Geospatial analysis of primary healthcare accessibility and qualitative assessment of affordability in rural communities of Twifo Ati-Morkwaa District, Ghana

Regardless of the efforts of the government and the private sector to improve health facilities in Ghana, a significant number of rural communities still experience inadequate access to primary healthcare. This study used the mixed-methods approach to provide an overview of the geographic distribution of healthcare facilities and the accessibility and affordability of primary healthcare within the Twifo Ati-Morkwaa District. Accessibility was assessed using Euclidean buffer analysis around primary healthcare facilities, while affordability was examined qualitatively using in-depth interviews and focus group discussions with community members, community leaders and health workers. Focus group discussions and interviews were conducted using the purposive sampling technique to select 97 respondents including community members, community leaders and healthcare personnel. Additionally, the Geographic Information System (GIS) software, specifically ArcGIS Pro, was used to analyze the spatial distribution of health facilities. The findings reveal that approximately 95% of sampled communities were located within 5 km of a primary healthcare facility based on straight-line distance; however, qualitative findings indicated that transport costs, poor road conditions, and physical barriers substantially constrained effective access. Furthermore, primary healthcare was found not to be affordable due to the high cost of transportation because of the poor nature of roads. Recommendations include government investment in road infrastructure to reduce transportation costs, thereby improving the affordability of primary healthcare and facilitating access to services. These findings bear important implications for achieving the health-related Sustainable Development Goals set forth by the United Nations.