Socioeconomic Determinants and Barriers to Accessing Newly Commissioned District Hospitals in Ghana’s Ashanti Region: An Accessibility Dimensions Perspective

Socioeconomic Determinants and Barriers to Accessing Newly Commissioned District Hospitals in Ghana’s Ashanti Region: An Accessibility Dimensions Perspective | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Socioeconomic Determinants and Barriers to Accessing Newly Commissioned District Hospitals in Ghana’s Ashanti Region: An Accessibility Dimensions Perspective Felix Frimpong, Charles Peprah, Ebenezer Owusu-Addo, Ebenezer Essaw, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7503566/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Access to healthcare is a multidimensional concept encompassing not only the individuals' ability to seek, access, afford, and utilise care. In Ghana, the commissioning of new district hospitals under the “Agenda 111” initiative marks a major step toward Universal Health Coverage (UHC). However, evidence on whether such infrastructure investments translate into equitable access remains limited. This study examined socioeconomic determinants and systemic barriers to accessing three newly commissioned district hospitals in the Ashanti Region, applying Penchansky and Thomas’s five dimensions of accessibility. A convergent mixed-methods design combined quantitative survey data from 1,192 healthcare seekers with qualitative insights from 15 key informants. Findings revealed that gender, age, education, employment status, income, and residential location significantly influenced access (p < 0.001). Respondents highlighted affordability as the most critical barrier, with many disagreeing that they had reliable means of payment (M = 1.84) or that healthcare costs were reasonable (M = 2.20). Despite widespread health insurance coverage, financial difficulties (M = 3.23) and lack of insurance (M = 3.23) continued to limit access, particularly in Bekwai District Hospital, which consistently recorded the lowest scores across accessibility dimensions. Strong intercorrelations between availability, accommodation, and acceptability underscored the interconnected nature of access challenges. Policy recommendations include expanding health insurance coverage, reducing out-of-pocket payments, strengthening staffing and diagnostics, improving transport infrastructure, and promoting culturally competent care. These findings highlight that infrastructure expansion alone is insufficient for achieving UHC and that multidimensional, equity-focused strategies are essential both in Ghana and in other low and middle-income countries (LMICs) undertaking similar health system investments. Healthcare access socioeconomic determinants district hospitals affordability Ghana Ashanti Region equity accessibility dimensions Figures Figure 1 Introduction Healthcare access is a fundamental human right and a core pillar of the Sustainable Development Goals (SDG 3.8), which commit countries to achieving Universal Health Coverage (UHC) through equitable, affordable, and quality care for all (WHO, 2021 ). While global health systems have made notable progress, disparities in access persist, especially in low and middle-income countries (LMICs) where socioeconomic inequities and systemic barriers limit service use (Kruk et al., 2018 ). In such settings, accessibility is shaped by a complex interplay of service availability, geographical reach, affordability, organizational responsiveness, and cultural acceptability (Penchansky & Thomas, 1981 ). Infrastructure-led health reforms have emerged as a popular strategy to address service gaps, with examples ranging from Ethiopia’s Health Extension Program to Rwanda’s nationwide hospital expansion (Binagwaho et al., 2014 ; Assefa et al., 2019 ). Ghana’s “Agenda 111” initiative follows a similar approach, commissioning new district hospitals to bridge geographical and infrastructural divides, particularly in underserved areas (Kolbila, 2019 ). The Ashanti Region, Ghana’s most populous and socioeconomically diverse region, offers a critical testing ground for evaluating whether such investments reduce inequities in healthcare access. However, physical infrastructure alone does not guarantee equitable service utilization. Evidence from LMICs suggests that without simultaneous improvements in financing, workforce distribution, supply chain systems, and culturally sensitive care, new facilities may remain underutilized or exacerbate inequalities (O’Donnell et al., 2008 ; Lagomarsino et al., 2012 ). Moreover, access barriers are often multidimensional and interrelated; a single constraint, such as high out-of-pocket payments, can undermine gains in other areas. This study applies the five-dimensional accessibility framework to examine how socioeconomic determinants influence access to newly commissioned district hospitals in Ghana’s Ashanti Region. By integrating quantitative and qualitative evidence, it provides multifaceted insights into the real-world performance of infrastructure-led health expansion strategies, with lessons relevant not only to Ghana but also to other LMICs pursuing UHC through health facility construction. Methodology Study Setting The study was conducted in three districts within the Ashanti Region of Ghana, where newly commissioned district hospitals have been established: Bekwai, Asante Akim Central, and Ahafo Ano North. These districts were purposively selected due to their geographic spread, demographic diversity, and recent inclusion in Ghana’s health infrastructure expansion program. The Ashanti Region is a strategically important area for examining healthcare access, given its mix of urban and rural populations and its significant role in Ghana’s health system decentralization agenda. Study Design This study adopted a convergent parallel mixed-methods design to obtain a comprehensive understanding of the socioeconomic factors and barriers influencing access to newly commissioned district hospitals. The mixed-methods approach enabled the collection and integration of both quantitative and qualitative data, allowing for integration of findings and deeper insight into contextual and individual-level access issues. This approach was deemed appropriate given the multidimensional nature of healthcare access and the need to explore both measurable patterns and lived experiences. Study Population The study population comprised two main groups: (1) adult healthcare seekers aged 18 years and above who had accessed services at the selected district hospitals within the last 12 months and (2) key institutional stakeholders, including hospital administrators, district health management teams, and traditional leaders. Sampling Procedure A multistage sampling technique was employed for the quantitative component. First, sub-districts within each district were stratified into urban, peri-urban, and rural categories. From each stratum, communities were randomly selected, followed by systematic sampling of households. Within each household, one eligible adult who had used the district hospital services was randomly selected for participation. The final sample size for the quantitative survey (n = 1,192) was determined using Cochran’s formula for cross-sectional surveys, assuming a 95% confidence level, a 5% margin of error, and an anticipated access prevalence of 50% to maximize sample size, with adjustments for a design effect of 2.0 and an anticipated non-response rate of 10%. For the qualitative component, purposive sampling was used to recruit 15 key informants. These included hospital managers, district health officers, community health nurses, assembly members, and opinion leaders. The selection was guided by their roles in health service delivery and their knowledge of the accessibility challenges faced by community members. Data Collection Instruments and Techniques Quantitative data were collected using a structured, pre-tested questionnaire. The tool consisted of questions formulated entirely by the study investigators based on the five dimensions of healthcare access described by Penchansky and Thomas ( 1981 ): availability, geographical accessibility, affordability, accommodation, and acceptability. The questionnaire collected socio-demographic information and included closed-ended items assessing respondents’ experiences and perceptions of access barriers. The qualitative data were collected using a semi-structured interview guide. Questions were designed to probe participants’ perspectives on the accessibility of newly commissioned hospitals, with attention to systemic, cultural, and infrastructural barriers. Interviews were conducted in either English or Twi, depending on participant preference, and were audio-recorded with consent. Each interview lasted between 30 and 60 minutes. Data Analysis Quantitative data were cleaned, coded, and analyzed using SPSS version 25. Descriptive statistics such as frequencies, percentages, and means were used to summarize participants’ characteristics and responses. Inferential statistics, including chi-square tests and Spearman correlation coefficients, were applied to examine the relationships between socioeconomic variables (such as education, income, gender, employment, and residence) and access to healthcare services. Qualitative data were transcribed verbatim and analyzed thematically using NVivo software. A coding framework was developed based on Penchansky and Thomas’s five dimensions of access. Thematic analysis allowed for the identification of recurring patterns and context-specific barriers. The findings from both datasets were compared and integrated during the interpretation phase to ensure complementarity and to enhance the validity of conclusions. Ethical Considerations Ethical clearance for the study was obtained from the Committee on Human Research, Publications and Ethics at the Kwame Nkrumah University of Science and Technology (CHRPE/AP/367/22). Written informed consent was obtained from all participants before their involvement in the study. Participants were informed of their right to withdraw at any point without consequence. Data confidentiality and anonymity were assured throughout the research process, and all records were securely stored and accessed only by the research team. RESULTS Socio-demographic characteristics of respondents Table 1 presents the socio-demographic profile of the 1,192 respondents who participated in the study across three districts: Ahafo Ano North (33.3%), Asante Akim Central (33.3%), and Bekwai (33.4%). Slightly more respondents resided in rural communities (53.6%) compared to urban areas (46.4%). The gender distribution was relatively balanced, with females constituting 51.1% and males 48.9%. In terms of age, the largest group fell within the 20 to 29 years range (35.2%), followed by 30 to 39 years (23.9%), while those aged 60 years and above represented only 4.4% of the sample. Educational attainment varied, with 38.6% having tertiary education, 29.4% senior high education, and 11.2% with no formal education. Employment status data showed that nearly two-thirds (63.5%) were employed, while 36.5% were unemployed. Annual household income was generally low, with over half (57.3%) earning less than GHS 5,000, and only 3.1% earning above GHS 30,000. This demographic distribution highlights a predominantly rural, relatively young, and modest-income population, with a considerable proportion attaining at least secondary education. Socio-demographic characteristics and accessibility to healthcare Table 2 presents the socio-demographic factors associated with accessibility to healthcare among respondents. Significant gender differences were observed (p = 0.003), with females (52.0%) reporting higher accessibility than males (48.0%). Age was also significant (p < 0.001), with the majority aged 20–29 years (35.2%), followed by 30–39 years (23.9%). Educational status showed strong significance (p < 0.001), as most respondents had a tertiary (38.6%) or senior high school education (29.4%). Employment status was a significant factor (p < 0.001), with 63.5% of participants employed and 36.5% unemployed. Accessibility