Health Entrepreneurship in Universal Health Coverage Delivery: Evidence from Emerging Economies

Health Entrepreneurship in Universal Health Coverage Delivery: Evidence from Emerging Economies | 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 Health Entrepreneurship in Universal Health Coverage Delivery: Evidence from Emerging Economies Brian Kipkoech, Martin Owusu-Ansah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5453580/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Introduction: Universal health coverage aims for all populations to access quality healthcare without exposure to financial hardship from expensive out-of-pocket payments for the services. Health entrepreneurs are individuals or organizations who take financial risks to develop innovative and sustainable business models to deliver quality healthcare services and products to populations in various contexts. This study aimed to analyze the influence of health entrepreneurship on accelerating the progress towards the realization of universal health coverage in Kenya and Ghana. Methods: The research applied a cross-sectional, quantitative technique, survey design, and an explanatory analysis to understand the relationships between affordability and accessibility of healthcare services. The study's target respondents were health entrepreneurs running various healthcare services. Results: The study found that health entrepreneurs in Kenya and Ghana contribute to healthcare accessibility and affordability in varying degrees. Accessibility scores highlighted no statistically significant difference between the two settings (t = 0.91, p = 0.38). Similarly, affordability differences were not statistically significant (U = 10.5, p = 0.561). Additionally, the study identified regulatory and financial constraints as key challenges faced by health entrepreneurs in both countries. The study established that opportunities exist in leveraging technology and expanding public-private partnerships to improve healthcare access and affordability. Conclusion: This study underscores and provides empirical evidence that health entrepreneurship is significant in realizing Universal Health Coverage. Through this study's findings, healthcare entrepreneurs demonstrate their role in expanding access to care and ameliorating affordability by applying innovative care delivery approaches. Universal health coverage affordability accessibility Kenya Ghana Health entrepreneurship Figures Figure 1 Figure 2 Background In December 2012, the United Nations made a commitment to global health and foreign policy that urged member countries to accelerate efforts towards Universal Health Coverage (UHC)—that everyone, everywhere, ought to have access to quality healthcare at an affordable cost. There have been discussions on its universality and access, especially in low and middle-income countries whose infrastructural and financial muscle to implement this is weaker [ 1 ]. Notably, universal health coverage aims for all populations to access quality healthcare without exposure to financial hardship from expensive out-of-pocket payments for the services [ 2 ]. Access to quality care is made of various dimensions. Physical accessibility includes the availability of quality health systems within reach to communities with much ease of appointment and attendance [ 3 ]. Further, financial affordability is critical, emphasizing the measure of the population's capacity to pay for healthcare services without risk of financial hardships. Precisely this considers the pricing of the healthcare services and indirect costs that can be incurred when exploring access, including the cost of transport to the healthcare facilities and time away from productive work [ 4 ]. Lastly, acceptability is informed by the population's willingness to seek service, which is affected by various social and cultural factors that inform health-seeking behavior [ 5 ]. Health entrepreneurship is critical for expanding access to and achieving universal health coverage. Health entrepreneurs are individuals or organizations who take financial risks to develop innovative and sustainable business models to deliver quality healthcare services and products to populations in various contexts [ 6 ]. Wholistically, health entrepreneurship is the application of innovative, sustainable, and market-driven approaches by individuals or entities to address healthcare challenges and improve access, affordability, and quality of care within diverse health systems. In recent developments, there has been an embrace of technology in access to care, especially the application of telemedicine to deliver care to remote and underserved populations. The achievement of Universal Health Coverage remains a significant challenge for many countries, especially the low- and middle-income countries, most within sub-Saharan Africa. Kenya and Ghana, holding a GDP of USD 113.4 billion and USD 73.77 billion in 2022, respectively, are classified as lower middle-income countries by the World Bank [ 7 ]. Further, with much dependence on donor funding, the budgetary allocation towards healthcare within both settings is limited. In 2023/24, Kenya allocated 11% of her budget (USD 1.27 billion) on health, while Ghana allocated 6.7% (USD 2.4 billion) to health [ 7 ]. Notably, both fall below the Abuja Declaration of 2001, pledged by the African Union to allocate at least 15% of the annual budget to health. The novelty of health entrepreneurship fits timely towards the achievement of expanded coverage. While the traditional approaches to healthcare delivery have made significant efforts towards improving access to care, there has been a consistent need to address the ever-changing, diverse, and dynamic population needs. It is vital to understand the role of health entrepreneurship in UHC realization to inform the paradigm shift and capacity building critical for developing innovative approaches to care, expanded access, and delivery of cost-effective care to diverse populations. Even though Kenya and Ghana hold a space of exploration in health entrepreneurship in sub-Saharan Africa, both settings present uniquely distinct variations in strengths and challenges. Moreover, although Kenya and Ghana are both located in sub-Saharan Africa, they are geographically distant, with differing geographical conditions. However, they share similarities in economic structures, political frameworks, and health infrastructure, while also exhibiting distinct difference in disease burden and policy architecture. A juxtaposed analysis of the similarities and differences through a comparative evaluation gave a valuable understanding of contextual factors that shape and dictate the implementation and effectiveness of health entrepreneurship in scaling the journey toward UHC goals. Therefore, this study will inform evidence-based policy development and practice to improve healthcare quality, access, and affordability globally through a symbiotic health entrepreneurial ecosystem. This study’s research questions are: a) How does health entrepreneurship contribute to improving access to healthcare services in Kenya and Ghana? b) What impact does health entrepreneurship have on the affordability of healthcare services in Kenya and Ghana? c) What are the primary challenges encountered by health entrepreneurs in the healthcare sectors of Kenya and Ghana? d) What are the primary potential opportunities for health entrepreneurs in the healthcare sectors of Kenya and Ghana? Methods Study Aim, Design, and Setting The study aimed to conduct a comparative analysis of health entrepreneurship's role in advancing Universal Health Coverage (UHC) within two distinct metropolitan areas: Eldoret in Kenya and Kumasi in Ghana. While employing a descriptive design and a survey strategy, the study collected primary data from health entrepreneurs operating within these settings. The questionnaire was developed specifically for this study to explore key constructs such as accessibility, affordability, challenges, and opportunities for health entrepreneurship. An English version of the questionnaire is provided as a supplementary file. This comparative framework enabled an in-depth examination of the contextual differences and similarities in health entrepreneurship and their implications for UHC delivery in Kenya and Ghana. Eldoret and Kumasi host major referral hospitals—Moi Teaching and Referral Hospital and Komfo Anokye Teaching Hospital, respectively—supported by vibrant entrepreneurial ecosystems offering services such as drug dispensation, curative outpatient and inpatient care, laboratory and diagnostic services, home-based care, medical equipment sales, and multiservice provision. These cities' diverse health service landscapes provide a real-world context for analyzing the role of health entrepreneurship in Universal Health Coverage delivery. Participants Participants in this study included health entrepreneurs from both metropolitan regions, totaling 168 respondents—84 from Eldoret District- Kenya, and 84 from Kumasi District- Ghana. These participants own and run healthcare-related setups, including private clinics, pharmacies, diagnostic centers, medical equipment suppliers, and other health service enterprises. Kumasi district in Ghana and Eldoret district in Kenya were selected for this study based on their comparative similarities in population characteristics, socio-economic structures, public health structures, and healthcare infrastructure. Both cities carry key metropolitan areas with similar urbanization trends. A self-administered questionnaire was used to collect data, targeting key constructs such as demographic information, Access to Healthcare Services, Affordability of Healthcare Services, Challenges Faced by Health Entrepreneurs, and Potential Opportunities for Health Entrepreneurs. The primary authors developed the questionnaire based on a literature review and expert consultation to ensure relevance to the study objectives. Respondents indicated their levels of agreement with the under-listed statements on a 5-point Likert scale by choosing from a scale of 1 (strongly disagree) to 5 (strongly agree). (1-strongly disagree, 2-disagree, 3- Neutral, 4-agree, and 5-strongly agree). Accessibility was defined by the ease with which clients get healthcare services, including physical proximity to the health facility, operational hours, and availability of essential healthcare infrastructure. Affordability was defined as the extent to which care services are financially accessible without putting clients through individual hardships, assessed through pricing architecture, flexibility of payment options, and integration of insurance schemes to care delivery. Moreover, challenges refer to the barriers health entrepreneurs face during their healthcare delivery, while opportunities are the factors that irrigate growth, innovation, and service scale-up for health entrepreneurs. Non-probability purposive sampling was employed, supplemented by convenience sampling to accommodate logistical constraints and facilitate timely data collection. Statistical Analysis Data were analyzed on the Statistical Package for Social Sciences (SPSS) version 27.0, combining descriptive and inferential statistical methods. Descriptive statistics, including central tendency and variability measures, summarized the responses' demographic characteristics and key findings. Cronbach's alpha was calculated to assess the internal consistency of the survey items and ensure reliability. On piloting, the Cronbach’s Alpha values were 0.830, 0.744, 0.862, and 0.911 for Access to Healthcare Services, Affordability of Healthcare Services, Challenges Faced by Health Entrepreneurs, and Potential Opportunities for Health Entrepreneurs constructs, respectively. Further, inferential statistical analyses were conducted to compare the two settings. An independent (comparing the means of two independent groups) t-test was utilized to compare the mean scores when the data met parametric assumptions, while for variables that did not meet normality assumptions, a Mann-Whitney