Page 16 - IJPS-10-4

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

a study by Lattof (2017) revealed that the majority that internal migrants relied on divine interventions
(88%) of internal migrants who worked as head porters or higher religious powers when faced with health
were unaware of the procedures to register for health challenges. Many of the migrants sought or relied
insurance and did not know about NHIS registration on religious powers for relief, especially when facing
exemptions such as free antenatal and childbirth care. reproductive health challenges. They preferred to rely
on religion rather than seeking help from neighbors or
3.3.2. Coping strategies of internal migrants for their local health professionals in their new communities,
health needs due to concerns that local people would not care
Eleven studies (Akazili et al., 2018; Asaana, 2015; Baada enough to help them or keep their information
et al., 2021; Boateng, 2020; Nyarko & Tahiru, 2018; confidential.
Owusu-Ansah et al., 2016; Rizwan et al., 2022; Shamsu- (d) Taking a rest
Deen & Adadow, 2019; Sznajder et al., 2020; Teye, 2019; Another coping strategy identified was taking a rest
Yiran et al., 2015) reported on measures taken by internal without medication. A study by Nyarko & Tahiru
migrants to access and utilize healthcare at their present (2018) found that internal migrants with health
locations. Four sub-themes were identified. conditions would take some time off to recuperate and
(a) Local chemists, drug peddlers, and traditional healers then return to work without taking any medication.
Eleven articles (Akazili et al., 2018; Asaana, 2015; Most internal migrants neither bought drugs nor
Baada et al., 2021; Boateng, 2020; Nyarko & Tahiru, visited health facilities for assessment. They perceived
2018; Owusu-Ansah et al., 2016; Rizwan et al., 2022; visiting a hospital for medical care as irrelevant unless
Shamsu-Deen & Adadow, 2019; Sznajder et al., 2020; their condition was critical.
Teye, 2019; Yiran et al., 2015) reported that internal 3.3.3. Health system interventions and strategies
migrants often resort to traditional healers, local
chemists, and drug peddlers for herbal medicines to Recommendations on potential health system measures
treat their health conditions instead of seeking help and interventions to improve healthcare access for internal
from the formal health-care system. For instance, migrants were identified in six eligible studies (Akazili
a study by Asaana (2015) discovered that internal et al., 2018; Boateng, 2020; Boateng et al., 2017; Lattof,
migrants carried traditional medicines with them 2017; Owusu & Yeboah, 2018; Teye, 2019). Based on the
when they migrated to Kumasi (or other southern part findings, five sub-themes were identified.
of Ghana) to treat ailments such as malaria, back pain, (a) Reforming of the National Health Insurance Policy
and flu. It was revealed that they preferred the services Four articles (Akazili et al., 2018; Boateng, 2020; Boateng
of traditional healers because they are affordable and et al., 2017; Lattof, 2017) proposed that policymakers
allow for payment in installments when they do not should review the pooled pre-payment mechanisms,
have enough money (Akazili et al., 2018; Baada et such as community-based insurance schemes, for rural–
al., 2021). Our review discovered that most of these urban migration populations to improve the enrolment
traditional healers are from the north and can speak of migrants in the scheme. Our review recommended
the migrants’ northern dialects. implementing mobile van operations to bring NHIS
(b) Savings, borrowing, and selling properties services to slum areas where most of the internal
Borrowing or selling properties was a common source migrants live. It was, further, suggested that an effective
of finance for internal migrants to pay for their health- reimbursement system be put in place to promptly
care costs (Akazili et al., 2018; Boateng, 2020). This reimburse health-care providers. The authors argued
trend was most prevalent among internal migrants for an extension of the annual NHIS renewal period to
working in the informal sector, especially head porters. 5 years to reduce the financial and bureaucratic burdens
This review identified that limited avenues for health internal migrants face when trying to renew their
support often resulted in dependence on community insurance each year. To complement the function of the
groups and programs that encourage internal migrants NHIS, Akazili et al. (2018) suggested adopting a family
to save for their basic needs, including health-care health-care system, which would contain all relevant
expenditures. Thus, they often used savings meant health information for each family, enabling internal
for other essential needs, such as food and shelter, to migrants to access health services countrywide.
cover health-care expenses. (b) Restructuring primary health-care services and
(c) Supreme being as their healer political support
Another significant finding from three articles (Baada To address proximity challenges faced by internal
et al., 2021; Lattof, 2017; Rizwan et al., 2022) identified migrants, the articles argued for the establishment of

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