varied significantly by district (p < 0.001), with near-equal distributions across Ahafo Ano North (33.3%), Asante Akim Central (33.3%), and Bekwai (33.4%). The type of residence was also significant (p < 0.001), with most respondents living in rural areas (53.6%), followed by urban areas (39.9%), and peri-urban areas (6.5%). Household income demonstrated strong associations (p < 0.001), with the majority earning below GHS 5,000 annually (57.3%). Socioeconomic factors influencing accessibility to healthcare Table 3 presents respondents’ views on the socioeconomic factors shaping healthcare accessibility. Using a 3.0 mean threshold, findings show that respondents disagreed with having reliable means of payment (M = 1.84) and with the reasonableness of healthcare costs (M = 2.20). They agreed, however, that financial status influences care-seeking decisions (M = 3.40) and that health insurance helps reduce financial burdens (M = 3.50). Respondents further acknowledged the need for measures to make healthcare more affordable (M = 3.63) and agreed that lack of insurance (M = 3.23) and financial difficulties (M = 3.23) pose barriers. While some agreed that financial concerns deter care-seeking (M = 3.22), they disagreed that financial constraints had ever prevented them or their households from seeking care (M = 2.44). Overall, financial considerations, particularly affordability and insurance coverage, emerged as key determinants of healthcare access. Accessibility Dimension Framework for the Newly Commissioned District Hospitals in the Ashanti Region Table 4 presents the mean, mode, and median scores for each of the five dimensions of healthcare accessibility, which are geographical access, availability, acceptability, accommodation, and affordability across the three study districts: Ahafo Ano North, Asante Akim Central, and Bekwai. Each district accounted for approximately one-third of the respondents. For geographical access, Asante Akim Central recorded the highest mean score (3.76), followed by Ahafo Ano North (3.62) and Bekwai (3.25), indicating relatively better ease of reaching the facility in Asante Akim Central. In terms of availability of services, Ahafo Ano North (3.78) and Asante Akim Central (3.77) scored similarly and higher than Bekwai (3.18), suggesting more consistent staffing and resource presence in the first two districts. Acceptability scores were highest in Asante Akim Central (3.82), reflecting stronger cultural alignment and patient-provider rapport, while Bekwai had the lowest (3.15). For accommodation, which reflects organizational efficiency, Ahafo Ano North (3.78) and Asante Akim Central (3.81) again scored higher than Bekwai (3.19). Affordability had the lowest overall scores among the five dimensions, with Asante Akim Central (3.51) performing best, followed by Ahafo Ano North (3.21) and Bekwai (2.98), indicating that financial constraints were a notable barrier, especially in Bekwai. Overall, Asante Akim Central consistently scored highest across most dimensions, suggesting comparatively better performance in accessibility, while Bekwai scored lowest across all dimensions, highlighting more significant access challenges. Accessibility Dimension Scores for Newly Commissioned District Hospitals Figure 1 illustrates the mean scores for five dimensions of healthcare accessibility, which are geographical access, availability, acceptability, accommodation, and affordability across three newly commissioned district hospitals in the Ashanti Region: Ahafo Ano North, Asante Akim Central, and Bekwai. A target benchmark score of 3.0 is indicated by a horizontal yellow line. Across all dimensions, Asante Akim Central consistently recorded the highest scores, ranging from approximately 3.51 in affordability to 3.82 in acceptability. Ahafo Ano North generally ranked second, with mean scores between 3.21 in affordability and 3.78 in availability and accommodation. Bekwai recorded the lowest mean scores in all dimensions, with the most pronounced gap in availability (3.18) and affordability (2.98). All districts scored above the target line in most dimensions, except Bekwai in affordability, which fell slightly below the target, indicating affordability challenges. The performance pattern suggests that while all hospitals meet or exceed the basic accessibility threshold, notable disparities exist, especially in the Bekwai District Hospital. Affordability as a Barrier to Healthcare Access in the Newly Commissioned District Hospitals in Ashanti Region Table 5 presents the mean, median, and mode scores for variables measuring affordability as a barrier to healthcare access across Ahafo Ano North, Asante Akim Central, and Bekwai district hospitals. The results are based on responses to items assessing payment modes, financial considerations before seeking care, health insurance coverage, perceptions of cost, and the impact of financial constraints on healthcare-seeking behaviour. Across all districts, the mode of payment for services was predominantly through the National Health Insurance Scheme (NHIS), as reflected by a uniform score of 2 for all three districts. In terms of considering financial situation before seeking care, Asante Akim Central scored highest (mean 4), indicating stronger agreement, while Ahafo Ano North (mean 3) and Bekwai (mean 3) reflected more neutral responses. For health insurance coverage as a means of reducing financial burden, Ahafo Ano North and Asante Akim Central both scored a mean of 4, suggesting adequate insurance support, whereas Bekwai scored lower at 3. Similar patterns were observed for the perception that district hospitals should implement measures to make healthcare more affordable, with higher agreement in Ahafo Ano North and Asante Akim Central (mean 4) compared to Bekwai (mean 3). Responses to experiencing financial difficulties in paying for healthcare services were relatively consistent across districts, with means ranging from 3 to 3, indicating occasional financial strain. On the perception of whether the cost of services is reasonable, Asante Akim Central scored the highest (mean 4), followed by Ahafo Ano North (mean 3) and Bekwai (mean 3). When asked whether financial concerns had deterred them from seeking healthcare in the past, Asante Akim Central respondents showed stronger disagreement (mean 4) compared to Ahafo Ano North (mean 3) and Bekwai (mean 3). Similarly, Asante Akim Central respondents rated the overall cost of healthcare more favorably (mean 4) than the other two districts (both mean 3). For the item on financial constraints deterring households from seeking healthcare, Bekwai and Ahafo Ano North both had lower mean scores (2), suggesting a moderate impact, whereas Asante Akim Central scored 2, indicating a lesser perceived impact. Spearman Correlation of Accessibility Dimensions to Healthcare in the Newly Commissioned District Hospitals Table 6 presents the Spearman correlation coefficients between the five dimensions of healthcare accessibility, which are geographical access, availability, acceptability, accommodation, and affordability, based on responses from 1,192 participants. All correlations are statistically significant at the 0.01 level (p < 0.01), indicating strong interrelationships between the accessibility dimensions. The strongest correlation was observed between acceptability and accommodation (r = 0.745), suggesting that improvements in how services are organized and delivered are closely linked to patients’ perceptions of cultural and interpersonal acceptability of care. Availability also showed a strong correlation with accommodation (r = 0.687) and acceptability (r = 0.680), implying that when services and resources are consistently available, organizational efficiency and patient satisfaction tend to improve. Geographical access was most strongly correlated with availability (r = 0.674) and acceptability (r = 0.637), reflecting that shorter travel distances and easier physical access to facilities are often associated with better service provision and more culturally acceptable care. Affordability demonstrated the weakest correlations overall, with its highest association being with acceptability (r = 0.508). This suggests that while financial considerations are important, they may influence perceptions of other dimensions to a lesser extent compared to the interplay among the non-financial dimensions. Discussion This study assessed how socioeconomic factors and multidimensional barriers influence access to newly commissioned district hospitals in the Ashanti Region of Ghana. Using the accessibility framework proposed by Penchansky and Thomas, the findings reveal that infrastructure development, while necessary, is not sufficient to ensure equitable access to health services. Instead, access is determined by a complex interaction of socioeconomic characteristics and structural challenges that either enable or restrict the ability of individuals to use available health services. Socioeconomic Determinants of Access Socioeconomic disparities continue to significantly influence healthcare access. This is particularly evident in countries with constrained health systems and unequal resource distribution, such as Ghana. In this study, gender, age, education, employment status, income, and place of residence were all found to affect healthcare utilization. These results are consistent with previous research indicating that both personal and contextual factors contribute to disparities in healthcare use (O’Donnell et al., 2008 ; Giedion et al., 2013 ). Gender was an important determinant, with female respondents reporting higher service utilization. This supports prior findings that women are generally more engaged with health systems, largely due to maternal responsibilities and their traditional role as caregivers within households (Buor, 2003 ; Awumbila, 2016 ). However, some women expressed discomfort when care was provided by male health workers during sensitive procedures. This highlights the importance of culturally sensitive and gender-responsive healthcare delivery (Chiarenza et al., 2019 ; Essien et al., 2021 ). Age was positively associated with healthcare use. Older adults, especially those aged 60 and above, reported more frequent visits due to the increasing burden of noncommunicable and age-related diseases. This finding aligns with research emphasizing the importance of age-friendly services in strengthening primary healthcare delivery for aging populations (WHO, 2021 ; HelpAge International, 2019 ). Education emerged as a key enabler. Participants with tertiary education levels were more likely to access care because they understood the structure of the health system, were aware of their rights, and could more easily enroll in and use health insurance. These findings support evidence that health literacy and formal education improve service uptake and navigation of complex care environments (Nutbeam, 2008 ; Osborn et al., 2011 ). Employment and income also significantly influenced healthcare access. Employed individuals had more financial flexibility to seek care. In contrast, unemployed and low-income respondents frequently postponed care due to high out-of-pocket expenses. Despite being enrolled in the National Health Insurance Scheme, many respondents still paid for laboratory tests, medications, and imaging services. These results align with previous studies that argue the National Health Insurance Scheme does not fully protect the poor from financial hardship (Amporfu, 2013 ; Blanchet et al., 2012 ). Residential location created another access barrier. Respondents living in urban areas had better access than those in rural and peri-urban communities. The urban advantage was largely due to shorter distances, better roads, and greater access to transportation. Similar geographic disparities have been documented in earlier research, where rural residents had lower rates of health service utilization and longer travel times to reach care facilities (Agbenyo et al., 2017 ; Dotse-Gborgbortsi et al., 2023 ). Multidimensional Barriers to Access The application of the five dimensions of access (availability, geographical