Page 13 - IJPS-10-4

International Journal of
Population Studies Healthcare access and use among rural–urban migrants

particularly those who work as head porters (Akazili them from seeking healthcare. These delays have
et al., 2018; Asaana, 2015; Lattof, 2017; Munemo et influenced their health-seeking behaviors. Our review
al., 2021; Owusu & Yeboah, 2018; Yiran et al., 2015). identified that long waiting hours for medical care at
Specifically, a study by Owusu & Yeboah (2018) health facilities negatively affected internal migrants’
disclosed that some female internal migrants were daily productivity, as most of them work in the
reluctant to attend antenatal clinics because they informal sector, particularly in the head porterage
perceived health-care professionals as unfriendly business (Owusu & Yeboah, 2018; Yiran et al., 2015).
toward them due to their attire. Furthermore, this In addition, the articles reported that internal migrants
review revealed that some internal migrants at times risked losing their daily income or jobs if they had to
felt demeaned by health professionals due to their consistently visit health facilities for medical care.
migrant status, indicating differences in respect and (g) Influence of gender and sociocultural barriers
the quality of care they received. In addition, some Four articles (Baada et al., 2021; Munemo et al., 2021;
health professionals blamed them for their illnesses, Owusu & Yeboah, 2018; Rizwan et al., 2022) revealed
which affected their confidence in the health system that female internal migrants had to obtain permission
(Asaana, 2015). from the male head of their households before
(d) Adequacy of the National Health Insurance Scheme accessing reproductive health-care services. Our
Six articles (Akazili et al., 2018; Baada et al., 2021; review reported that cultural norms or customs affect
Boateng, 2020; Boateng et al., 2017; Lattof, 2017; Teye, women’s use of reproductive health services, such as
2019) described enrolment difficulties (such as long contraceptives, as they are obliged to seek consent
processing times, registration costs, and distance to from their male counterparts. Among the Dagaaba
the NHIS registration office) and the inadequacy of and Sissala of the Upper West Region (UWR), a study
the NHIS as barriers to health-care utilization among by Baada et al. (2021) described how the payment of
internal migrants in Ghana. For instance, a study by a bride price confers a woman’s reproductive rights to
Boateng (2017) found that despite the high (78.8%) her spouse. It was reported that internal migrants from
NHIS enrolment among internal migrants (specifically UWR still maintain this tradition, which limits their
head porters), 53.8% were unable to renew their ability to independently seek reproductive healthcare.
NHIS enrolment annually, which is required to access Another barrier discovered was the failure of health-
health-care services. It was also reported that internal care professionals to consider patients’ cultural values
migrants, who are not required to pay for health-care
services in the northern part of the country, are always and health practices, leading to negative health-seeking
asked to pay additional bills for health-care services in behavior among these migrant populations (Munemo
et al., 2021). Our review identified that cultural orientation
the south (Boateng et al., 2017).
(e) Linguistic barriers and perceptions of migrants have implications for their
health-seeking behavior. Thus, many internal migrants
This review found that most internal migrants could
only speak their local dialect and lacked confidence in only use formal health services when their health condition
their ability to communicate effectively to seek health- significantly deteriorates (Owusu & Yeboah, 2018).
care services (Lattof, 2017; Owusu & Yeboah, 2018; (h) Health illiteracy and ignorance of formal structures
Rizwan et al., 2022; Yiran et al., 2015). Many migrants for the National Health Insurance Scheme
have difficulties with the dominant languages (Twi Internal migrants’ level of knowledge and
and English) in southern Ghana. Health professionals, understanding of health information also affected
on the other, often do not comprehend the languages their utilization of healthcare in urban areas (Lattof,
spoken by the migrants, which affect effective 2017; Rizwan et al., 2022). Most of them were unaware
communication during diagnosis and the provision or uncertain about whether health insurance cards
of care. from the north (rural areas) could be used to access
(f) Time spent at the health facility for medical care healthcare in the south (urban areas) of Ghana (Teye,
While the availability of health services was not a 2019). It was reported that internal migrants were
problem for internal migrants in the south (urban unaware of the NHIS registration costs in Ghana.
areas), 8 articles (Akazili et al., 2018; Lattof, 2017; For example, Boateng et al. (2020) revealed that
Lattof, 2018; Munemo et al., 2021; Nyarko & Tahiru, some internal migrants believed that they needed to
2018; Owusu & Yeboah, 2018; Sznajder et al., 2020; save GHȻ 80 − 100 ($7.95 − $9.95) before they could
Yiran et al., 2015) reported that long queues and register with the NHIS, which far exceeds the actual
unnecessary waiting times at health facilities deterred GHȻ 25 − 30 ($2.5) NHIS registration fee. In addition,

Volume 10 Issue 4 (2024) 7 https://doi.org/10.36922/ijps.2314