U test was performed as a non-parametric alternative, comparing ranks between the two groups. Confirmatory Factor Analysis (CFA) was conducted using Analysis of Moment Structures (AMOS) software to assess the validity and reliability of the data collection tool and evaluate the measurement model. CFA was employed to assess the construct validity of the key latent variables (Accessibility, Affordability, Challenges, and Opportunities). The model fit was evaluated using standard goodness-of-fit indices. The analysis yielded a Chi-square minimum discrepancy (CMIN) value of 316.833, with 146 degrees of freedom (DF), resulting in a probability level of .000. In this analysis, the CMIN/DF value was approximately 2.17, which falls within the commonly accepted range of 2 to 3 for indicating a reasonable model fit [8]. The study used Root Mean Square Error of Approximation (RMSEA) to evaluate the model fit further. The RMSEA value for the default model was 0.080 (RMSEA > 0.05), with a 90% confidence interval ranging from 0.071 to 0.096. These values suggest that the model demonstrates a reasonable fit to the data. However, it does not meet the criteria for a close fit, typically indicated by an RMSEA value of 0.05 or lower. An RMSEA between .06 and .08 reflects an acceptable fit, while values above 0.10 indicate a poor fit [9]. The RMSEA values are provided in Table 1. Table 1 Root Mean Square Error of Approximation Model RMSEA LO 90 HI 90 PCLOSE Default model 0.084 0.071 0.096 0.000 Independence model 0.120 0.110 0.130 0.000 Note: * CMIN/DF= 2.17 Results Demographic Information In Kenya, the majority of healthcare entrepreneurs were aged 26–35 years (44, 52.38%), followed by those aged 36–45 years (19, 22.63%) and 18–25 years (18, 21.43%). Only a small percentage were above 45 years (3, 3.57%). Gender distribution was evenly split between female (42, 50.00%) and male (42, 50.00%). Most participants had been in healthcare entrepreneurship for 1–3 years (34, 40.48%), followed by 4–6 years (29, 34.52%). The remaining participants had either been in healthcare entrepreneurship for 7–10 years (11, 13.10%), less than 1 year (6, 7.14%), or more than 10 years (4, 4.76%). Drug dispensation (50, 59.52%) was the most common service provided, followed by curative out-patient care (18, 21.43%), and laboratory and diagnostic services (7, 8.33%). A majority were not accredited by private or social health insurance programs (50, 60.98%), while a smaller percentage were accredited (32, 39.02%) (See Table 2 ). In Ghana, the majority of healthcare entrepreneurs were aged 26–35 years (36, 42.85%), followed by 18–25 years (23, 27.38%) and 36–45 years (20, 23.81%). A smaller group was above 45 years (5, 5.95%). Gender distribution was predominantly male (51, 60.71%), with fewer female entrepreneurs (33, 39.29%). Most participants had been in health entrepreneurship for 1–3 years (32, 38.10%), followed by 4–6 years (28, 33.33%), and 7–10 years (12, 14.29%), with the remaining having been in healthcare entrepreneurship for less than 1 year (6, 7.14%) or more than 10 years (6, 7.14%). Drug dispensation (37, 44.05%) was the most common service provided, with multi-service provision (21, 25.00%) following. Most entrepreneurs were accredited by private or social health insurance programs (74, 88.10%), while a minority were not accredited (10, 11.91%). (See Table 2 ). Table 2 Demographic information Ghana Kenya Variable Categories Frequency Percentage Frequency Percentage a Age 26–35 36 42.86 44 52.38 36–45 20 23.81 19 22.62 18–25 23 27.38 18 21.43 Above 45 5 5.95 3 3.57 Gender* Male 51 60.71 42 50.00 Female 33 39.29 42 50.00 a No. of years in Health Entrepreneurship 1–3 32 38.10 34 40.48 4–6 28 33.33 29 34.52 7–10 12 14.29 11 13.10 Less than 1 6 7.14 6 7.14 More than 10 6 7.14 4 4.76 a Insurance Accreditation Yes 74 88.10 34 40.48 No 10 11.90 50 59.52 Type of Health Service Provided* Frequency Ghana Kenya Drug dispensation 37 50 Home-based care 1 3 Curative outpatient care 16 18 Curative inpatient care 3 2 Lab and diagnostic services 6 7 Medical equipment sales 3 2 End of life care 0 0 Preventive care 0 0 Rehabilitative care 0 0 Multiservice provision ( Ticked more than one service provided ) 21 22 The demographic analysis revealed notable similarities and some variations between Kenya and Ghana. In both countries, the mean age of health entrepreneurs was identical, standing at 2.08 years (on a normalized scale). However, Ghana showed slightly more variation in age, with a standard deviation (SD) of 0.876, compared to Kenya’s SD of 0.764, indicating a more diverse age range among Ghana participants than Kenya. The average number of years in health entrepreneurship was marginally higher in Ghana (2.76 years) than in Kenya (2.68 years). This experience spread was also broader in Ghana (SD = 1.075) compared to Kenya (SD = 0.959), suggesting that Ghana's health entrepreneurs include newer entrants and more seasoned professionals. In contrast, Kenya's participants displayed a more concentrated range of experience. An independent t-test comparing the ages of health entrepreneurs between the two settings revealed no statistically significant difference (t = 0.00, p = 1.0000), confirming that the age profiles of both groups are essentially the same. Similarly, a t-test comparing the years in health entrepreneurship found no significant difference between Kenya and Ghana (t = -0.54, p = 0.5871). However, there was a significant difference in insurance accreditation levels, with Kenya having slightly higher levels than Ghana (t = 7.59, p = 0.0000). Gender distribution between the two countries was also analyzed, and a chi-square test revealed no significant difference (χ² = 0.20, p = 0.6550). This indicates that the gender balance among health entrepreneurs in Kenya and Ghana is similar, with both countries showing comparable participation rates for men and women. A chi-square test was conducted to compare the types of services provided between the two countries, showing no statistically significant difference in the distribution of service types between Kenya and Ghana (χ² = 38.12, p = 0.6550). *Note: List of Abbreviations ACC - Accessibility (in context, a variable), AFF - Affordability (in context, a variable), CHA - Challenges (in context, a variable), and OPP - Opportunities (in context, a variable). Access to Healthcare Services Table 3 summarizes access to healthcare services in Ghana and Kenya, addressing the first research question. Table 3 Access to Healthcare Services Ghana Kenya X̅ σ X̅ σ ACC1 My healthcare enterprise has all essential health commodities and equipment. 3.51 1.15 3.92 1.00 ACC2 My enterprise has significantly reduced the geographical barriers to accessing healthcare services. 3.76 1.12 3.80 1.21 ACC3 My facility is near my target population; they stay within a 5 km radius of the facility. 3.81 1.21 3.77 1.07 ACC4 Most of my clients incur transport costs to access services from our enterprise. 3.14 1.25 3.30 1.25 ACC5 My enterprise adopts innovative approaches to delivering healthcare services, such as mobile-based applications, to reach clients. 3.61 1.26 3.88 1.25 ACC6 The services I offer are acceptable in my target society per societal and cultural norms. 4.33 0.91 4.62 0.58 ACC7 There is a sufficient skilled workforce for my healthcare enterprise. 4.12 1.01 4.58 0.62 Note: X̅- Mean; σ- Standard deviation Table 4 presents the weighted averages of accessibility scores for Kenya and Ghana. Weighted averages were applied to give a balanced comparison between Kenya and Ghana, considering the relative importance of different accessibility indicators. Weighted averaging reduces bias from extreme values and provides a standardized measure of accessibility across both study settings. Kenya consistently showed higher accessibility scores across most variables, with the highest score observed in ACC6 (4.84), which reflects entrepreneurs' perception of service availability. Ghana, while slightly lower, still displayed notable accessibility, with the highest score in ACC6 as well. Table 4 Weighted average Comparison of accessibility Accessibility Variable Kenya (Weighted Average) Ghana (Weighted Average) ACC1 4.16 3.76 ACC2 4.25 4.05 ACC3 4.00 4.24 ACC4 3.44 3.16 ACC5 4.44 3.99 ACC6 4.84 4.61 ACC7 4.81 4.48 Kenya exhibited slightly higher accessibility scores overall, with a weighted average of 4.16 compared to Ghana's 3.76. The most significant difference was observed in ACC5 and ACC7, which reflect service availability and effectiveness, with Kenya showing higher scores in these areas. An independent t-test was conducted to determine if there was a statistically significant difference in accessibility scores between health entrepreneurs in Kenya and Ghana. The results yielded a t-statistic of 0.91 and a p-value of 0.38 (p > 0.05), indicating that the difference in accessibility scores was not statistically significant. Both countries exhibit similar levels of accessibility to healthcare services. Affordability of Healthcare Services Table 5 summarizes the affordability of healthcare services in Ghana and Kenya, addressing the second research question. Table 5 Affordability of Healthcare Services Ghana Kenya X̅ σ X̅ σ AFF1 My healthcare enterprise offers affordable healthcare services to the community. 4.24 1.00 4.61 0.69 AFF2 Accreditation with health insurance does not help reduce the overall cost of care for my clients. 2.90 1.23 2.72 1.47 AFF3 My enterprise provides flexible payment options to ensure affordability for patients/ clients. 3.77 1.09 4.17 0.98 AFF4 My clients in long-term care or long-term service continually visit my services without defaulting on the grounds of inability to afford them. 3.779 1.18 3.83 1.12 Note: X̅- Mean; σ- Standard deviation Table 6 presents the weighted averages of affordability scores for Kenya and Ghana. Kenya exhibited slightly higher affordability scores overall, with the highest score observed in AFF1 (4.61), indicating a solid perception of affordability, while Ghana's highest score was in AFF1 (4.24). Table 6 Weighted average Comparison of affordability Affordability Variable Kenya (Weighted Average) Ghana (Weighted Average) AFF1 4.61 4.24 AFF2 2.41 2.88 AFF3 4.57 4.05 AFF4 4.18 4.18 Kenya demonstrated a higher perceived affordability of healthcare services, with a weighted average score of 4.57 compared to Ghana's 4.05. Health entrepreneurs in Kenya reported more affordable services in most affordability variables, though both countries showed relatively high perceptions of affordability. A Mann-Whitney U test was conducted to determine if there was a statistically significant difference in affordability scores between health entrepreneurs in Kenya and Ghana. The results yielded a U-statistic of 10.5 and a p-value of 0.561 (p > 0.05), indicating no statistically significant difference in affordability between the two countries. Both countries demonstrated similar levels of perceived affordability. Challenges Faced by Health Entrepreneurs Table 7 outlines the challenges faced by healthcare entrepreneurs, addressing the third research question. Table 7 Challenges Faced by Health Entrepreneurs Ghana Kenya X̅ σ X̅ σ CHA1 Regulatory hurdles are a significant challenge for my healthcare enterprise. 3.15 1.10 3.19 1.22 CHA2 Access to funding is not a significant obstacle for health entrepreneurs. 2.42 1.24 2.52 1.18 CHA3 Government policies, including taxation, are conducive to health entrepreneurship. 2.75 1.37 2.75 1.56 CHA4 My target clients/population is receptive to innovative means of service delivery, including technology-based innovations. 