accessibility, affordability, accommodation, and acceptability) enabled a deeper understanding of the challenges faced by healthcare seekers. Availability was uneven across the study sites. Although all three hospitals were newly constructed, some lacked sufficient personnel and essential diagnostic services. Bekwai District Hospital reported the greatest shortages, which discouraged patients from utilizing the facility and led to referrals elsewhere. This observation confirms that infrastructure must be accompanied by investment in human resources and supply chains to deliver meaningful access (Kruk et al., 2018 ). Geographical accessibility was a notable constraint, particularly in rural and hard-to-reach communities. Long distances, poor roads, and limited public transport options made it difficult for residents to access care, especially during emergencies. Respondents from Asante Akim Central reported the shortest travel times, while those in Bekwai experienced significant transport challenges. These findings are consistent with spatial accessibility studies in sub-Saharan Africa that show distance and travel time are strong predictors of healthcare use (Noor et al., 2006 ; Nesbitt et al., 2014 ). Affordability emerged as the most pressing concern among all five dimensions. Although over 80% of respondents were enrolled in the National Health Insurance Scheme, many continued to pay for services that were not covered, including diagnostics, medications, and specialist consultations. These financial burdens were especially acute among low-income households. Similar issues have been documented in other parts of Ghana, where the scheme is criticized for limited coverage and poor protection for vulnerable populations (Witter & Garshong, 2009 ; Lagomarsino et al., 2012 ). Accommodation challenges affected service efficiency. Respondents frequently complained about long waiting times, lack of appointment systems, and limited consultation hours. Many patients preferred walk-in visits due to difficulties in securing scheduled appointments, which contributed to congestion and dissatisfaction. This aligns with previous research that highlights the impact of organizational efficiency on patients’ willingness to return for care (Darzi, 2008 ). Acceptability issues were also significant. Patients from minority language groups faced communication barriers. Others cited disrespectful staff attitudes and discomfort with provider gender. These experiences affected patient satisfaction and reduced trust in the health system. The importance of respectful and culturally competent care has been well documented in the literature, showing that acceptability influences not only first-time use but also continuity of care (Betancourt et al., 2003 ; Saha et al., 2008 ). Interconnectedness of Access Dimensions A key finding of the study is that the five dimensions of access are interrelated. Statistical analysis showed strong correlations between availability and accommodation, as well as between affordability and both accessibility and acceptability. This suggests that a single barrier can impact multiple domains of access. For example, a shortage of healthcare staff (availability) can result in longer wait times (accommodation) and reduce patient satisfaction (acceptability). These findings support the growing view that health system challenges must be addressed through integrated and holistic interventions (Kruk et al., 2018 ). Limitations of the Study. This study has some limitations that should be acknowledged. First, the cross-sectional design limits causal inferences regarding the relationship between socioeconomic determinants and healthcare access. Second, while the study covered three newly commissioned district hospitals, findings may not be generalizable to all hospitals under Ghana’s “Agenda 111” initiative or to other regions with different socioeconomic and cultural contexts. Additionally, the reliance on self-reported data for the quantitative survey may have introduced recall and social desirability bias, particularly in responses related to healthcare-seeking behavior and affordability. Finally, the qualitative component included only 15 key informants, which, although sufficient for thematic saturation, may not fully capture the diversity of stakeholder perspectives. Conclusion Ghana’s investment in new district hospitals under the “Agenda 111” initiative represents a major step toward expanding healthcare infrastructure. However, this study demonstrates that socioeconomic inequities and multidimensional barriers, particularly affordability, continue to limit equitable access. Gender, education, income, and place of residence remain significant determinants of service use, with Bekwai District Hospital exhibiting the greatest access gaps. The strong correlations between access dimensions highlight that addressing one barrier in isolation is insufficient; instead, holistic, integrated strategies are required. These findings have broad implications for LMICs adopting infrastructure-led approaches to UHC. Investments must be accompanied by policies that strengthen financing, workforce distribution, service readiness, transport infrastructure, and cultural acceptability. Ghana’s experience underscores the need for continuous monitoring of access dimensions to ensure that infrastructure expansion translates into genuine, equitable, and sustainable improvements in health service utilization. By embedding these strategies within global health policy frameworks, countries can accelerate progress toward UHC while ensuring no one is left behind. Abbreviations UHC: Universal Health Coverage LMICs; Low and Middle-Income Countries SDGs: Sustainable Development Goals WHO: World Health Organization Declarations Ethics approval and consent to participate The study adhered to the principles of informed, voluntary consent, confidentiality of information, and respondent anonymity. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (2013) and the guidelines of the General Research Ethics Board of the Kwame Nkrumah University of Science and Technology (KNUST). Ethical approval was obtained from the KNUST Humanities and Social Research Ethics Committee (Ref. No: HUSSREC/AP/30/Vol 3). Approval from the Department of Planning at KNUST permitted the conduct of surveys, interviews, participant observations, and secondary data collection. Before data collection, the purpose of the study was explained to participating agencies, institutions, and community study sites. The letters of approval endorsed by the University enhanced cooperation from key informants, particularly at the institutional level. All participants willingly agreed and individually signed an informed consent form to participate in the study without coercion and their identities were kept strictly confidential and untraceable by third parties. Consent for publication Management of the facilities and the study participants consented to the dissemination of the study findings, including the article publication, as part of the study approval protocol. Availability of data and material The instruments used and the primary data collected are available and will be shared upon request. Competing interests The authors declare that they have no competing interests in all aspects of the study. Funding The study did not receive any external funding. It was a self-funded study. Author’s Contributions Conceptualization (F.F., C.P., and E.O-A.), Data collection (F.F., and C.P.), Data Analysis (F.F.) Writing – original draft (F.F., C.P., E.O-A., E.E., and H.A.A.), Methods (F.F., C.P., and E.O-A.), Writing – review and editing (F.F., C.P., E.O-A., E.E., and H.A.A.) References Agbenyo, F., Marshall, N., & Akwasi, K. (2017). Accessibility mapping of health facilities in rural Ghana. 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Tables Table 1: Socio-demographic characteristics of respondents Variables Characteristics Frequency Percent District Ahafo Ano North 397 33.3 Asante Akim Central 397 33.3 Bekwai 398 33.4 Type of community Urban 553 46.4 Rural 639 53.6 Sex of Respondent Male 583 48.9 Female 609 51.1 Age(yrs) < 20 168 14.1 20-29 420 35.2 30-39 285 23.9 40-49 164 13.8 50-59 103 8.6 60+ 52 4.4 Educational Level No formal education 133 11.2 Primary 72 6 Junior High 177 14.8 Senior High 350 29.4 Tertiary 460 38.6 Employment Status Unemployed 435 36.5 Employed 757 63.5 Annual household income < 5,000 683 57.3 5,100 - 10,000 261 21.9 10,001 - 20,000 111 9.3 20,001 - 30,000 100 8.4 More than 30,000 37 3.1 Total 1,192 100 Table 2: Socio-demographic characteristics and accessibility to healthcare VARIABLE ACCESSIBILITY TO HEALTHCARE P- VALUE SEX FREQUENCY PERCENTAGE Female 620 52.01 0.003 Male 572 47.99 AGE < 20 168 14.09 0.000 20-29 420 35.23 30-39 285 23.91 40-49 164 13.76 50-59 103 8.64 60+ 52 4.36 EDUCATIONAL STATUS No formal education 133 11.16 0.000 Primary 72 6.04 Junior High 177 14.85 Senior High 350 29.36 Tertiary 460 38.59 EMPLOYMENT Unemployed 435 36.49 0.000 Employed 757 63.51 DISTRICTS Ahafo Ano north 397 33.31 0.000 Asante Akim Central 397 33.31 Bekwai 398 33.39 TYPE OF RESIDENCE Urban 476 39.93 0.000 Peri-urban 77 6.46 Rural 639 53.61 HOUSEHOLD INCOME 30,000 37 3.10 TOTAL 1,192 100 Table 3: Socioeconomic factors influencing accessibility to healthcare S/N STATEMENT MEAN SD DECISION 1. I have the means of payment for the services I receive at the facility. 1.84 0.365 Disagreed 2. I consider my financial status before deciding to seek healthcare services 3.40 0.857 Agreed 3. I have health insurance coverage that helps alleviate my financial burden 3.50 0.819 Agreed 4. I believe the district hospital should implement measures to make healthcare services more affordable 3.63 0.773 Agreed 5. Not having health insurance has been a barrier to accessing healthcare services 3.23 0.923 Agreed 6. I experience financial difficulties in accessing healthcare services 3.23 0.941 Agreed 7. The cost of seeking healthcare services is reasonable. 2.20 0.934 Agreed 8. Financial concerns deterred me from seeking healthcare services. 3.22 0.923 Agreed 9. Financial constraints have ever deterred me and my household members from seeking healthcare services. 2.44 1.085 Disagreed Table 4: Accessibility Dimension Framework for the Newly Commissioned District Hospitals in the Ashanti Region. Dimension District Ahafo Ano North Asante Akim Central Bekwai Geographical access Mean 3.62 3.76 3.25 Row N % 33.3% 33.3% 33.4% Mode 3.75 4.00 3.19 Median 3.63 3.88 3.19 Availability Mean 3.78 3.77 3.18 Row N % 33.3% 33.3% 33.4% Mode 4.00 4.00 3.00 Median 3.87 3.93 3.00 Acceptability Mean 3.57 3.82 3.15 Row N % 33.3% 33.3% 33.4% Mode 3.64 4.00 3.00 Median 3.64 4.00 3.00 Accommodation Mean 3.78 3.81 3.19 Row N % 33.3% 33.3% 33.4% Mode 3.93 3.93 3.00 Median 3.93 3.93 3.07 Affordability Mean 3.21 3.51 2.98 Row N % 33.3% 33.3% 33.4% Mode 3.38 3.63 2.88 Median 3.25 3.63 2.88 Table 5: Affordability as a barrier to healthcare access in the newly commissioned district hospitals in Ashanti Region Affordability Variables Ahafo Ano North Asante Akim Central Bekwai Scale of measure Mean Median Mode Mean Median Mode Mean Median Mode What was your mode of payment for the services 2 2 2 2 2 2 2 2 2 1 = "Out of Pocked Payment", 2 = "NHIS" Do you consider your financial situation before deciding to seek healthcare services at the district hospital? 3 4 4 4 4 4 3 3 3 1="Strongly Disagree" 2 ="Disagree" 3 = "Neutral" 4 = "Agree" 5 = "Strongly Agree" Do you have health insurance coverage that helps alleviate the financial burden of healthcare services at the district hospital? 4 4 4 4 4 4 3 3 3 I believe the district hospital should implement measures to make healthcare services more affordable for the community. 4 4 4 4 4 4 3 3 3 Did you experienced financial difficulties in paying for healthcare services at the newly commissioned district hospital? 3 3 2 3 3 3 3 3 3 The cost of healthcare services at the new district hospital is reasonable. 3 2 2 4 4 4 3 3 3 Financial concerns deterred you from seeking healthcare services at the district hospital in the past? 3 3 2 4 4 4 3 3 3 How would you describe the cost of seeking healthcare services at the new district hospital? 