Moreover, the NHIS was related with improved time from onset of illness to healthcare use (β = 1.347). However, even with NHIS enrollment, the intermediate (OR = 1.468) and richer groups (OR = 2.149) had higher odds of seeking healthcare compared with the poor. In addition, features of meaningful informal social support including contacts with family and friends, social participation and remittances significantly improved psychological wellbeing and health services utilisation. Somewhat counter-intuitively, spousal cohabitation was associated with decreased health services use (OR = 0.999). Whilst self-rated health revealed a strong positive association with functional status of older persons (fair SRH: β = 1.346; poor SRH: β = 2.422), the relationship differed by gender and also was moderated by marital status for women but not men. The employed and urban residents somewhat surprisingly had lower odds of formal healthcare use. The findings support the hypotheses that interactive impacts of aspects of structural and functional social support and removal of catastrophic healthcare costs are particularly important in older persons’ psychological health and health service utilisation. Nevertheless, Ghana’s NHIS currently apparently lacks the capacity to improve equitable attendance at health facility between poor and non-poor. In contributing to the public health and social policy discourse, this study proposes that, whilst policies to ensure improved health status of older people are recommended, multidimensional social support and NHIS policy should be properly resourced and strengthened so they may act as critical tools for improving health and health services utilization of this marginalized and vulnerable older people in Ghana. Moreover, policies targeting and addressing economic empowerment including universal social pensions and welfare payments should be initiated and maintained to complement the NHIS for older people. The achievement of age-relevant policies and Universal Health Coverage (UCH) as advocated by WHO could be enhanced by adopting some of these suggestions. |