3.81 1.10 3.90 1.09 Note: X̅- Mean; σ- Standard deviation In this comparative analysis between Kenya and Ghana, the cluster analysis and boxplot findings reveal distinct patterns of challenges and opportunities. For Ghana (represented by Cluster 0), the respondents face significant challenges, with high median values for CHA2 (1.27) and CHA3 (0.86), indicating that issues such as infrastructure and operational hurdles are prominent. The boxplot visualizations confirm that Ghanaian respondents experience wide variability in these challenges. Opportunities, however, are mixed, with OPP4 showing a moderate median (0.42), while OPP3 has a negative median (-0.32), suggesting that despite the challenges, opportunities for growth or expansion are somewhat limited in Ghana. In contrast, Kenya (represented by Clusters 1 and 2) exhibits a different pattern. Cluster 1 shows fewer perceived challenges, with a low median for CHA3 (-1.20), indicating that respondents in Kenya face fewer operational difficulties compared to their Ghanaian counterparts. Opportunities are more positive, with OPP1 having a high median (0.93), reflecting a more optimistic outlook on entrepreneurial opportunities. However, Cluster 2 in Kenya highlights a group that faces significant challenges, particularly in CHA1 (0.72) and CHA4 (1.05), but also perceives fewer opportunities, as indicated by negative medians for OPP1 (-1.51) and OPP2 (-1.85). This comparative analysis underscores that while Kenya offers more perceived opportunities, certain groups still face notable challenges, especially compared to Ghana. Figure 1 depicts the distribution of challenges among health entrepreneurs in a box plot. Potential Opportunities for Health Entrepreneurs Table 8 presents the opportunities available for health entrepreneurs, addressing the fourth research question. Table 8 Potential Opportunities for Health Entrepreneurs Ghana Kenya X̅ σ X̅ σ OPP1 There are significant growth opportunities for health entrepreneurs in my country. 3.87 1.13 3.85 1.34 OPP2 The adoption of innovative technologies presents new opportunities for my healthcare enterprise. 4.18 0.96 3.88 1.22 OPP3 Partnerships with other healthcare providers can enhance the services offered by my enterprise. 4.29 0.90 4.27 0.86 OPP4 There is no growing demand for healthcare services that my enterprise can fulfil. 2.37 1.22 2.48 1.50 Note : X̅- Mean; σ- Standard deviation Figure 2 illustrates the distribution opportunities identified in the study in a box plot. Discussion Health entrepreneurship plays a critical role in expanding health accessibility. Similar to these findings, there has been evidence that entrepreneurial innovations are essential to overcoming the physical and geographical barriers to access to care in sub-Saharan Africa [ 10 , 11 ]. Low resource settings, such as Kenya and Ghana, within a young age of embracing entrepreneurial models to draw solutions ought to leverage on technology to bridge the geographical divide, especially through the application of mobile health and telemedicine arena, therefore improving reach and convenience for underserved and vulnerable populations. Studies established mobile applications, including the application of MYDAWA in Kenya, have been critical in advancing HIV prophylaxis delivery, affirming the need for innovative digital solutions to expand access in both rural and urban areas [ 12 ]. There is a divergence of literature on the sustainability of these accessibility models to improve access over time. mHealth innovation models, despite enhancing physical access, often face limitations mostly related to infrastructural deficiencies, including limited internet access and electricity access in rural sub-Saharan Africa and other low and middle-income countries across the globe [ 13 , 14 ]. The limitations are mirrored in Kenya’s accessibility scores, which, despite being high, highlight variability fueled by resource deficiencies in remote areas. Conversely, Ghana’s community-based health model, focused more on local and in-person care delivery, leverages community health volunteers to reach rural and vulnerable populations, suggesting more sustainability, unlike reliance on a tech-centric model. Kenya’s microinsurance models are critical in expanding affordability, especially within the informal sector, which makes up a significant part of the population. In most low- and middle-income countries, microinsurance schemes have been critical in mitigating financial burdens within the healthcare space, a finding consistent with this study [ 15 ]. Affordable insurance options accommodate a wider population segment that wants to access healthcare services at a lower cost, similar to what is highlighted in this study. On the contrary, it has been established that in some settings, micro-insurance schemes aren’t enough to significantly reduce out-of-pocket costs for most low-income households, especially in Sub-Saharan Africa [ 16 ]. High taxation and operation costs exacerbate affordability concerns by pushing the financial burden on the health entrepreneurs and the subsequent end person, the client [ 17 ]. While health entrepreneurship is established to increase affordability, systemic financial barriers and policy inadequacies hinder the extent of its impact, causing higher financial constraints in most settings, including in Ghana. Health entrepreneurs face similar challenges in low- and middle-income countries. Similar to these findings, Khandelwal et al. [ 18 ] established that they face regulatory hurdles, limited funding opportunities and high statutory taxation. The bureaucratic landscape that health entrepreneurs ought to scale, especially in sub-Saharan Africa, pushes the cost of healthcare further, making it unaffordable for low-income households, which make up the majority of the sub-Saharan population. Regulatory obstacles, including long licensing processes and complicated compliance prerequisites, impede profitability and growth, therefore limiting the sustainable growth of healthcare service providers. Kotzias et al. [ 19 ] established that public-private partnerships are key in addressing regulatory barriers and further creating an amble environment for health entrepreneurship. Initiatives in Ghana, including the National Entrepreneurship and Innovation Plan (NEIP), have been critical in making the policy environment in Ghana more favorable, unlike in Kenya. This program supports small businesses precisely through the provision of finances and technical support. However, despite the presence of supportive frameworks, operationalization is needed to ensure its success. As the globe gears towards the Universal Health Coverage Agenda 2030 and embraces sustainable solutions to bridge global problems, there are numerous opportunities for health entrepreneurs. Consistent with the findings of this study, Kaplinsky & Kraemer-Mbula [ 20 ] identified that health in low- and middle-income countries is ripe to drive entrepreneurial innovation to their larger underserved populations and unmet healthcare needs. The growing population, coupled with the rising burden of non-communicable diseases (NCDs) and improved diagnostic techniques, creates a conducive ecosystem for the growth and expansion of health entrepreneurship. With the expanding generational embrace of innovative technology, telemedicine and mobile health applications offer novel avenues to reach underserved populations. In the future, technology-based healthcare delivery will hold a significant opportunity for health entrepreneurs. Limitations and Future Studies This study was confined to a survey conducted within the urban setting of Kumasi, Ghana, and Eldoret, Kenya, as these locations were accessible and fit within the researcher's budget constraints. Consequently, the sampling frame did not include rural or peri-urban areas, limiting the generalizability of the findings across broader geographic and socio-economic contexts. Future studies are encouraged to extend the sampling frame to encompass rural communities and other regions, providing a more representative view of health entrepreneurship across varied settings. Additionally, the study’s findings are based on data from a sample of 168 respondents, primarily drawn from urban centers, which may not fully mirror the perspectives of all health entrepreneurs across both countries. As such, the generalization of these results ought to be done with wariness. For future replication, a larger and more diverse sample population could yield a broader insight of the entrepreneurial landscape in healthcare. This study applied non-probability sampling techniques, purposive and convenience sampling, due to logistical constraints and the need to target health entrepreneurs operating within the selected study settings. While these sampling techniques facilitated data collection from relevant participants, they may introduce selection bias, potentially limiting the broader applicability of these findings. Future research should consider using probability sampling techniques to enhance the results' representativeness and external validity. A cross-sectional design was employed, caping the study’s capacity to establish causality or observe changes over time. To address this, future studies could scale benefit from using longitudinal methods to track changes in health entrepreneurship and UHC outcomes, allowing for a deeper understanding of trends and shifts within this industry. Time and logistical constraints prevented a follow-up qualitative interview with participants. Consolidating qualitative methods could provide richer insights into health entrepreneurs’ experiences and contextual challenges, ameliorating the depth of understanding of this field in the future. Conclusion of the Study In conclusion, this study underscores and provides empirical evidence that health entrepreneurship is significant in the realization of Universal Health Coverage, not only in both study settings, Kenya and Ghana, but also in other settings globally. Through the findings of this study, healthcare entrepreneurs demonstrate their role and ability to expand access to care and ameliorate affordability by applying innovative care delivery approaches. A comparative analysis between Kenya and Ghana exhibits notable dissimilarity in health entrepreneurial ecosystems between the two study settings. While at the same time, Kenya has shown relatively higher levels of accessibility and affordability, reflecting a more enabling environment for health entrepreneurship, with a clearer characterization of the use of technology in care delivery. On the other hand, Ghana, while indicating more expanded affordability to care, faces more regulatory and funding challenges. The findings from these studies suggest tailored policies to address various constraints both healthcare entrepreneurs face in either setting to make enabling environments that can stimulate innovation, hence further improve access and affordability of care, thereby expanding Universal Health Coverage. Abbreviations ACC - Accessibility (in context, a variable), AFF - Affordability (in context, a variable), CHA - Challenges (in context, a variable), CMIN - Chi-square minimum discrepancy, DF- Degrees of Freedom, HIV- Human Immunodeficiency Virus, NCDs - Non-Communicable Diseases, OPP - Opportunities (in context, a variable), AMOS- Analysis of Moment Structures, RMSEA - Root Mean Square Error of Approximation, SD - Standard Deviation, and UHC- Universal Health Coverage. Declarations Ethics approval This study got ethical approval from Kwame Nkrumah University of Science and Technology-Humanities and Social Sciences Research Ethics Committee (KNUST-HuSSREC). Further, it was conducted in accordance with the ethical principles highlighted in the Belmont Report, which emphasize respect for persons, beneficence, and justice. Written informed consent was obtained from all participants before their involvement in the study, ensuring their rights, dignity, and confidentiality were upheld throughout the research process. Availability of data Data used in the study can be requested and sourced from the corresponding author. Competing interests Authors declare they have no competing interests. Funding This study received $600 in research facilitation funding as part of the Mastercard Foundation Africa Higher Education Health Collaborative (AHEHC) Scholarship for MSc—Health Entrepreneurship at Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Consent for Publication Not applicable, as no identifying images or personal/clinical details of participants were included in this study. Author contributions Brian Kipkoech (MSc Health Entrepreneurship student) was the primary researcher responsible for conceptualizing the study, conducting data collection, performing analysis, and drafting the manuscript. Dr. Martin Owusu-Ansah (supervisor) provided supervision throughout the research process, offering guidance in study design, data interpretation, and critical review of the manuscript. All authors read and approved the final manuscript. Acknowledgment I acknowledge the Africa Higher Education Health Collaborative (AHEHC) and the MasterCard Foundation for the scholarship opportunity to study for an MSc. Health Entrepreneurship. Further, we recognize Lameck Koibarak and Ernest Ankomah for their relentless effort during the data collection. Authors information Brian Kipkoech- https://orcid.org/0000-0002-9167-1728 Dr. Martin Owusu-Ansah- https://orcid.org/0000-0002-5005-5670 References Dzingirai M. 