3 3 3 4 4 4 3 3 3 Financial constraints have deterred you and your household members from seeking healthcare services at the new district hospital? 3 3 4 2 2 1 2 2 2 1 = "To a Great Extent" 2 = "Somewhat" 3 = "Very Little" 4 = "Not at all" Table 6: Spearman correlation of accessibility dimension to healthcare in the new District hospitals Correlations Geographical access Availability Acceptability Accommodation Affordability Spearman's rho Geographical access Correlation Coefficient 1.000 .674 ** .637 ** .596 ** .436 ** Sig. (2-tailed) . .000 .000 .000 .000 N 1192 1192 1192 1192 1192 Availability Correlation Coefficient .674 ** 1.000 .680 ** .687 ** .427 ** Sig. (2-tailed) .000 . .000 .000 .000 N 1192 1192 1192 1192 1192 Acceptability Correlation Coefficient .637 ** .680 ** 1.000 .745 ** .508 ** Sig. (2-tailed) .000 .000 . .000 .000 N 1192 1192 1192 1192 1192 Accommodation Correlation Coefficient .596 ** .687 ** .745 ** 1.000 .476 ** Sig. (2-tailed) .000 .000 .000 . .000 N 1192 1192 1192 1192 1192 Affordability Correlation Coefficient .436 ** .427 ** .508 ** .476 ** 1.000 Sig. (2-tailed) .000 .000 .000 .000 . N 1192 1192 1192 1192 1192 Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":65648,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBarriers to Access to Healthcare Services\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7503566/v1/4c7600806bd35763f7733506.png"},{"id":94464365,"identity":"6a402eda-2322-4299-b660-cb132011c564","added_by":"auto","created_at":"2025-10-27 15:10:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1649292,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7503566/v1/d3c9fcdf-c2b1-4c05-96c9-9117ee01cc36.pdf"},{"id":94439420,"identity":"95c0690d-c247-49e2-9468-9bdd011e1016","added_by":"auto","created_at":"2025-10-27 14:22:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":198953,"visible":true,"origin":"","legend":"","description":"","filename":"Questionniare.docx","url":"https://assets-eu.researchsquare.com/files/rs-7503566/v1/f77f337bbb744d702185f4eb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Socioeconomic Determinants and Barriers to Accessing Newly Commissioned District Hospitals in Ghana’s Ashanti Region: An Accessibility Dimensions Perspective","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealthcare access is a fundamental human right and a core pillar of the Sustainable Development Goals (SDG 3.8), which commit countries to achieving Universal Health Coverage (UHC) through equitable, affordable, and quality care for all (WHO, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). While global health systems have made notable progress, disparities in access persist, especially in low and middle-income countries (LMICs) where socioeconomic inequities and systemic barriers limit service use (Kruk et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In such settings, accessibility is shaped by a complex interplay of service availability, geographical reach, affordability, organizational responsiveness, and cultural acceptability (Penchansky \u0026amp; Thomas, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1981\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eInfrastructure-led health reforms have emerged as a popular strategy to address service gaps, with examples ranging from Ethiopia\u0026rsquo;s Health Extension Program to Rwanda\u0026rsquo;s nationwide hospital expansion (Binagwaho et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Assefa et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Ghana\u0026rsquo;s \u0026ldquo;Agenda 111\u0026rdquo; initiative follows a similar approach, commissioning new district hospitals to bridge geographical and infrastructural divides, particularly in underserved areas (Kolbila, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The Ashanti Region, Ghana\u0026rsquo;s most populous and socioeconomically diverse region, offers a critical testing ground for evaluating whether such investments reduce inequities in healthcare access.\u003c/p\u003e\u003cp\u003eHowever, physical infrastructure alone does not guarantee equitable service utilization. Evidence from LMICs suggests that without simultaneous improvements in financing, workforce distribution, supply chain systems, and culturally sensitive care, new facilities may remain underutilized or exacerbate inequalities (O\u0026rsquo;Donnell et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Lagomarsino et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Moreover, access barriers are often multidimensional and interrelated; a single constraint, such as high out-of-pocket payments, can undermine gains in other areas.\u003c/p\u003e\u003cp\u003eThis study applies the five-dimensional accessibility framework to examine how socioeconomic determinants influence access to newly commissioned district hospitals in Ghana\u0026rsquo;s Ashanti Region. By integrating quantitative and qualitative evidence, it provides multifaceted insights into the real-world performance of infrastructure-led health expansion strategies, with lessons relevant not only to Ghana but also to other LMICs pursuing UHC through health facility construction.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Setting\u003c/h2\u003e\u003cp\u003eThe study was conducted in three districts within the Ashanti Region of Ghana, where newly commissioned district hospitals have been established: Bekwai, Asante Akim Central, and Ahafo Ano North. These districts were purposively selected due to their geographic spread, demographic diversity, and recent inclusion in Ghana\u0026rsquo;s health infrastructure expansion program. The Ashanti Region is a strategically important area for examining healthcare access, given its mix of urban and rural populations and its significant role in Ghana\u0026rsquo;s health system decentralization agenda.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThis study adopted a convergent parallel mixed-methods design to obtain a comprehensive understanding of the socioeconomic factors and barriers influencing access to newly commissioned district hospitals. The mixed-methods approach enabled the collection and integration of both quantitative and qualitative data, allowing for integration of findings and deeper insight into contextual and individual-level access issues. This approach was deemed appropriate given the multidimensional nature of healthcare access and the need to explore both measurable patterns and lived experiences.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study population comprised two main groups: (1) adult healthcare seekers aged 18 years and above who had accessed services at the selected district hospitals within the last 12 months and (2) key institutional stakeholders, including hospital administrators, district health management teams, and traditional leaders.\u003c/p\u003e\n\u003ch3\u003eSampling Procedure\u003c/h3\u003e\n\u003cp\u003eA multistage sampling technique was employed for the quantitative component. First, sub-districts within each district were stratified into urban, peri-urban, and rural categories. From each stratum, communities were randomly selected, followed by systematic sampling of households. Within each household, one eligible adult who had used the district hospital services was randomly selected for participation. The final sample size for the quantitative survey (n\u0026thinsp;=\u0026thinsp;1,192) was determined using Cochran\u0026rsquo;s formula for cross-sectional surveys, assuming a 95% confidence level, a 5% margin of error, and an anticipated access prevalence of 50% to maximize sample size, with adjustments for a design effect of 2.0 and an anticipated non-response rate of 10%.\u003c/p\u003e\u003cp\u003eFor the qualitative component, purposive sampling was used to recruit 15 key informants. These included hospital managers, district health officers, community health nurses, assembly members, and opinion leaders. The selection was guided by their roles in health service delivery and their knowledge of the accessibility challenges faced by community members.\u003c/p\u003e\n\u003ch3\u003eData Collection Instruments and Techniques\u003c/h3\u003e\n\u003cp\u003eQuantitative data were collected using a structured, pre-tested questionnaire. The tool consisted of questions formulated entirely by the study investigators based on the five dimensions of healthcare access described by Penchansky and Thomas (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1981\u003c/span\u003e): availability, geographical accessibility, affordability, accommodation, and acceptability. The questionnaire collected socio-demographic information and included closed-ended items assessing respondents\u0026rsquo; experiences and perceptions of access barriers.\u003c/p\u003e\u003cp\u003eThe qualitative data were collected using a semi-structured interview guide. Questions were designed to probe participants\u0026rsquo; perspectives on the accessibility of newly commissioned hospitals, with attention to systemic, cultural, and infrastructural barriers. Interviews were conducted in either English or Twi, depending on participant preference, and were audio-recorded with consent. Each interview lasted between 30 and 60 minutes.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eQuantitative data were cleaned, coded, and analyzed using SPSS version 25. Descriptive statistics such as frequencies, percentages, and means were used to summarize participants\u0026rsquo; characteristics and responses. Inferential statistics, including chi-square tests and Spearman correlation coefficients, were applied to examine the relationships between socioeconomic variables (such as education, income, gender, employment, and residence) and access to healthcare services.\u003c/p\u003e\u003cp\u003eQualitative data were transcribed verbatim and analyzed thematically using NVivo software. A coding framework was developed based on Penchansky and Thomas\u0026rsquo;s five dimensions of access. Thematic analysis allowed for the identification of recurring patterns and context-specific barriers. The findings from both datasets were compared and integrated during the interpretation phase to ensure complementarity and to enhance the validity of conclusions.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e Ethical clearance for the study was obtained from the Committee on Human Research, Publications and Ethics at the Kwame Nkrumah University of Science and Technology (CHRPE/AP/367/22). Written informed consent was obtained from all participants before their involvement in the study. Participants were informed of their right to withdraw at any point without consequence. Data confidentiality and anonymity were assured throughout the research process, and all records were securely stored and accessed only by the research team.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic characteristics of respondents\u003c/h2\u003e\u003cp\u003e Table\u0026nbsp;1 presents the socio-demographic profile of the 1,192 respondents who participated in the study across three districts: Ahafo Ano North (33.3%), Asante Akim Central (33.3%), and Bekwai (33.4%). Slightly more respondents resided in rural communities (53.6%) compared to urban areas (46.4%). The gender distribution was relatively balanced, with females constituting 51.1% and males 48.9%.\u003c/p\u003e\u003cp\u003eIn terms of age, the largest group fell within the 20 to 29 years range (35.2%), followed by 30 to 39 years (23.9%), while those aged 60 years and above represented only 4.4% of the sample. Educational attainment varied, with 38.6% having tertiary education, 29.4% senior high education, and 11.2% with no formal education.\u003c/p\u003e\u003cp\u003eEmployment status data showed that nearly two-thirds (63.5%) were employed, while 36.5% were unemployed. Annual household income was generally low, with over half (57.3%) earning less than GHS 5,000, and only 3.1% earning above GHS 30,000.\u003c/p\u003e\u003cp\u003eThis demographic distribution highlights a predominantly rural, relatively young, and modest-income population, with a considerable proportion attaining at least secondary education.