Date of Award
Doctor of Philosophy (PhD)
Professor David Ralph Matthews
Conventional health care services (CHCS) have failed to meet the health needs of many people in rural Ghana. Relevant literature highlights poverty, underdevelopment and inequities in allocation of resources as largely accountable. Currently in vogue and as a solution to these inequalities is the concept of comprehensive primary health care (CPHC) which implies community participation or "health by the people". Since its adoption and implementation, the CPHC strategy to health has not been successful in most of these rural communities, an issue that poses a new challenge to both "experts" and "students" of utilization studies.
In this study, funeral rites participation (as a sociocultural phenomenon) is used to examine the character and levels of use of CPHC services among the Dagaaba in the Upper West Region (UWR) of Ghana. Using a qualitative-ethnographic design to gather data, special emphasis is given to inter- and intra-gender variations in utilization patterns. The process of data analysis, like that of data collection, derives from grounded theory. This theory is especially suitable for determining health explanatory models of lay and professional people as well as for identifying which cultural beliefs and social norms influence healthcare practices.
Lack of viable economic activities in the UWR cause many able-bodied Dagaaba men to migrate. Over 50% of these migrants work in the minus where they fall victims to and die in epidemic proportions from new occupational accidents, injuries and diseases. The effects of such migrations and epidemic mortality of these men on the community's economic and social life are issues of great concern. Apart from the nutritional consequences of the socioeconomic deprivations, funeral rites, performed following death, have their impact on health. As part of a complex network of symbols and actions associated with life, health and illness, death rites redefine identities and inhibit the health seeking behaviour of participants of these rites. For instance, the symbolic structural and functional readjustments made, like "widow inheritance", in order to reach a new equilibrium and ensure continuity in the family inhibit the utilization behaviour of both the widow and the "heir". For them, the dead are actually not dead. Rather, they are transformed into a community of spirits (the "living-dead") policing and exerting influence on their behaviour in the human world.
Within the context of this belief system, the Dagaaba conceptualize and articulate the causes of most illnesses in terms of spiritual dysfunctions and/or relational fragmentations. Consequently, solutions to them are viewed in the context of spiritual renewal and relational reintegration. Healthcare is thus seen as a collective enterprise having little to do with the clinical reality of the individual and everything to do with the corporate interest of the community (the philosophy of N'taan be). In light of this, the study contends that to understand and facilitate utilization of CPHC services in the region (especially among the Dagaaba) we must depart from conventional models that explain services utilization in terms of macro-structure and micro-psychology. We must develop meso-models that identify with the meanings local people attach to ritual symbols and utilization actions.
Bagah, Daniel Anleu-Mwine, "Funeral Rites Participation and Health Services Utilization in Rural Ghana" (1995). Open Access Dissertations and Theses. Paper 2271.