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J Healthcare. 2022;5(1):129-40. https://doi.org/10.36959/569/474 Khatri RB, Assefa Y. Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC public health. 2022 May 3;22(1):880. https://doi.org/10.1186/s12889-022-13256-z Lüdeke‐Freund F. Sustainable entrepreneurship, innovation, and business models: Integrative framework and propositions for future research. Business Strategy and the Environment. 2020 Feb;29(2):665-81. https://doi.org/10.1002/bse.2396 World Bank. Africa's Pulse, No. 28, October 2023: Delivering Growth to People through Better Jobs. https://doi.org/10.1596/978-1-4648-2043-4 Nur L, Disman D, Ahman E, Hendrayati H, Budiman A. Measuring Lecturer Motivation Scales: A Second-Order Confirmatory Factor Analysis (CFA). In6th Global Conference on Business, Management, and Entrepreneurship (GCBME 2021) 2022 Jul 12 (pp. 391-397). Atlantis Press. https://doi.org/10.2991/aebmr.k.220701.074 McNeish D. Generalizability of dynamic fit index, equivalence testing, and Hu & Bentler cutoffs for evaluating fit in factor analysis. Multivariate Behavioral Research. 2023 Jan 2;58(1):195-219. https://doi.org/10.1080/00273171.2022.2163477 Cambaza E. The role of fintech in sustainable healthcare development in sub-saharan africa: a narrative review. FinTech. 2023 Jul 10;2(3):444-60. https://doi.org/10.3390/fintech2030025 Motiwala F, Ezezika O. Barriers to scaling health technologies in sub-Saharan Africa: lessons from Ethiopia, Nigeria, and Rwanda. African Journal of Science, Technology, Innovation and Development. 2022 Nov 10;14(7):1788-97. https://doi.org/10.1080/20421338.2021.1985203 Harris B, Ajisola M, Alam RM, Watkins JA, Arvanitis TN, Bakibinga P, Chipwaza B, Choudhury NN, Kibe P, Fayehun O, Omigbodun A. Mobile consulting as an option for delivering healthcare services in low-resource settings in low-and middle-income countries: A mixed-methods study. Digital Health. 2021 Aug;7:20552076211033425. https://doi.org/10.1177/20552076211033425 Aboye GT, Vande Walle M, Simegn GL, Aerts JM. mHealth in sub-Saharan Africa and Europe: A systematic review comparing the use and availability of mHealth approaches in sub-Saharan Africa and Europe. Digital health. 2023 Jun;9:20552076231180972. https://doi.org/10.1177/20552076231180972 Hampshire K, Mwase-Vuma T, Alemu K, Abane A, Munthali A, Awoke T, Mariwah S, Chamdimba E, Owusu SA, Robson E, Castelli M. Informal mhealth at scale in Africa: Opportunities and challenges. World development. 2021 Apr 1;140:105257. https://doi.org/10.1016/j.worlddev.2020.105257 Wondirad HA. The impacts of mobile insurance and microfinance institutions (MFIs) in Kenya. Journal of Banking and Financial Technology. 2020 Apr;4:95-110. https://doi.org/10.1007/s42786-020-00021-2 Loewe M. Micro-insurance. InHandbook on social protection systems 2021 Aug 10 (pp. 123-133). Edward Elgar Publishing. https://doi.org/10.4337/9781839109119.00023 Loewenson R, Mukumba C. Tax justice for universal public sector health systems in East and Southern Africa. https://doi.org/10.1136/bmjgh-2023-011820 Khandelwal R, Kolte A, Rossi M. A study on entrepreneurial opportunities in digital health-care post-Covid-19 from the perspective of developing countries. foresight. 2022 Apr 29;24(3/4):527-44. https://doi.org/10.1108/fs-02-2021-0043 Kotzias K, Bukhsh FA, Arachchige JJ, Daneva M, Abhishta A. Industry 4.0 and healthcare: Context, applications, benefits and challenges. Iet Software. 2023 Jun;17(3):195-248. https://doi.org/10.1049/sfw2.12074 Kaplinsky R, Kraemer-Mbula E. Innovation and uneven development: The challenge for low-and middle-income economies. Research Policy. 2022 Mar 1;51(2):104394. https://doi.org/10.1016/j.respol.2021.104394 Additional Declarations No competing interests reported. Supplementary Files QUESTIONNAREKipkoechBrian.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Jun, 2025 Reviewers agreed at journal 06 Jun, 2025 Reviewers invited by journal 06 Jun, 2025 Editor assigned by journal 06 Jun, 2025 Submission checks completed at journal 09 Apr, 2025 First submitted to journal 08 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5453580","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":440389532,"identity":"765583e8-0969-4ccd-9518-c56a124a3c56","order_by":0,"name":"Brian Kipkoech","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACAwbGBgaGAxIMDMyMjQ8+AEXY2InXwtxsOAOkhZmgFhA4ACLY26R5QDQhLebShxs/F5yxyDc4zthsbPNrmzwfMwPjh485uLVY9iU2S8+4IWG54TBj4+PcvtuGbcwMzJIzt+Fx2BnGBmmeDxIGBoeBtuT23GYEamFj5sWvpfk3VEubtGXPbXtitAB9fQOqheHH7USCWix7GNusec5IGEgCHWbY23A7uY2ZsRmvX8x52B/f5jlWZ8B3/vjDBz/+3Lad39588MNHPFpQAWMbmGwgVj0I/CFF8SgYBaNgFIwUAAA4x09rGmqJ4AAAAABJRU5ErkJggg==","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Brian","middleName":"","lastName":"Kipkoech","suffix":""},{"id":440389533,"identity":"ed541964-61fe-4d32-ab1e-847aac399ec1","order_by":1,"name":"Martin Owusu-Ansah","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"","lastName":"Owusu-Ansah","suffix":""}],"badges":[],"createdAt":"2024-11-14 11:38:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5453580/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5453580/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81340743,"identity":"e706dadb-504d-497d-89f1-28652c7ef57c","added_by":"auto","created_at":"2025-04-25 03:12:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18618,"visible":true,"origin":"","legend":"\u003cp\u003eBoxplot of Challenges Faced by Health Entrepreneurs\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5453580/v1/c38a879bc1fc0a7ae8f0429c.png"},{"id":81340972,"identity":"12007344-f680-41dd-ad33-74304d3d244f","added_by":"auto","created_at":"2025-04-25 03:20:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17246,"visible":true,"origin":"","legend":"\u003cp\u003eBox Plot of Potential Opportunities for Health Entrepreneurs\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5453580/v1/edd987f14ab81c09231f32ec.png"},{"id":81696014,"identity":"ad7f82d1-5dad-4a53-8631-668ba5f5fa57","added_by":"auto","created_at":"2025-04-30 12:09:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1053248,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5453580/v1/d278eae2-e847-4e49-accb-034cbf260e3e.pdf"},{"id":81341498,"identity":"7d0dc6ed-bc14-499f-be20-36bb4475c6d4","added_by":"auto","created_at":"2025-04-25 03:28:26","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":3969884,"visible":true,"origin":"","legend":"","description":"","filename":"QUESTIONNAREKipkoechBrian.docx","url":"https://assets-eu.researchsquare.com/files/rs-5453580/v1/ae0d2b5f54196f4ab2f93f64.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health Entrepreneurship in Universal Health Coverage Delivery: Evidence from Emerging Economies","fulltext":[{"header":"Background","content":"\u003cp\u003eIn December 2012, the United Nations made a commitment to global health and foreign policy that urged member countries to accelerate efforts towards Universal Health Coverage (UHC)\u0026mdash;that everyone, everywhere, ought to have access to quality healthcare at an affordable cost. There have been discussions on its universality and access, especially in low and middle-income countries whose infrastructural and financial muscle to implement this is weaker [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNotably, universal health coverage aims for all populations to access quality healthcare without exposure to financial hardship from expensive out-of-pocket payments for the services [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Access to quality care is made of various dimensions. Physical accessibility includes the availability of quality health systems within reach to communities with much ease of appointment and attendance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Further, financial affordability is critical, emphasizing the measure of the population's capacity to pay for healthcare services without risk of financial hardships. Precisely this considers the pricing of the healthcare services and indirect costs that can be incurred when exploring access, including the cost of transport to the healthcare facilities and time away from productive work [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Lastly, acceptability is informed by the population's willingness to seek service, which is affected by various social and cultural factors that inform health-seeking behavior [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHealth entrepreneurship is critical for expanding access to and achieving universal health coverage. Health entrepreneurs are individuals or organizations who take financial risks to develop innovative and sustainable business models to deliver quality healthcare services and products to populations in various contexts [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Wholistically, health entrepreneurship is the application of innovative, sustainable, and market-driven approaches by individuals or entities to address healthcare challenges and improve access, affordability, and quality of care within diverse health systems. In recent developments, there has been an embrace of technology in access to care, especially the application of telemedicine to deliver care to remote and underserved populations.\u003c/p\u003e \u003cp\u003eThe achievement of Universal Health Coverage remains a significant challenge for many countries, especially the low- and middle-income countries, most within sub-Saharan Africa. Kenya and Ghana, holding a GDP of USD 113.4\u0026nbsp;billion and USD 73.77\u0026nbsp;billion in 2022, respectively, are classified as lower middle-income countries by the World Bank [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Further, with much dependence on donor funding, the budgetary allocation towards healthcare within both settings is limited. In 2023/24, Kenya allocated 11% of her budget (USD 1.27\u0026nbsp;billion) on health, while Ghana allocated 6.7% (USD 2.4\u0026nbsp;billion) to health [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Notably, both fall below the Abuja Declaration of 2001, pledged by the African Union to allocate at least 15% of the annual budget to health. The novelty of health entrepreneurship fits timely towards the achievement of expanded coverage. While the traditional approaches to healthcare delivery have made significant efforts towards improving access to care, there has been a consistent need to address the ever-changing, diverse, and dynamic population needs. It is vital to understand the role of health entrepreneurship in UHC realization to inform the paradigm shift and capacity building critical for developing innovative approaches to care, expanded access, and delivery of cost-effective care to diverse populations. Even though Kenya and Ghana hold a space of exploration in health entrepreneurship in sub-Saharan Africa, both settings present uniquely distinct variations in strengths and challenges. Moreover, although Kenya and Ghana are both located in sub-Saharan Africa, they are geographically distant, with differing geographical conditions. However, they share similarities in economic structures, political frameworks, and health infrastructure, while also exhibiting distinct difference in disease burden and policy architecture. A juxtaposed analysis of the similarities and differences through a comparative evaluation gave a valuable understanding of contextual factors that shape and dictate the implementation and effectiveness of health entrepreneurship in scaling the journey toward UHC goals. Therefore, this study will inform evidence-based policy development and practice to improve healthcare quality, access, and affordability globally through a symbiotic health entrepreneurial ecosystem. This study\u0026rsquo;s research questions are: a) How does health entrepreneurship contribute to improving access to healthcare services in Kenya and Ghana? b) What impact does health entrepreneurship have on the affordability of healthcare services in Kenya and Ghana? c) What are the primary challenges encountered by health entrepreneurs in the healthcare sectors of Kenya and Ghana? d) What are the primary potential opportunities for health entrepreneurs in the healthcare sectors of Kenya and Ghana?