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic characteristics and accessibility to healthcare\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;2 presents the socio-demographic factors associated with accessibility to healthcare among respondents. Significant gender differences were observed (p\u0026thinsp;=\u0026thinsp;0.003), with females (52.0%) reporting higher accessibility than males (48.0%). Age was also significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with the majority aged 20\u0026ndash;29 years (35.2%), followed by 30\u0026ndash;39 years (23.9%). Educational status showed strong significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as most respondents had a tertiary (38.6%) or senior high school education (29.4%). Employment status was a significant factor (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with 63.5% of participants employed and 36.5% unemployed. Accessibility varied significantly by district (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with near-equal distributions across Ahafo Ano North (33.3%), Asante Akim Central (33.3%), and Bekwai (33.4%). The type of residence was also significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with most respondents living in rural areas (53.6%), followed by urban areas (39.9%), and peri-urban areas (6.5%). Household income demonstrated strong associations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with the majority earning below GHS 5,000 annually (57.3%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSocioeconomic factors influencing accessibility to healthcare\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;3 presents respondents\u0026rsquo; views on the socioeconomic factors shaping healthcare accessibility. Using a 3.0 mean threshold, findings show that respondents disagreed with having reliable means of payment (M\u0026thinsp;=\u0026thinsp;1.84) and with the reasonableness of healthcare costs (M\u0026thinsp;=\u0026thinsp;2.20). They agreed, however, that financial status influences care-seeking decisions (M\u0026thinsp;=\u0026thinsp;3.40) and that health insurance helps reduce financial burdens (M\u0026thinsp;=\u0026thinsp;3.50). Respondents further acknowledged the need for measures to make healthcare more affordable (M\u0026thinsp;=\u0026thinsp;3.63) and agreed that lack of insurance (M\u0026thinsp;=\u0026thinsp;3.23) and financial difficulties (M\u0026thinsp;=\u0026thinsp;3.23) pose barriers. While some agreed that financial concerns deter care-seeking (M\u0026thinsp;=\u0026thinsp;3.22), they disagreed that financial constraints had ever prevented them or their households from seeking care (M\u0026thinsp;=\u0026thinsp;2.44). Overall, financial considerations, particularly affordability and insurance coverage, emerged as key determinants of healthcare access.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eAccessibility Dimension Framework for the Newly Commissioned District Hospitals in the Ashanti Region\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;4 presents the mean, mode, and median scores for each of the five dimensions of healthcare accessibility, which are geographical access, availability, acceptability, accommodation, and affordability across the three study districts: Ahafo Ano North, Asante Akim Central, and Bekwai. Each district accounted for approximately one-third of the respondents.\u003c/p\u003e\u003cp\u003eFor geographical access, Asante Akim Central recorded the highest mean score (3.76), followed by Ahafo Ano North (3.62) and Bekwai (3.25), indicating relatively better ease of reaching the facility in Asante Akim Central.\u003c/p\u003e\u003cp\u003eIn terms of availability of services, Ahafo Ano North (3.78) and Asante Akim Central (3.77) scored similarly and higher than Bekwai (3.18), suggesting more consistent staffing and resource presence in the first two districts.\u003c/p\u003e\u003cp\u003eAcceptability scores were highest in Asante Akim Central (3.82), reflecting stronger cultural alignment and patient-provider rapport, while Bekwai had the lowest (3.15).\u003c/p\u003e\u003cp\u003eFor accommodation, which reflects organizational efficiency, Ahafo Ano North (3.78) and Asante Akim Central (3.81) again scored higher than Bekwai (3.19).\u003c/p\u003e\u003cp\u003eAffordability had the lowest overall scores among the five dimensions, with Asante Akim Central (3.51) performing best, followed by Ahafo Ano North (3.21) and Bekwai (2.98), indicating that financial constraints were a notable barrier, especially in Bekwai.\u003c/p\u003e\u003cp\u003eOverall, Asante Akim Central consistently scored highest across most dimensions, suggesting comparatively better performance in accessibility, while Bekwai scored lowest across all dimensions, highlighting more significant access challenges.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eAccessibility Dimension Scores for Newly Commissioned District Hospitals\u003c/h2\u003e\u003cp\u003eFigure 1 illustrates the mean scores for five dimensions of healthcare accessibility, which are geographical access, availability, acceptability, accommodation, and affordability across three newly commissioned district hospitals in the Ashanti Region: Ahafo Ano North, Asante Akim Central, and Bekwai. A target benchmark score of 3.0 is indicated by a horizontal yellow line.\u003c/p\u003e\u003cp\u003eAcross all dimensions, Asante Akim Central consistently recorded the highest scores, ranging from approximately 3.51 in affordability to 3.82 in acceptability. Ahafo Ano North generally ranked second, with mean scores between 3.21 in affordability and 3.78 in availability and accommodation. Bekwai recorded the lowest mean scores in all dimensions, with the most pronounced gap in availability (3.18) and affordability (2.98).\u003c/p\u003e\u003cp\u003eAll districts scored above the target line in most dimensions, except Bekwai in affordability, which fell slightly below the target, indicating affordability challenges. The performance pattern suggests that while all hospitals meet or exceed the basic accessibility threshold, notable disparities exist, especially in the Bekwai District Hospital.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAffordability as a Barrier to Healthcare Access in the Newly Commissioned District Hospitals in Ashanti Region\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;5 presents the mean, median, and mode scores for variables measuring affordability as a barrier to healthcare access across Ahafo Ano North, Asante Akim Central, and Bekwai district hospitals. The results are based on responses to items assessing payment modes, financial considerations before seeking care, health insurance coverage, perceptions of cost, and the impact of financial constraints on healthcare-seeking behaviour.\u003c/p\u003e\u003cp\u003eAcross all districts, the mode of payment for services was predominantly through the National Health Insurance Scheme (NHIS), as reflected by a uniform score of 2 for all three districts. In terms of considering financial situation before seeking care, Asante Akim Central scored highest (mean 4), indicating stronger agreement, while Ahafo Ano North (mean 3) and Bekwai (mean 3) reflected more neutral responses.\u003c/p\u003e\u003cp\u003eFor health insurance coverage as a means of reducing financial burden, Ahafo Ano North and Asante Akim Central both scored a mean of 4, suggesting adequate insurance support, whereas Bekwai scored lower at 3. Similar patterns were observed for the perception that district hospitals should implement measures to make healthcare more affordable, with higher agreement in Ahafo Ano North and Asante Akim Central (mean 4) compared to Bekwai (mean 3).\u003c/p\u003e\u003cp\u003eResponses to experiencing financial difficulties in paying for healthcare services were relatively consistent across districts, with means ranging from 3 to 3, indicating occasional financial strain. On the perception of whether the cost of services is reasonable, Asante Akim Central scored the highest (mean 4), followed by Ahafo Ano North (mean 3) and Bekwai (mean 3).\u003c/p\u003e\u003cp\u003eWhen asked whether financial concerns had deterred them from seeking healthcare in the past, Asante Akim Central respondents showed stronger disagreement (mean 4) compared to Ahafo Ano North (mean 3) and Bekwai (mean 3). Similarly, Asante Akim Central respondents rated the overall cost of healthcare more favorably (mean 4) than the other two districts (both mean 3).\u003c/p\u003e\u003cp\u003eFor the item on financial constraints deterring households from seeking healthcare, Bekwai and Ahafo Ano North both had lower mean scores (2), suggesting a moderate impact, whereas Asante Akim Central scored 2, indicating a lesser perceived impact.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSpearman Correlation of Accessibility Dimensions to Healthcare in the Newly Commissioned District Hospitals\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;6 presents the Spearman correlation coefficients between the five dimensions of healthcare accessibility, which are geographical access, availability, acceptability, accommodation, and affordability, based on responses from 1,192 participants. All correlations are statistically significant at the 0.01 level (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating strong interrelationships between the accessibility dimensions.\u003c/p\u003e\u003cp\u003eThe strongest correlation was observed between acceptability and accommodation (r\u0026thinsp;=\u0026thinsp;0.745), suggesting that improvements in how services are organized and delivered are closely linked to patients\u0026rsquo; perceptions of cultural and interpersonal acceptability of care. Availability also showed a strong correlation with accommodation (r\u0026thinsp;=\u0026thinsp;0.687) and acceptability (r\u0026thinsp;=\u0026thinsp;0.680), implying that when services and resources are consistently available, organizational efficiency and patient satisfaction tend to improve.\u003c/p\u003e\u003cp\u003eGeographical access was most strongly correlated with availability (r\u0026thinsp;=\u0026thinsp;0.674) and acceptability (r\u0026thinsp;=\u0026thinsp;0.637), reflecting that shorter travel distances and easier physical access to facilities are often associated with better service provision and more culturally acceptable care.\u003c/p\u003e\u003cp\u003eAffordability demonstrated the weakest correlations overall, with its highest association being with acceptability (r\u0026thinsp;=\u0026thinsp;0.508). This suggests that while financial considerations are important, they may influence perceptions of other dimensions to a lesser extent compared to the interplay among the non-financial dimensions.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed how socioeconomic factors and multidimensional barriers influence access to newly commissioned district hospitals in the Ashanti Region of Ghana. Using the accessibility framework proposed by Penchansky and Thomas, the findings reveal that infrastructure development, while necessary, is not sufficient to ensure equitable access to health services. Instead, access is determined by a complex interaction of socioeconomic characteristics and structural challenges that either enable or restrict the ability of individuals to use available health services.