Access to and Utilisation of Primary Healthcare Services among North-South Migrants in Kumasi, Ghana: A Cross-Sectional Mixed-Methods Study

Health is not just about having a hospital nearby; it is about whether a person can actually walk through the door and receive care. For people who move from one place to another within their own country, this gap between having a service available and using it can be wide and difficult to cross. In Ghana, thousands of people leave the poorer northern regions to find work in the bustling cities of the south, such as Kumasi. These migrants often face a unique set of challenges: they may work in unstable jobs, live in crowded conditions, and struggle to afford basic needs. While the government provides a national health insurance scheme intended to make care affordable, many migrants find that the system does not cover them fully or that the costs remain too high. Understanding why these individuals, who are physically close to medical help, often do not seek it is crucial for improving the health of the entire population.

A team of researchers from the Kwame Nkrumah University of Science and Technology set out to investigate this exact puzzle in Kumasi. They focused on migrants who had traveled from the northern parts of Ghana to work in the city's major markets. The researchers wanted to know two things: how easy it was for these migrants to reach a health facility, and what factors actually stopped them from going when they were sick. To get a complete picture, they did not just count heads or ask simple questions. They combined a large survey of nearly four hundred migrants with in-depth conversations and group discussions. This approach allowed them to see the numbers behind the trends while also hearing the personal stories of the people living through these challenges.

The study began by mapping the physical reality of the migrants' lives. The results were clear and somewhat surprising: the migrants were not far from help. On average, they reported that a health facility was close to where they lived, that transportation was available, and that they could reach a clinic within thirty minutes. In fact, the data showed that the physical distance to a hospital or pharmacy was not the main problem. The barriers were hidden in the details of daily life. When the researchers asked about the cost of care, the answers told a different story. Many migrants said they could not afford the fees, even with insurance. They expressed frustration that their national health insurance cards did not cover the specific services they needed, leaving them to pay out of pocket for things as simple as basic painkillers.

Beyond money, the researchers found that the way people were treated and the time they had to wait played a huge role. Many migrants felt that healthcare workers did not understand their language or cultural background, making them feel uncomfortable or even discriminated against. Long waiting times were another major deterrent. For a migrant working in a market, spending hours in a queue meant losing a day's wages, a cost they could not afford. Consequently, even when they were sick, many chose not to go to a hospital. Instead, they turned to pharmacies to buy medicine directly or relied on traditional herbal healers and faith healers who were more accessible and less expensive.

The study also revealed how personal circumstances shaped these choices. The researchers found that gender made a significant difference; women in the study were less likely to visit a hospital than men, likely due to specific economic and social pressures they faced. Being married, however, seemed to help. Married migrants were more likely to use hospital services, suggesting that having a spouse provided a support network and shared resources that made seeking care easier. The type of job a person held also mattered. Those with more stable employment were better able to afford and access formal healthcare. Interestingly, the length of time a person had lived in Kumasi did not automatically lead to better hospital use. Even those who had been in the city for many years still faced the same structural barriers, though they were more likely to rely on pharmacies and over-the-counter medicines as they settled in.

These findings challenge the simple idea that building more clinics will solve the problem of poor health among migrants. The researchers concluded that while the buildings are there, the system surrounding them is broken for this specific group. The physical access is high, but the financial, cultural, and time-related costs are too high for many to pay. The study suggests that to fix this, policymakers need to look beyond geography. They need to reform health insurance to actually cover the services migrants need, reduce waiting times, and train staff to be more culturally sensitive. Without addressing these deeper issues, the gap between having a hospital nearby and getting the care one needs will remain, leaving a vulnerable population at risk.