\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Aim, Design, and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study aimed to conduct a comparative analysis of health entrepreneurship\u0026apos;s role in advancing Universal Health Coverage (UHC) within two distinct metropolitan areas: Eldoret in Kenya and Kumasi in Ghana. While employing a descriptive design and a survey strategy, the study collected primary data from health entrepreneurs operating within these settings. The questionnaire was developed specifically for this study to explore key constructs such as accessibility, affordability, challenges, and opportunities for health entrepreneurship. An English version of the questionnaire is provided as a supplementary file. This comparative framework enabled an in-depth examination of the contextual differences and similarities in health entrepreneurship and their implications for UHC delivery in Kenya and Ghana.\u003c/p\u003e\n\u003cp\u003eEldoret and Kumasi host major referral hospitals\u0026mdash;Moi Teaching and Referral Hospital and Komfo Anokye Teaching Hospital, respectively\u0026mdash;supported by vibrant entrepreneurial ecosystems offering services such as drug dispensation, curative outpatient and inpatient care, laboratory and diagnostic services, home-based care, medical equipment sales, and multiservice provision. These cities\u0026apos; diverse health service landscapes provide a real-world context for analyzing the role of health entrepreneurship in Universal Health Coverage delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in this study included health entrepreneurs from both metropolitan regions, totaling 168 respondents\u0026mdash;84 from Eldoret District- Kenya, and 84 from Kumasi District- Ghana. These participants own and run healthcare-related setups, including private clinics, pharmacies, diagnostic centers, medical equipment suppliers, and other health service enterprises. Kumasi district in Ghana and Eldoret district in Kenya were selected for this study based on their comparative similarities in population characteristics, socio-economic structures, public health structures, and healthcare infrastructure. Both cities carry key metropolitan areas with similar urbanization trends. A self-administered questionnaire was used to collect data, targeting key constructs such as demographic information, Access to Healthcare Services, Affordability of Healthcare Services, Challenges Faced by Health Entrepreneurs, and Potential Opportunities for Health Entrepreneurs. The primary authors developed the questionnaire based on a literature review and expert consultation to ensure relevance to the study objectives. Respondents indicated their levels of agreement with the under-listed statements on a 5-point Likert scale by choosing from a scale of 1 (strongly disagree) to 5 (strongly agree). (1-strongly disagree, 2-disagree, 3- Neutral, 4-agree, and 5-strongly agree).\u003c/p\u003e\n\u003cp\u003eAccessibility was defined by the ease with which clients get healthcare services, including physical proximity to the health facility, operational hours, and availability of essential healthcare infrastructure. Affordability was defined as the extent to which care services are financially accessible without putting clients through individual hardships, assessed through pricing architecture, flexibility of payment options, and integration of insurance schemes to care delivery. Moreover, challenges refer to the barriers health entrepreneurs face during their healthcare delivery, while opportunities are the factors that irrigate growth, innovation, and service scale-up for health entrepreneurs. \u0026nbsp; Non-probability purposive sampling was employed, supplemented by convenience sampling to accommodate logistical constraints and facilitate timely data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed on the Statistical Package for Social Sciences (SPSS) version 27.0, combining descriptive and inferential statistical methods. Descriptive statistics, including central tendency and variability measures, summarized the responses\u0026apos; demographic characteristics and key findings. Cronbach\u0026apos;s alpha was calculated to assess the internal consistency of the survey items and ensure reliability. On piloting, the Cronbach\u0026rsquo;s Alpha values were 0.830, 0.744, 0.862, and 0.911 for Access to Healthcare Services, Affordability of Healthcare Services, Challenges Faced by Health Entrepreneurs, and Potential Opportunities for Health Entrepreneurs constructs, respectively.\u003c/p\u003e\n\u003cp\u003eFurther, inferential statistical analyses were conducted to compare the two settings. An independent (comparing the means of two independent groups) t-test was utilized to compare the mean scores when the data met parametric assumptions, while for variables that did not meet normality assumptions, a Mann-Whitney U test was performed as a non-parametric alternative, comparing ranks between the two groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConfirmatory Factor Analysis (CFA) was conducted using Analysis of Moment Structures (AMOS) software to assess the validity and reliability of the data collection tool and evaluate the measurement model. CFA was employed to assess the construct validity of the key latent variables (Accessibility, Affordability, Challenges, and Opportunities). The model fit was evaluated using standard goodness-of-fit indices. The analysis yielded a Chi-square minimum discrepancy (CMIN) value of 316.833, with 146 degrees of freedom (DF), resulting in a probability level of .000. In this analysis, the CMIN/DF value was approximately 2.17, which falls within the commonly accepted range of 2 to 3 for indicating a reasonable model fit\u0026nbsp;[8].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study used Root Mean Square Error of Approximation (RMSEA) to evaluate the model fit further. The RMSEA value for the default model was 0.080 (RMSEA \u0026gt; 0.05), with a 90% confidence interval ranging from 0.071 to 0.096. These values suggest that the model demonstrates a reasonable fit to the data. However, it does not meet the criteria for a close fit, typically indicated by an RMSEA value of 0.05 or lower. An RMSEA between .06 and .08 reflects an acceptable fit, while values above 0.10 indicate a poor fit\u0026nbsp;[9]. The RMSEA values are provided in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eRoot Mean Square Error of Approximation\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"607\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9967%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv align=\"center\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3168%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRMSEA\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv align=\"center\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLO 90\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv align=\"center\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.4422%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHI 90\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv align=\"center\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7624%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCLOSE\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv align=\"center\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9967%;\"\u003e\n \u003cp\u003eDefault model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3168%;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4818%;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.4422%;\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7624%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9967%;\"\u003e\n \u003cp\u003eIndependence model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3168%;\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.4818%;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.4422%;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7624%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: * CMIN/DF= 2.17\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eDemographic Information\u003c/h2\u003e\n \u003cp\u003eIn Kenya, the majority of healthcare entrepreneurs were aged 26\u0026ndash;35 years (44, 52.38%), followed by those aged 36\u0026ndash;45 years (19, 22.63%) and 18\u0026ndash;25 years (18, 21.43%). Only a small percentage were above 45 years (3, 3.57%). Gender distribution was evenly split between female (42, 50.00%) and male (42, 50.00%). Most participants had been in healthcare entrepreneurship for 1\u0026ndash;3 years (34, 40.48%), followed by 4\u0026ndash;6 years (29, 34.52%). The remaining participants had either been in healthcare entrepreneurship for 7\u0026ndash;10 years (11, 13.10%), less than 1 year (6, 7.14%), or more than 10 years (4, 4.76%). Drug dispensation (50, 59.52%) was the most common service provided, followed by curative out-patient care (18, 21.43%), and laboratory and diagnostic services (7, 8.33%). A majority were not accredited by private or social health insurance programs (50, 60.98%), while a smaller percentage were accredited (32, 39.02%) (See Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eIn Ghana, the majority of healthcare entrepreneurs were aged 26\u0026ndash;35 years (36, 42.85%), followed by 18\u0026ndash;25 years (23, 27.38%) and 36\u0026ndash;45 years (20, 23.81%). A smaller group was above 45 years (5, 5.95%). Gender distribution was predominantly male (51, 60.71%), with fewer female entrepreneurs (33, 39.29%). Most participants had been in health entrepreneurship for 1\u0026ndash;3 years (32, 38.10%), followed by 4\u0026ndash;6 years (28, 33.33%), and 7\u0026ndash;10 years (12, 14.29%), with the remaining having been in healthcare entrepreneurship for less than 1 year (6, 7.14%) or more than 10 years (6, 7.14%). Drug dispensation (37, 44.05%) was the most common service provided, with multi-service provision (21, 25.00%) following. Most entrepreneurs were accredited by private or social health insurance programs (74, 88.10%), while a minority were not accredited (10, 11.91%). (See Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eDemographic information\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eGhana\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKenya\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbove 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eNo. of years in Health Entrepreneurship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMore than 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eInsurance Accreditation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Health Service Provided*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eGhana\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eKenya\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrug dispensation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHome-based care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurative outpatient care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurative inpatient care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLab and diagnostic services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical equipment sales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnd of life care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreventive care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRehabilitative care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiservice provision (\u003cem\u003eTicked more than one service provided\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eThe demographic analysis revealed notable similarities and some variations between Kenya and Ghana. In both countries, the mean age of health entrepreneurs was identical, standing at 2.08 years (on a normalized scale). However, Ghana showed slightly more variation in age, with a standard deviation (SD) of 0.876, compared to Kenya\u0026rsquo;s SD of 0.764, indicating a more diverse age range among Ghana participants than Kenya. The average number of years in health entrepreneurship was marginally higher in Ghana (2.76 years) than in Kenya (2.68 years). This experience spread was also broader in Ghana (SD\u0026thinsp;=\u0026thinsp;1.075) compared to Kenya (SD\u0026thinsp;=\u0026thinsp;0.959), suggesting that Ghana\u0026apos;s health entrepreneurs include newer entrants and more seasoned professionals. In contrast, Kenya\u0026apos;s participants displayed a more concentrated range of experience.