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eSocioeconomic Determinants of Access\u003c/h2\u003e\u003cp\u003eSocioeconomic disparities continue to significantly influence healthcare access. This is particularly evident in countries with constrained health systems and unequal resource distribution, such as Ghana. In this study, gender, age, education, employment status, income, and place of residence were all found to affect healthcare utilization. These results are consistent with previous research indicating that both personal and contextual factors contribute to disparities in healthcare use (O\u0026rsquo;Donnell et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Giedion et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGender was an important determinant, with female respondents reporting higher service utilization. This supports prior findings that women are generally more engaged with health systems, largely due to maternal responsibilities and their traditional role as caregivers within households (Buor, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Awumbila, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). However, some women expressed discomfort when care was provided by male health workers during sensitive procedures. This highlights the importance of culturally sensitive and gender-responsive healthcare delivery (Chiarenza et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Essien et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAge was positively associated with healthcare use. Older adults, especially those aged 60 and above, reported more frequent visits due to the increasing burden of noncommunicable and age-related diseases. This finding aligns with research emphasizing the importance of age-friendly services in strengthening primary healthcare delivery for aging populations (WHO, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; HelpAge International, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEducation emerged as a key enabler. Participants with tertiary education levels were more likely to access care because they understood the structure of the health system, were aware of their rights, and could more easily enroll in and use health insurance. These findings support evidence that health literacy and formal education improve service uptake and navigation of complex care environments (Nutbeam, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Osborn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEmployment and income also significantly influenced healthcare access. Employed individuals had more financial flexibility to seek care. In contrast, unemployed and low-income respondents frequently postponed care due to high out-of-pocket expenses. Despite being enrolled in the National Health Insurance Scheme, many respondents still paid for laboratory tests, medications, and imaging services. These results align with previous studies that argue the National Health Insurance Scheme does not fully protect the poor from financial hardship (Amporfu, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Blanchet et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResidential location created another access barrier. Respondents living in urban areas had better access than those in rural and peri-urban communities. The urban advantage was largely due to shorter distances, better roads, and greater access to transportation. Similar geographic disparities have been documented in earlier research, where rural residents had lower rates of health service utilization and longer travel times to reach care facilities (Agbenyo et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Dotse-Gborgbortsi et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eMultidimensional Barriers to Access\u003c/h2\u003e\u003cp\u003eThe application of the five dimensions of access (availability, geographical accessibility, affordability, accommodation, and acceptability) enabled a deeper understanding of the challenges faced by healthcare seekers.\u003c/p\u003e\u003cp\u003eAvailability was uneven across the study sites. Although all three hospitals were newly constructed, some lacked sufficient personnel and essential diagnostic services. Bekwai District Hospital reported the greatest shortages, which discouraged patients from utilizing the facility and led to referrals elsewhere. This observation confirms that infrastructure must be accompanied by investment in human resources and supply chains to deliver meaningful access (Kruk et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGeographical accessibility was a notable constraint, particularly in rural and hard-to-reach communities. Long distances, poor roads, and limited public transport options made it difficult for residents to access care, especially during emergencies. Respondents from Asante Akim Central reported the shortest travel times, while those in Bekwai experienced significant transport challenges. These findings are consistent with spatial accessibility studies in sub-Saharan Africa that show distance and travel time are strong predictors of healthcare use (Noor et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Nesbitt et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAffordability emerged as the most pressing concern among all five dimensions. Although over 80% of respondents were enrolled in the National Health Insurance Scheme, many continued to pay for services that were not covered, including diagnostics, medications, and specialist consultations. These financial burdens were especially acute among low-income households. Similar issues have been documented in other parts of Ghana, where the scheme is criticized for limited coverage and poor protection for vulnerable populations (Witter \u0026amp; Garshong, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Lagomarsino et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccommodation challenges affected service efficiency. Respondents frequently complained about long waiting times, lack of appointment systems, and limited consultation hours. Many patients preferred walk-in visits due to difficulties in securing scheduled appointments, which contributed to congestion and dissatisfaction. This aligns with previous research that highlights the impact of organizational efficiency on patients\u0026rsquo; willingness to return for care (Darzi, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAcceptability issues were also significant. Patients from minority language groups faced communication barriers. Others cited disrespectful staff attitudes and discomfort with provider gender. These experiences affected patient satisfaction and reduced trust in the health system. The importance of respectful and culturally competent care has been well documented in the literature, showing that acceptability influences not only first-time use but also continuity of care (Betancourt et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Saha et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eInterconnectedness of Access Dimensions\u003c/h2\u003e\u003cp\u003eA key finding of the study is that the five dimensions of access are interrelated. Statistical analysis showed strong correlations between availability and accommodation, as well as between affordability and both accessibility and acceptability. This suggests that a single barrier can impact multiple domains of access. For example, a shortage of healthcare staff (availability) can result in longer wait times (accommodation) and reduce patient satisfaction (acceptability). These findings support the growing view that health system challenges must be addressed through integrated and holistic interventions (Kruk et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations of the Study.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has some limitations that should be acknowledged. First, the cross-sectional design limits causal inferences regarding the relationship between socioeconomic determinants and healthcare access. Second, while the study covered three newly commissioned district hospitals, findings may not be generalizable to all hospitals under Ghana\u0026rsquo;s \u0026ldquo;Agenda 111\u0026rdquo; initiative or to other regions with different socioeconomic and cultural contexts. Additionally, the reliance on self-reported data for the quantitative survey may have introduced recall and social desirability bias, particularly in responses related to healthcare-seeking behavior and affordability. Finally, the qualitative component included only 15 key informants, which, although sufficient for thematic saturation, may not fully capture the diversity of stakeholder perspectives.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGhana\u0026rsquo;s investment in new district hospitals under the \u0026ldquo;Agenda 111\u0026rdquo; initiative represents a major step toward expanding healthcare infrastructure. However, this study demonstrates that socioeconomic inequities and multidimensional barriers, particularly affordability, continue to limit equitable access. Gender, education, income, and place of residence remain significant determinants of service use, with Bekwai District Hospital exhibiting the greatest access gaps. The strong correlations between access dimensions highlight that addressing one barrier in isolation is insufficient; instead, holistic, integrated strategies are required.\u003c/p\u003e\u003cp\u003eThese findings have broad implications for LMICs adopting infrastructure-led approaches to UHC. Investments must be accompanied by policies that strengthen financing, workforce distribution, service readiness, transport infrastructure, and cultural acceptability. Ghana\u0026rsquo;s experience underscores the need for continuous monitoring of access dimensions to ensure that infrastructure expansion translates into genuine, equitable, and sustainable improvements in health service utilization. By embedding these strategies within global health policy frameworks, countries can accelerate progress toward UHC while ensuring no one is left behind.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUHC:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Universal Health Coverage\u003c/p\u003e\n\u003cp\u003eLMICs;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Low and Middle-Income Countries\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSDGs:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sustainable Development Goals\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; World Health Organization\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adhered to the principles of informed, voluntary consent, confidentiality of information, and respondent anonymity. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (2013) and the guidelines of the General Research Ethics Board of the Kwame Nkrumah University of Science and Technology (KNUST). Ethical approval was obtained from the KNUST Humanities and Social Research Ethics Committee (Ref. No: HUSSREC/AP/30/Vol 3). Approval from the Department of Planning at KNUST permitted the conduct of surveys, interviews, participant observations, and secondary data collection. Before data collection, the purpose of the study was explained to participating agencies, institutions, and community study sites. The letters of approval endorsed by the University enhanced cooperation from key informants, particularly at the institutional level. All participants willingly agreed and individually signed an informed consent form to participate in the study without coercion and their identities were kept strictly confidential and untraceable by third parties.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eManagement of the facilities and the study participants consented to the dissemination of the study findings, including the article publication, as part of the study approval protocol.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe instruments used and the primary data collected are available and will be shared upon request. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests in all aspects of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study did not receive any external funding. It was a self-funded study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization (F.F., C.P., and E.O-A.), Data collection (F.F., and C.P.), Data Analysis (F.F.) Writing \u0026ndash; original draft (F.F., C.P., E.O-A., E.E., and H.A.A.), Methods (F.F., C.P., and E.O-A.), Writing \u0026ndash; review and editing (F.F., C.P., E.O-A., E.E., and H.A.A.)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAgbenyo, F., Marshall, N., \u0026amp; Akwasi, K. (2017). Accessibility mapping of health facilities in rural Ghana. \u003cem\u003eJournal of Transport \u0026amp; Health, 5\u003c/em\u003e(1), 40\u0026ndash;49. https://doi.org/10.1016/j.jth.2017.01.002\u003c/li\u003e\n\u003cli\u003eAmporfu, E. (2013). Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage. \u003cem\u003eInternational Journal for Equity in Health, 12\u003c/em\u003e(1), 4. https://doi.org/10.1186/1475-9276-12-4\u003c/li\u003e\n\u003cli\u003eAssefa, Y., Hill, P. S., \u0026amp; Gilks, C. F. (2019). Health system strengthening through a comprehensive primary health care approach in Ethiopia. \u003cem\u003eBMJ Global Health, 4\u003c/em\u003e(2), e001143. https://doi.org/10.1136/bmjgh-2018-001143\u003c/li\u003e\n\u003cli\u003eAwumbila, M. (2016). Gender equality and poverty in Ghana: Implications for public policy. \u003cem\u003eGhana Social Science Journal, 13\u003c/em\u003e(1), 45\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eBetancourt, J. R., Green, A. R., Carrillo, J. E., \u0026amp; Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. \u003cem\u003ePublic Health Reports, 118\u003c/em\u003e(4), 293\u0026ndash;302. https://doi.org/10.1016/S0033-3549(04)50253-4\u003c/li\u003e\n\u003cli\u003eBinagwaho, A., Scott, K. W., \u0026amp; Rosewall, T. (2014). Improving the world\u0026apos;s health through the post-2015 development agenda: Perspectives from Rwanda. \u003cem\u003eInternational Journal of Health Policy and Management, 2\u003c/em\u003e(3), 137\u0026ndash;140. https://doi.org/10.15171/ijhpm.2014.36\u003c/li\u003e\n\u003cli\u003eBlanchet, N. J., Fink, G., \u0026amp; Osei-Akoto, I. (2012). The effect of Ghana\u0026rsquo;s National Health Insurance Scheme on health care utilisation. \u003cem\u003eGhana Medical Journal, 46\u003c/em\u003e(2), 76\u0026ndash;84.\u003c/li\u003e\n\u003cli\u003eBuor, D. (2003). Analysing the socio-spatial inequalities in the access of health services in sub-Saharan Africa: Interrogating geographical imbalances in the provision of health care. \u003cem\u003eInternational Journal of Health Planning and Management, 18\u003c/em\u003e(4), 273\u0026ndash;286. https://doi.org/10.1002/hpm.729\u003c/li\u003e\n\u003cli\u003eChiarenza, A., Dauvrin, M., Chiesa, V., Baatout, S., \u0026amp; Verrept, H. (2019). Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure. \u003cem\u003eBMC Health Services Research, 19\u003c/em\u003e(513), 1\u0026ndash;14. https://doi.org/10.1186/s12913-019-4353-1\u003c/li\u003e\n\u003cli\u003eDarzi, A. (2008). High quality care for all: NHS next stage review final report. \u003cem\u003eDepartment of Health\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eDotse-Gborgbortsi, W., Wardrop, N. A., Adewole, A., Thomas, M. L., Wright, J., \u0026amp; Hill, A. G. (2023). The spatial accessibility of healthcare in Ghana: A multi-modal approach. \u003cem\u003eInternational Journal of Health Geographics, 22\u003c/em\u003e(1), 1\u0026ndash;16. https://doi.org/10.1186/s12942-023-00343-4\u003c/li\u003e\n\u003cli\u003eEssien, C., Ndep, A., \u0026amp; Eyo, E. (2021). Gender-sensitive approaches in health service delivery: Bridging the gap in patient care. \u003cem\u003eAfrican Journal of Reproductive Health, 25\u003c/em\u003e(3), 53\u0026ndash;63. https://doi.org/10.29063/ajrh2021/v25i3.6\u003c/li\u003e\n\u003cli\u003eGiedion, U., Alfonso, E. A., \u0026amp; D\u0026iacute;az, Y. (2013). The impact of universal coverage schemes in the developing world: A review of the existing evidence. \u003cem\u003eThe World Bank\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eHelpAge International. (2019). \u003cem\u003eAgeing in the twenty-first century: A celebration and a challenge\u003c/em\u003e. United Nations Population Fund.\u003c/li\u003e\n\u003cli\u003eKolbila, D. Z. (2019). Ghana\u0026apos;s Agenda 111: Bridging healthcare infrastructure gaps. \u003cem\u003eGhana Health Service Bulletin, 10\u003c/em\u003e(2), 15\u0026ndash;20.\u003c/li\u003e\n\u003cli\u003eKruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., ... \u0026amp; Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. \u003cem\u003eThe Lancet Global Health, 6\u003c/em\u003e(11), e1196\u0026ndash;e1252. https://doi.org/10.1016/S2214-109X(18)30386-3\u003c/li\u003e\n\u003cli\u003eLagomarsino, G., Garabrant, A., Adyas, A., Muga, R., \u0026amp; Otoo, N. (2012). Moving towards universal health coverage: Health insurance reforms in nine developing countries in Africa and Asia. \u003cem\u003eThe Lancet, 380\u003c/em\u003e(9845), 933\u0026ndash;943. https://doi.org/10.1016/S0140-6736(12)61147-7\u003c/li\u003e\n\u003cli\u003eNesbitt, R. C., Gabrysch, S., Soremekun, S., Manu, A., Kirkwood, B. R., \u0026amp; Owusu-Agyei, S. (2014). Trends in care seeking for fever in children under five years in rural Ghana. \u003cem\u003eBMC Public Health, 14\u003c/em\u003e, 1116. https://doi.org/10.1186/1471-2458-14-1116\u003c/li\u003e\n\u003cli\u003eNoor, A. M., Zurovac, D., Hay, S. I., Ochola, S. A., \u0026amp; Snow, R. W. (2006). Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya. \u003cem\u003eTropical Medicine \u0026amp; International Health, 11\u003c/em\u003e(1), 70\u0026ndash;78. https://doi.org/10.1111/j.1365-3156.2005.01518.x\u003c/li\u003e\n\u003cli\u003eNutbeam, D. (2008). The evolving concept of health literacy. \u003cem\u003eSocial Science \u0026amp; Medicine, 67\u003c/em\u003e(12), 2072\u0026ndash;2078. https://doi.org/10.1016/j.socscimed.2008.09.050\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Donnell, O., van Doorslaer, E., Wagstaff, A., \u0026amp; Lindelow, M. (2008). \u003cem\u003eAnalyzing health equity using household survey data: A guide to techniques and their implementation\u003c/em\u003e. The World Bank.\u003c/li\u003e\n\u003cli\u003eOsborn, C. Y., Paasche-Orlow, M. K., Bailey, S. C., \u0026amp; Wolf, M. S. (2011). The mechanisms linking health literacy to behavior and health status. \u003cem\u003eAmerican Journal of Health Behavior, 35\u003c/em\u003e(1), 118\u0026ndash;128. https://doi.org/10.5993/AJHB.35.1.11\u003c/li\u003e\n\u003cli\u003ePenchansky, R., \u0026amp; Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. \u003cem\u003eMedical Care, 19\u003c/em\u003e(2), 127\u0026ndash;140. https://doi.org/10.1097/00005650-198102000-00001\u003c/li\u003e\n\u003cli\u003eSaha, S., Beach, M. C., \u0026amp; Cooper, L. A. (2008). Patient centeredness, cultural competence and healthcare quality. \u003cem\u003eJournal of the National Medical Association, 100\u003c/em\u003e(11), 1275\u0026ndash;1285. https://doi.org/10.1016/S0027-9684(15)31505-4\u003c/li\u003e\n\u003cli\u003eWHO. (2021). \u003cem\u003eUniversal health coverage: What it is, what it\u0026rsquo;s not\u003c/em\u003e. World Health Organization.\u003c/li\u003e\n\u003cli\u003eWitter, S., \u0026amp; Garshong, B. (2009). Something old or something new? Social health insurance in Ghana. \u003cem\u003eBMC International Health and Human Rights, 9\u003c/em\u003e(1), 20. https://doi.org/10.1186/1472-698X-9-20.\u003c/li\u003e\n\u003cli\u003eWorld Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191\u0026ndash;2194. https://doi.org/10.1001/jama.2013.281053.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Socio-demographic characteristics of respondents\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eDistrict\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eAhafo Ano North\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eAsante Akim Central\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eBekwai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e33.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eType of community\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eSex of Respondent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e51.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eAge(yrs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u0026lt; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e60+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eEducational Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eJunior High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eSenior High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eEmployment Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e63.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eAnnual household income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u0026lt; 5,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e5,100 - 10,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e10,001 - 20,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e20,001 - 30,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eMore than 30,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1,192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Socio-demographic characteristics and accessibility to healthcare\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVARIABLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eACCESSIBILITY TO HEALTHCARE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- VALUE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSEX\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFREQUENCY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePERCENTAGE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e52.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e47.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAGE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e\u0026lt; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e14.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e35.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e23.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e13.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e8.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e60+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e4.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEDUCATIONAL STATUS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e11.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e6.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eJunior High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e14.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eSenior High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e29.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e38.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEMPLOYMENT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e36.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e63.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDISTRICTS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eAhafo Ano north\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e33.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eAsante Akim Central\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e33.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eBekwai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e33.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTYPE OF RESIDENCE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e39.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003ePeri-urban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e6.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e53.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHOUSEHOLD INCOME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e\u0026lt;5,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e57.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e5,100 \u0026ndash; 10,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e21.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e10,001 \u0026ndash; 20,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e9.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e20,001 \u0026ndash; 30,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e8.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e\u0026gt;30,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,192\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Socioeconomic factors influencing accessibility to healthcare\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS/N\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTATEMENT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEAN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDECISION\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eI have the means of payment for the services I receive at the facility.