abstract: 'Policy analysis on why women and children in low- and middle-income

  settings are still disadvantaged by access to appropriate care despite

  Primary Health Care (PHC) programmes implementation is limited. Drawing

  on the street-level bureaucracy theory, we explored how and why

  frontline providers (FLP) actions on their own and in interaction with

  health system factors shape Ghana''s community-based PHC implementation

  to the disadvantage of women and children accessing and using health

  services. This was a qualitative study conducted in 4 communities drawn

  from rural and urban districts of the Upper West region. Data were

  collected from 8 focus group discussions with community informants, 73

  in-depth interviews with clients, 13 in-depth interviews with district

  health managers and FLP, and observations. Data were recorded,

  transcribed and coded deductively and inductively for themes with the

  aid of Nvivo 11 software. Findings showed that apart from FLP frequent

  lateness to, and absenteeism from work, that affected care seeking for

  children, their exercise of discretionary power in determining children

  who deserve care over others had ripple effects: families experienced

  financial hardships in seeking alternative care for children, and

  avoided that by managing symptoms with care provided in non-traditional

  spaces. FLP adverse behaviours were driven by weak implementation

  structures embedded in the district health systems. Basic obstetric

  facilities such as labour room, infusion stand, and beds for deliveries,

  detention and palpation were lacking prompting FLP to cope by conducting

  deliveries using a patchwork of improvised delivery methods which worked

  out to encourage unassisted home deliveries. Perceived poor conditions

  of service weakened FLP commitment to quality maternal and child care

  delivery. Findings suggest the need for strategies to induce behaviour

  change in FLP, strengthen district administrative structures, and

  improve on the supply chain and logistics system to address gaps in CHPS

  maternal and child care delivery.'
affiliation: 'Atinga, RA (Corresponding Author), Univ Ghana, Business Sch, Dept Publ
  Adm \& Hlth Serv Management, Box LG 78, Legon, Accra, Ghana.

  Atinga, Roger A., Univ Ghana, Business Sch, Dept Publ Adm \& Hlth Serv Management,
  Box LG 78, Legon, Accra, Ghana.

  Agyepong, Irene Akua, Ghana Hlth Serv, Res \& Dev Div, POB MB-190, Greats Accra
  Region, Ghana.

  Esena, Reuben K., Univ Ghana, Sch Publ Hlth, Dept Hlth Policy Planning \& Management,
  POB LG 13, Legon, Accra, Ghana.'
author: Atinga, Roger A. and Agyepong, Irene Akua and Esena, Reuben K.
author-email: 'ayimbillah@yahoo.com

  iagyepong@hotmail.com

  rkesena@hotmail.com'
author_list:
- family: Atinga
  given: Roger A.
- family: Agyepong
  given: Irene Akua
- family: Esena
  given: Reuben K.
da: '2023-09-28'
doi: 10.1016/j.socscimed.2018.02.001
eissn: 1873-5347
files: []
issn: 0277-9536
journal: SOCIAL SCIENCE \& MEDICINE
keywords: 'Women; Children; PHC; CHPS; Street bureaucrats; Frontline provider;

  Implementation; Ghana'
keywords-plus: 'MIDDLE-INCOME COUNTRIES; ALMA-ATA; MATERNAL HEALTH; SCALING-UP; POLICY;

  SERVICES; DELIVERY; PROGRAM; WORKERS; REBIRTH'
language: English
month: MAR
number-of-cited-references: '67'
orcid-numbers: 'Agyepong, Irene Akua/0000-0002-0193-5882

  Atinga, Roger/0000-0001-7724-4706'
pages: 27-34
papis_id: d23efe5641675eed84f8b7d0ba3ef216
ref: Atinga2018ghanascommunitybased
times-cited: '17'
title: 'Ghana''s community-based primary health care: Why women and children are `disadvantaged''
  by its implementation'
type: Article
unique-id: WOS:000431159800004
usage-count-last-180-days: '3'
usage-count-since-2013: '17'
volume: '201'
web-of-science-categories: 'Public, Environmental \& Occupational Health; Social Sciences,

  Biomedical'
year: '2018'