\u003c/p\u003e\n \u003cp\u003eAn independent t-test comparing the ages of health entrepreneurs between the two settings revealed no statistically significant difference (t\u0026thinsp;=\u0026thinsp;0.00, p\u0026thinsp;=\u0026thinsp;1.0000), confirming that the age profiles of both groups are essentially the same. Similarly, a t-test comparing the years in health entrepreneurship found no significant difference between Kenya and Ghana (t = -0.54, p\u0026thinsp;=\u0026thinsp;0.5871). However, there was a significant difference in insurance accreditation levels, with Kenya having slightly higher levels than Ghana (t\u0026thinsp;=\u0026thinsp;7.59, p\u0026thinsp;=\u0026thinsp;0.0000).\u003c/p\u003e\n \u003cp\u003eGender distribution between the two countries was also analyzed, and a chi-square test revealed no significant difference (\u0026chi;\u0026sup2; = 0.20, p\u0026thinsp;=\u0026thinsp;0.6550). This indicates that the gender balance among health entrepreneurs in Kenya and Ghana is similar, with both countries showing comparable participation rates for men and women. A chi-square test was conducted to compare the types of services provided between the two countries, showing no statistically significant difference in the distribution of service types between Kenya and Ghana (\u0026chi;\u0026sup2; = 38.12, p\u0026thinsp;=\u0026thinsp;0.6550).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003e*Note: List of Abbreviations\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eACC - Accessibility (in context, a variable), AFF - Affordability (in context, a variable), CHA - Challenges (in context, a variable), and OPP - Opportunities (in context, a variable).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eAccess to Healthcare Services\u003c/h3\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes access to healthcare services in Ghana and Kenya, addressing the first research question.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003eAccess to Healthcare Services\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tabc\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGhana\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKenya\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX̅\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026sigma;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX̅\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026sigma;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMy healthcare enterprise has all essential health commodities and equipment.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMy enterprise has significantly reduced the geographical barriers to accessing healthcare services.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMy facility is near my target population; they stay within a 5 km radius of the facility.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMost of my clients incur transport costs to access services from our enterprise.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMy enterprise adopts innovative approaches to delivering healthcare services, such as mobile-based applications, to reach clients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe services I offer are acceptable in my target society per societal and cultural norms.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThere is a sufficient skilled workforce for my healthcare enterprise.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003eX̅- Mean; \u0026sigma;- Standard deviation\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003epresents the weighted averages of accessibility scores for Kenya and Ghana. Weighted averages were applied to give a balanced comparison between Kenya and Ghana, considering the relative importance of different accessibility indicators. Weighted averaging reduces bias from extreme values and provides a standardized measure of accessibility across both study settings. Kenya consistently showed higher accessibility scores across most variables, with the highest score observed in ACC6 (4.84), which reflects entrepreneurs\u0026apos; perception of service availability. Ghana, while slightly lower, still displayed notable accessibility, with the highest score in ACC6 as well.\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv align=\"\" class=\"colspec\"\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Weighted average Comparison of accessibility\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tabd\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAccessibility Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKenya (Weighted Average)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGhana (Weighted Average)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eACC7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eKenya exhibited slightly higher accessibility scores overall, with a weighted average of 4.16 compared to Ghana\u0026apos;s 3.76. The most significant difference was observed in ACC5 and ACC7, which reflect service availability and effectiveness, with Kenya showing higher scores in these areas.\u003c/p\u003e\n\u003cp\u003eAn independent t-test was conducted to determine if there was a statistically significant difference in accessibility scores between health entrepreneurs in Kenya and Ghana. The results yielded a t-statistic of 0.91 and a p-value of 0.38 (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that the difference in accessibility scores was not statistically significant. Both countries exhibit similar levels of accessibility to healthcare services.\u003c/p\u003e\n\u003ch3\u003eAffordability of Healthcare Services\u003c/h3\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e summarizes the affordability of healthcare services in Ghana and Kenya, addressing the second research question.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u0026nbsp;\u003c/strong\u003eAffordability of Healthcare Services\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tabe\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGhana\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKenya\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX̅\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026sigma;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX̅\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026sigma;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFF1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMy healthcare enterprise offers affordable healthcare services to the community.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFF2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAccreditation with health insurance does not help reduce the overall cost of care for my clients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFF3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMy enterprise provides flexible payment options to ensure affordability for patients/ clients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFF4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMy clients in long-term care or long-term service continually visit my services without defaulting on the grounds of inability to afford them.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003eX̅- Mean; \u0026sigma;- Standard deviation\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e presents the weighted averages of affordability scores for Kenya and Ghana. Kenya exhibited slightly higher affordability scores overall, with the highest score observed in AFF1 (4.61), indicating a solid perception of affordability, while Ghana\u0026apos;s highest score was in AFF1 (4.24).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u0026nbsp;\u003c/strong\u003eWeighted average Comparison of affordability\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tabf\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAffordability Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKenya (Weighted Average)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGhana (Weighted Average)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFF1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFF2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFF3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFF4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eKenya demonstrated a higher perceived affordability of healthcare services, with a weighted average score of 4.57 compared to Ghana\u0026apos;s 4.05. Health entrepreneurs in Kenya reported more affordable services in most affordability variables, though both countries showed relatively high perceptions of affordability.\u003c/p\u003e\n\u003cp\u003eA Mann-Whitney U test was conducted to determine if there was a statistically significant difference in affordability scores between health entrepreneurs in Kenya and Ghana. The results yielded a U-statistic of 10.5 and a p-value of 0.561 (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating no statistically significant difference in affordability between the two countries. Both countries demonstrated similar levels of perceived affordability.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eChallenges Faced by Health Entrepreneurs\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e outlines the challenges faced by healthcare entrepreneurs, addressing the third research question.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 7\u0026nbsp;\u003c/strong\u003eChallenges Faced by Health Entrepreneurs\u003c/p\u003e\n \u003ctable id=\"Tabg\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGhana\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKenya\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX̅\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026sigma;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX̅\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026sigma;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHA1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRegulatory hurdles are a significant challenge for my healthcare enterprise.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHA2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAccess to funding is not a significant obstacle for health entrepreneurs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHA3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment policies, including taxation, are conducive to health entrepreneurship.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHA4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMy target clients/population is receptive to innovative means of service delivery, including technology-based innovations.