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eDisagreed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eI consider my financial status before deciding to seek healthcare services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAgreed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eI have health insurance coverage that helps alleviate my financial burden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAgreed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eI believe the district hospital should implement measures to make healthcare services more affordable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAgreed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eNot having health insurance has been a barrier to accessing healthcare services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAgreed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eI experience financial difficulties in accessing healthcare services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAgreed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e7.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eThe cost of seeking healthcare services is reasonable.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAgreed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e8.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eFinancial concerns deterred me from seeking healthcare services.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAgreed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003e9.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eFinancial constraints have ever deterred me and my household members from seeking healthcare services.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eDisagreed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Accessibility Dimension Framework for the Newly Commissioned District Hospitals in the Ashanti Region.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;District\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAhafo Ano North\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAsante Akim Central\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBekwai\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eGeographical access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eRow N %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e33.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAvailability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eRow N %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e33.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAcceptability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eRow N %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e33.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAccommodation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eRow N %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e33.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAffordability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eRow N %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e33.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Affordability as a barrier to healthcare access in the newly commissioned district hospitals in Ashanti Region\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"905\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAffordability Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAhafo Ano North\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAsante Akim Central\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBekwai\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScale of measure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eMode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eMode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eMode\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eWhat was your mode of payment for the services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1 = \u0026quot;Out of Pocked Payment\u0026quot;, 2 = \u0026quot;NHIS\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eDo you consider your financial situation before deciding to seek healthcare services at the district hospital?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1=\u0026quot;Strongly Disagree\u0026quot; 2 =\u0026quot;Disagree\u0026quot; 3 = \u0026quot;Neutral\u0026quot; 4 = \u0026quot;Agree\u0026quot; 5 = \u0026quot;Strongly Agree\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eDo you have health insurance coverage that helps alleviate the financial burden of healthcare services at the district hospital?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eI believe the district hospital should implement measures to make healthcare services more affordable for the community.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eDid you experienced financial difficulties in paying for healthcare services at the newly commissioned district hospital?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eThe cost of healthcare services at the new district hospital is reasonable.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eFinancial concerns deterred you from seeking healthcare services at the district hospital in the past?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eHow would you describe the cost of seeking healthcare services at the new district hospital?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eFinancial constraints have deterred you and your household members from seeking healthcare services at the new district hospital?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1 = \u0026quot;To a Great Extent\u0026quot; 2 = \u0026quot;Somewhat\u0026quot; 3 = \u0026quot;Very Little\u0026quot; 4 = \u0026quot;Not at all\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 6: Spearman correlation of accessibility dimension to healthcare in the new District hospitals\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"858\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 858px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eGeographical access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eAvailability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAcceptability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eAccommodation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eAffordability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"15\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eSpearman\u0026apos;s rho\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eGeographical access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eCorrelation Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.674\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.637\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e.596\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e.436\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAvailability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eCorrelation Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.674\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.680\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e.687\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e.427\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAcceptability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eCorrelation Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.637\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.680\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e.745\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e.508\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAccommodation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eCorrelation Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.596\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.687\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.745\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e.476\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eAffordability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eCorrelation Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.436\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.427\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.508\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e.476\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Healthcare access, socioeconomic determinants, district hospitals, affordability, Ghana, Ashanti Region, equity, accessibility dimensions","lastPublishedDoi":"10.21203/rs.3.rs-7503566/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7503566/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAccess to healthcare is a multidimensional concept encompassing not only the individuals' ability to seek, access, afford, and utilise care. In Ghana, the commissioning of new district hospitals under the \u0026ldquo;Agenda 111\u0026rdquo; initiative marks a major step toward Universal Health Coverage (UHC). However, evidence on whether such infrastructure investments translate into equitable access remains limited. This study examined socioeconomic determinants and systemic barriers to accessing three newly commissioned district hospitals in the Ashanti Region, applying Penchansky and Thomas\u0026rsquo;s five dimensions of accessibility. A convergent mixed-methods design combined quantitative survey data from 1,192 healthcare seekers with qualitative insights from 15 key informants. Findings revealed that gender, age, education, employment status, income, and residential location significantly influenced access (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Respondents highlighted affordability as the most critical barrier, with many disagreeing that they had reliable means of payment (M\u0026thinsp;=\u0026thinsp;1.84) or that healthcare costs were reasonable (M\u0026thinsp;=\u0026thinsp;2.20). Despite widespread health insurance coverage, financial difficulties (M\u0026thinsp;=\u0026thinsp;3.23) and lack of insurance (M\u0026thinsp;=\u0026thinsp;3.23) continued to limit access, particularly in Bekwai District Hospital, which consistently recorded the lowest scores across accessibility dimensions. Strong intercorrelations between availability, accommodation, and acceptability underscored the interconnected nature of access challenges. Policy recommendations include expanding health insurance coverage, reducing out-of-pocket payments, strengthening staffing and diagnostics, improving transport infrastructure, and promoting culturally competent care. These findings highlight that infrastructure expansion alone is insufficient for achieving UHC and that multidimensional, equity-focused strategies are essential both in Ghana and in other low and middle-income countries (LMICs) undertaking similar health system investments.\u003c/p\u003e","manuscriptTitle":"Socioeconomic Determinants and Barriers to Accessing Newly Commissioned District Hospitals in Ghana’s Ashanti Region: An Accessibility Dimensions Perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-27 10:46:23","doi":"10.21203/rs.3.rs-7503566/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-22T04:41:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208204536867231314920923467716864131973","date":"2025-10-21T23:26:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T15:24:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267331356532268915260234159920963254889","date":"2025-10-14T12:11:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-12T09:48:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-07T03:58:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-18T09:04:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-18T04:14:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-09-18T04:11:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"139df5f0-864b-4faa-8327-48090c041cae","owner":[],"postedDate":"October 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T10:46:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-27 10:46:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7503566","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7503566","identity":"rs-7503566","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}