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNote:\u0026nbsp;\u003c/strong\u003eX̅- Mean; \u0026sigma;- Standard deviation\u003c/p\u003e\n \u003cp\u003eIn this comparative analysis between Kenya and Ghana, the cluster analysis and boxplot findings reveal distinct patterns of challenges and opportunities. For Ghana (represented by Cluster 0), the respondents face significant challenges, with high median values for CHA2 (1.27) and CHA3 (0.86), indicating that issues such as infrastructure and operational hurdles are prominent. The boxplot visualizations confirm that Ghanaian respondents experience wide variability in these challenges. Opportunities, however, are mixed, with OPP4 showing a moderate median (0.42), while OPP3 has a negative median (-0.32), suggesting that despite the challenges, opportunities for growth or expansion are somewhat limited in Ghana.\u003c/p\u003e\n \u003cp\u003eIn contrast, Kenya (represented by Clusters 1 and 2) exhibits a different pattern. Cluster 1 shows fewer perceived challenges, with a low median for CHA3 (-1.20), indicating that respondents in Kenya face fewer operational difficulties compared to their Ghanaian counterparts. Opportunities are more positive, with OPP1 having a high median (0.93), reflecting a more optimistic outlook on entrepreneurial opportunities. However, Cluster 2 in Kenya highlights a group that faces significant challenges, particularly in CHA1 (0.72) and CHA4 (1.05), but also perceives fewer opportunities, as indicated by negative medians for OPP1 (-1.51) and OPP2 (-1.85). This comparative analysis underscores that while Kenya offers more perceived opportunities, certain groups still face notable challenges, especially compared to Ghana. Figure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the distribution of challenges among health entrepreneurs in a box plot.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003ePotential Opportunities for Health Entrepreneurs\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e presents the opportunities available for health entrepreneurs, addressing the fourth research question.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 8\u0026nbsp;\u003c/strong\u003ePotential Opportunities for Health Entrepreneurs \u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tabh\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGhana\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKenya\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX̅\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026sigma;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX̅\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026sigma;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOPP1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThere are significant growth opportunities for health entrepreneurs in my country.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOPP2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe adoption of innovative technologies presents new opportunities for my healthcare enterprise.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOPP3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartnerships with other healthcare providers can enhance the services offered by my enterprise.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOPP4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThere is no growing demand for healthcare services that my enterprise can fulfil.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e: X̅- Mean; \u0026sigma;- Standard deviation\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the distribution opportunities identified in the study in a box plot.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eHealth entrepreneurship plays a critical role in expanding health accessibility. Similar to these findings, there has been evidence that entrepreneurial innovations are essential to overcoming the physical and geographical barriers to access to care in sub-Saharan Africa [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Low resource settings, such as Kenya and Ghana, within a young age of embracing entrepreneurial models to draw solutions ought to leverage on technology to bridge the geographical divide, especially through the application of mobile health and telemedicine arena, therefore improving reach and convenience for underserved and vulnerable populations. Studies established mobile applications, including the application of MYDAWA in Kenya, have been critical in advancing HIV prophylaxis delivery, affirming the need for innovative digital solutions to expand access in both rural and urban areas [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is a divergence of literature on the sustainability of these accessibility models to improve access over time. mHealth innovation models, despite enhancing physical access, often face limitations mostly related to infrastructural deficiencies, including limited internet access and electricity access in rural sub-Saharan Africa and other low and middle-income countries across the globe [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The limitations are mirrored in Kenya’s accessibility scores, which, despite being high, highlight variability fueled by resource deficiencies in remote areas. Conversely, Ghana’s community-based health model, focused more on local and in-person care delivery, leverages community health volunteers to reach rural and vulnerable populations, suggesting more sustainability, unlike reliance on a tech-centric model.\u003c/p\u003e \u003cp\u003eKenya’s microinsurance models are critical in expanding affordability, especially within the informal sector, which makes up a significant part of the population. In most low- and middle-income countries, microinsurance schemes have been critical in mitigating financial burdens within the healthcare space, a finding consistent with this study [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Affordable insurance options accommodate a wider population segment that wants to access healthcare services at a lower cost, similar to what is highlighted in this study. On the contrary, it has been established that in some settings, micro-insurance schemes aren’t enough to significantly reduce out-of-pocket costs for most low-income households, especially in Sub-Saharan Africa [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. High taxation and operation costs exacerbate affordability concerns by pushing the financial burden on the health entrepreneurs and the subsequent end person, the client [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. While health entrepreneurship is established to increase affordability, systemic financial barriers and policy inadequacies hinder the extent of its impact, causing higher financial constraints in most settings, including in Ghana.\u003c/p\u003e \u003cp\u003eHealth entrepreneurs face similar challenges in low- and middle-income countries. Similar to these findings, Khandelwal \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] established that they face regulatory hurdles, limited funding opportunities and high statutory taxation. The bureaucratic landscape that health entrepreneurs ought to scale, especially in sub-Saharan Africa, pushes the cost of healthcare further, making it unaffordable for low-income households, which make up the majority of the sub-Saharan population. Regulatory obstacles, including long licensing processes and complicated compliance prerequisites, impede profitability and growth, therefore limiting the sustainable growth of healthcare service providers. Kotzias \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] established that public-private partnerships are key in addressing regulatory barriers and further creating an amble environment for health entrepreneurship. Initiatives in Ghana, including the National Entrepreneurship and Innovation Plan (NEIP), have been critical in making the policy environment in Ghana more favorable, unlike in Kenya. This program supports small businesses precisely through the provision of finances and technical support. However, despite the presence of supportive frameworks, operationalization is needed to ensure its success.\u003c/p\u003e \u003cp\u003eAs the globe gears towards the Universal Health Coverage Agenda 2030 and embraces sustainable solutions to bridge global problems, there are numerous opportunities for health entrepreneurs. Consistent with the findings of this study, Kaplinsky \u0026amp; Kraemer-Mbula [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] identified that health in low- and middle-income countries is ripe to drive entrepreneurial innovation to their larger underserved populations and unmet healthcare needs. The growing population, coupled with the rising burden of non-communicable diseases (NCDs) and improved diagnostic techniques, creates a conducive ecosystem for the growth and expansion of health entrepreneurship. With the expanding generational embrace of innovative technology, telemedicine and mobile health applications offer novel avenues to reach underserved populations. In the future, technology-based healthcare delivery will hold a significant opportunity for health entrepreneurs.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Studies\u003c/h2\u003e \u003cp\u003eThis study was confined to a survey conducted within the urban setting of Kumasi, Ghana, and Eldoret, Kenya, as these locations were accessible and fit within the researcher's budget constraints. Consequently, the sampling frame did not include rural or peri-urban areas, limiting the generalizability of the findings across broader geographic and socio-economic contexts. Future studies are encouraged to extend the sampling frame to encompass rural communities and other regions, providing a more representative view of health entrepreneurship across varied settings. Additionally, the study’s findings are based on data from a sample of 168 respondents, primarily drawn from urban centers, which may not fully mirror the perspectives of all health entrepreneurs across both countries. As such, the generalization of these results ought to be done with wariness. For future replication, a larger and more diverse sample population could yield a broader insight of the entrepreneurial landscape in healthcare.\u003c/p\u003e \u003cp\u003eThis study applied non-probability sampling techniques, purposive and convenience sampling, due to logistical constraints and the need to target health entrepreneurs operating within the selected study settings. While these sampling techniques facilitated data collection from relevant participants, they may introduce selection bias, potentially limiting the broader applicability of these findings. Future research should consider using probability sampling techniques to enhance the results' representativeness and external validity.\u003c/p\u003e \u003cp\u003eA cross-sectional design was employed, caping the study’s capacity to establish causality or observe changes over time. To address this, future studies could scale benefit from using longitudinal methods to track changes in health entrepreneurship and UHC outcomes, allowing for a deeper understanding of trends and shifts within this industry. Time and logistical constraints prevented a follow-up qualitative interview with participants. Consolidating qualitative methods could provide richer insights into health entrepreneurs’ experiences and contextual challenges, ameliorating the depth of understanding of this field in the future.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusion of the Study","content":"\u003cp\u003eIn conclusion, this study underscores and provides empirical evidence that health entrepreneurship is significant in the realization of Universal Health Coverage, not only in both study settings, Kenya and Ghana, but also in other settings globally. Through the findings of this study, healthcare entrepreneurs demonstrate their role and ability to expand access to care and ameliorate affordability by applying innovative care delivery approaches. A comparative analysis between Kenya and Ghana exhibits notable dissimilarity in health entrepreneurial ecosystems between the two study settings.\u003c/p\u003e\u003cp\u003eWhile at the same time, Kenya has shown relatively higher levels of accessibility and affordability, reflecting a more enabling environment for health entrepreneurship, with a clearer characterization of the use of technology in care delivery. On the other hand, Ghana, while indicating more expanded affordability to care, faces more regulatory and funding challenges. The findings from these studies suggest tailored policies to address various constraints both healthcare entrepreneurs face in either setting to make enabling environments that can stimulate innovation, hence further improve access and affordability of care, thereby expanding Universal Health Coverage.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACC - Accessibility (in context, a variable), AFF - Affordability (in context, a variable), CHA - Challenges (in context, a variable), CMIN - Chi-square minimum discrepancy, DF- Degrees of Freedom, HIV- Human Immunodeficiency Virus, NCDs - Non-Communicable Diseases, OPP - Opportunities (in context, a variable), AMOS- Analysis of Moment Structures, RMSEA - Root Mean Square Error of Approximation, SD - Standard Deviation, and UHC- Universal Health Coverage. \u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study got ethical approval from Kwame Nkrumah University of Science and Technology-Humanities and Social Sciences Research Ethics Committee (KNUST-HuSSREC). Further, it was conducted in accordance with the ethical principles highlighted in the Belmont Report, which emphasize respect for persons, beneficence, and justice. Written informed consent was obtained from all participants before their involvement in the study, ensuring their rights, dignity, and confidentiality were upheld throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used in the study can be requested and sourced from the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received $600 in research facilitation funding as part of the Mastercard Foundation Africa Higher Education Health Collaborative (AHEHC) Scholarship for MSc\u0026mdash;Health Entrepreneurship at Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable, as no identifying images or personal/clinical details of participants were included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBrian Kipkoech (MSc Health Entrepreneurship student) was the primary researcher responsible for conceptualizing the study, conducting data collection, performing analysis, and drafting the manuscript. Dr. Martin Owusu-Ansah (supervisor) provided supervision throughout the research process, offering guidance in study design, data interpretation, and critical review of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI acknowledge the Africa Higher Education Health Collaborative (AHEHC) and the MasterCard Foundation for the scholarship opportunity to study for an MSc. Health Entrepreneurship. Further, we recognize Lameck Koibarak and Ernest Ankomah for their relentless effort during the data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBrian Kipkoech- https://orcid.org/0000-0002-9167-1728\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr. Martin Owusu-Ansah- https://orcid.org/0000-0002-5005-5670\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDzingirai M. Health financing challenges towards accomplishment of sustainable development goals. InHandbook of Research on Quality and Competitiveness in the Healthcare Services Sector 2023 (pp. 63-83). IGI Global. https://doi.org/10.4018/978-1-6684-8103-5.ch004 \u003c/li\u003e\n\u003cli\u003eDerkyi-Kwarteng AN, Agyepong IA, Enyimayew N, Gilson L. A narrative synthesis review of out-of-pocket payments for health services under insurance regimes: a policy implementation gap hindering universal health coverage in sub-Saharan Africa. International journal of health policy and management. 2021 Jul;10(7):443. https://doi.org/10.34172/ijhpm.2021.38 \u003c/li\u003e\n\u003cli\u003eFalchetta G, Hammad AT, Shayegh S. Planning universal accessibility to public health care in sub-Saharan Africa. Proceedings of the National Academy of Sciences. 2020 Dec 15;117(50):31760-9. https://doi.org/10.1073/pnas.2009172117 \u003c/li\u003e\n\u003cli\u003eObiero BO, Kagendo P. Financial and Geographic Barriers to Health Care Access in Kenya: The Quest towards Universal Health Coverage. J Healthcare. 2022;5(1):129-40. https://doi.org/10.36959/569/474 \u003c/li\u003e\n\u003cli\u003eKhatri RB, Assefa Y. Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC public health. 2022 May 3;22(1):880. https://doi.org/10.1186/s12889-022-13256-z \u003c/li\u003e\n\u003cli\u003eL\u0026uuml;deke‐Freund F. Sustainable entrepreneurship, innovation, and business models: Integrative framework and propositions for future research. Business Strategy and the Environment. 2020 Feb;29(2):665-81. https://doi.org/10.1002/bse.2396 \u003c/li\u003e\n\u003cli\u003eWorld Bank. Africa\u0026apos;s Pulse, No. 28, October 2023: Delivering Growth to People through Better Jobs. https://doi.org/10.1596/978-1-4648-2043-4 \u003c/li\u003e\n\u003cli\u003eNur L, Disman D, Ahman E, Hendrayati H, Budiman A. Measuring Lecturer Motivation Scales: A Second-Order Confirmatory Factor Analysis (CFA). In6th Global Conference on Business, Management, and Entrepreneurship (GCBME 2021) 2022 Jul 12 (pp. 391-397). Atlantis Press. https://doi.org/10.2991/aebmr.k.220701.074 \u003c/li\u003e\n\u003cli\u003eMcNeish D. Generalizability of dynamic fit index, equivalence testing, and Hu \u0026amp; Bentler cutoffs for evaluating fit in factor analysis. Multivariate Behavioral Research. 2023 Jan 2;58(1):195-219. https://doi.org/10.1080/00273171.2022.2163477 \u003c/li\u003e\n\u003cli\u003eCambaza E. The role of fintech in sustainable healthcare development in sub-saharan africa: a narrative review. FinTech. 2023 Jul 10;2(3):444-60. https://doi.org/10.3390/fintech2030025 \u003c/li\u003e\n\u003cli\u003eMotiwala F, Ezezika O. Barriers to scaling health technologies in sub-Saharan Africa: lessons from Ethiopia, Nigeria, and Rwanda. African Journal of Science, Technology, Innovation and Development. 2022 Nov 10;14(7):1788-97. https://doi.org/10.1080/20421338.2021.1985203 \u003c/li\u003e\n\u003cli\u003eHarris B, Ajisola M, Alam RM, Watkins JA, Arvanitis TN, Bakibinga P, Chipwaza B, Choudhury NN, Kibe P, Fayehun O, Omigbodun A. Mobile consulting as an option for delivering healthcare services in low-resource settings in low-and middle-income countries: A mixed-methods study. Digital Health. 2021 Aug;7:20552076211033425. https://doi.org/10.1177/20552076211033425 \u003c/li\u003e\n\u003cli\u003eAboye GT, Vande Walle M, Simegn GL, Aerts JM. mHealth in sub-Saharan Africa and Europe: A systematic review comparing the use and availability of mHealth approaches in sub-Saharan Africa and Europe. Digital health. 2023 Jun;9:20552076231180972. https://doi.org/10.1177/20552076231180972 \u003c/li\u003e\n\u003cli\u003eHampshire K, Mwase-Vuma T, Alemu K, Abane A, Munthali A, Awoke T, Mariwah S, Chamdimba E, Owusu SA, Robson E, Castelli M. Informal mhealth at scale in Africa: Opportunities and challenges. World development. 2021 Apr 1;140:105257. https://doi.org/10.1016/j.worlddev.2020.105257 \u003c/li\u003e\n\u003cli\u003eWondirad HA. The impacts of mobile insurance and microfinance institutions (MFIs) in Kenya. Journal of Banking and Financial Technology. 2020 Apr;4:95-110. https://doi.org/10.1007/s42786-020-00021-2 \u003c/li\u003e\n\u003cli\u003eLoewe M. Micro-insurance. InHandbook on social protection systems 2021 Aug 10 (pp. 123-133). Edward Elgar Publishing. https://doi.org/10.4337/9781839109119.00023 \u003c/li\u003e\n\u003cli\u003eLoewenson R, Mukumba C. Tax justice for universal public sector health systems in East and Southern Africa. https://doi.org/10.1136/bmjgh-2023-011820 \u003c/li\u003e\n\u003cli\u003eKhandelwal R, Kolte A, Rossi M. A study on entrepreneurial opportunities in digital health-care post-Covid-19 from the perspective of developing countries. foresight. 2022 Apr 29;24(3/4):527-44. https://doi.org/10.1108/fs-02-2021-0043 \u003c/li\u003e\n\u003cli\u003eKotzias K, Bukhsh FA, Arachchige JJ, Daneva M, Abhishta A. Industry 4.0 and healthcare: Context, applications, benefits and challenges. Iet Software. 2023 Jun;17(3):195-248. https://doi.org/10.1049/sfw2.12074 \u003c/li\u003e\n\u003cli\u003eKaplinsky R, Kraemer-Mbula E. Innovation and uneven development: The challenge for low-and middle-income economies. Research Policy. 2022 Mar 1;51(2):104394. https://doi.org/10.1016/j.respol.2021.104394 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"Universal health coverage, affordability, accessibility, Kenya, Ghana, Health entrepreneurship","lastPublishedDoi":"10.21203/rs.3.rs-5453580/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5453580/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003eUniversal health coverage aims for all populations to access quality healthcare without exposure to financial hardship from expensive out-of-pocket payments for the services. Health entrepreneurs are individuals or organizations who take financial risks to develop innovative and sustainable business models to deliver quality healthcare services and products to populations in various contexts. This study aimed to analyze the influence of health entrepreneurship on accelerating the progress towards the realization of universal health coverage in Kenya and Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThe research applied a cross-sectional, quantitative technique, survey design, and an explanatory analysis to understand the relationships between affordability and accessibility of healthcare services. The study's target respondents were health entrepreneurs running various healthcare services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe study found that health entrepreneurs in Kenya and Ghana contribute to healthcare accessibility and affordability in varying degrees. Accessibility scores highlighted no statistically significant difference between the two settings (t = 0.91, p = 0.38). Similarly, affordability differences were not statistically significant (U = 10.5, p = 0.561). Additionally, the study identified regulatory and financial constraints as key challenges faced by health entrepreneurs in both countries. The study established that opportunities exist in leveraging technology and expanding public-private partnerships to improve healthcare access and affordability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThis study underscores and provides empirical evidence that health entrepreneurship is significant in realizing Universal Health Coverage. Through this study's findings, healthcare entrepreneurs demonstrate their role in expanding access to care and ameliorating affordability by applying innovative care delivery approaches.\u003c/p\u003e","manuscriptTitle":"Health Entrepreneurship in Universal Health Coverage Delivery: Evidence from Emerging Economies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-25 03:12:21","doi":"10.21203/rs.3.rs-5453580/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-06-11T19:37:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202548206649251780802674151456414109798","date":"2025-06-06T13:14:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-06T13:02:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-06T13:02:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-09T04:25:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-04-08T08:42:25+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":"c1f5cde1-49e3-4367-aaae-751a31eb2369","owner":[],"postedDate":"April 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-06T13:08:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-25 03:12:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5453580","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5453580","identity":"rs-5453580","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}