AccScience Publishing / IJPS / Online First / DOI: 10.36922/ijps.2314

Accessibility and utilization of health-care services among rural–urban migrants in Ghana: A scoping review

Godfred Otchere1 Samuel Egyakwa Ankomah2* Adam Fusheini1,3 Emmanuel Kumah4 Samuel Kofi Agyei5
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1 Department of Preventive and Social Medicine, Faculty of Medicine, University of Otago, Dunedin, Otago, New Zealand
2 Obstetrics and Gynaecology Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ashanti Region, Ghana
3 Public Service Department of New Zealand, Ministry of Social Development, Wellington, New Zealand
4 Department of Health Administration and Education, Faculty of Health, Allied Sciences and Home Economics Education, University of Education, Winneba, Central Region, Ghana
5 Department of Physician Assistant, Faculty of Health and Medical Sciences, Presbyterian University, Agogo, Ashanti Region, Ghana
Submitted: 26 November 2023 | Accepted: 13 March 2024 | Published: 10 July 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( )

Since the second half of the 20th century, internal migration patterns in Ghana have been dominated by movements from rural (or northern) to urban (or southern) areas. Numerous studies report wide socioeconomic gaps between the geographical north and south of Ghana, explaining the unidirectional movement in search of better opportunities. Differences in personal health profiles, values, and beliefs mean that internal migrants face a higher risk of ill health than urban natives. Compounding this issue is the barriers that impede their access to and utilization of health-care services. We synthesized evidence from existing literature to understand internal migrants’ access to and utilization of healthcare in Ghana, as well as their coping strategies. This review followed Arksey and O’Malley’s guidelines for conducting scoping reviews. We searched PubMed, EconLit, CINAHL, PsychINFO, and Medline (Ovid) electronic databases for studies published from January 2012 to June 2022. In addition, a manual literature search was conducted on Google by examining the reference lists of selected articles to identify other relevant studies. The majority of the studies (n = 12 [75%]) focused on female migrants, while 4 (25%) included both male and female migrants. This review identified several factors affecting access to health-care services for internal migrants in Ghana. These factors included infrastructural, financial, and language barriers, as well as long patient waiting times. Significantly, these barriers resulted in increased self-medication and self-diagnosis among internal migrants, leading to overall poor health outcomes. Based on the study findings, we propose a multidimensional approach to bridging the health access gap for internal migrants. This approach involves improving health system factors such as health service delivery, health workforce, availability of essential medicines, and health finance reforms to provide quality health-care services at affordable or no cost, while considering the socioeconomic and cultural conditions of the internal migrants.

Internal migrants
Health system

Abubakar, I., Aldridge, R.W., Devakumar, D., Orcutt, M., Burns, R., Barreto, M.L., et al. (2018). The UCL-Lancet Commission on Migration and Health: The health of a world on the move. The Lancet, 392(10164):2606-2654.


Adjei, P.O.W., & Buor, D. (2012). From poverty to poor health: Analysis of socio-economic pathways influencing health status in rural households of Ghana. Health Sociology Review, 21(2):232-241.


Afeadie, R.K. (2021). Rural-urban drift: Labour migration, health-seeking behaviour disparity in the urban slum of Madina, Ghana. Health Education, 121(4):337-355.


Akazili, J., Ataguba, J.E., Kanmiki, E.W., Gyapong, J., Sankoh, O., Oduro, A., et al. (2017). Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana. BMC International Health and Human Rights, 17(1):13.


Akazili, J., Chatio, S., Ataguba, J.E., Agorinya, I., Kanmiki, E.W., Sankoh, O., et al. (2018). Informal workers’ access to health care services: Findings from a qualitative study in the Kassena-Nankana districts of Northern Ghana. BMC International Health and Human Rights, 18(1):20.


Alfers, L. (2013). The Ghana National Health Insurance Scheme: Barriers to Access for Informal Workers. In: Women in Informal Employment Globalizing and Organizing Working Paper. Vol. 30, p.1-22.


Alhassan, R.K., Nketiah-Amponsah, E., & Arhinful, D.K. (2016). A review of the National Health Insurance Scheme in Ghana: What are the sustainability threats and prospects? PLoS One, 11(11):e0165151.


Amankwaa, A.A., Bavon, A., & Nkansah, P.T. (2003). Rural-urban migration and its effects on infant and child mortality in Ghana. African Population Studies, 18(2):1-26.


Amporfu, E., & Grépin, K.A. (2019). Measuring and explaining changing patterns of inequality in institutional deliveries between urban and rural women in Ghana: A decomposition analysis. International Journal for Equity in Health, 18(1):123.


Amrevurayire, E.O., & Ojeh, V.N. (2016). Consequences of rural-urban migration on the source region of Ughievwen clan Delta State Nigeria. European Journal of Geography, 7(3):42-57.


Ankomah, S.E., Fusheini, A., Ballard, C., Kumah, E., Gurung, G., & Derrett, S. (2021). Patient-public engagement strategies for health system improvement in sub-Saharan Africa: A systematic scoping review. BMC Health Services Research, 21(1):1047.


Apanga, P.A., & Adam, M.A. (2015). Factors influencing the uptake of family planning services in the Talensi District, Ghana. Pan African Medical Journal, 20(1):10.


Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1):19-32.


Aryeetey, R., Aikins, M., Dako-Gyeke, P., & Adongo, P.B. (2015). Pathways Utilized for antenatal health seeking among women in the Ga East District, Ghana. Ghana Medical Journal, 49(1):44-49.


Asaana, P. (2015). Migrant Health care Practices: The Perspectives of Women Head Porters in Kumasi, Ghana. Canada: University of Lethbridge.


Atun, R. (2012). Health systems, systems thinking and innovation. Health Policy and Planning, 27(Suppl 4):iv4-iv8.


Baada, J.N., Baruah, B., Sano, Y., & Luginaah, I. (2021). Mothers in a ‘Strange Land’: Migrant women farmers’ reproductive health in the brong-Ahafo Region of Ghana. Journal of Health Care for the Poor and Underserved, 32(2):910-930.


Badurdeen, S., Valladares, D.B., Farrar, J., Gozzer, E., Kroeger, A., Kuswara, N., et al. (2013). Sharing experiences: Towards an evidence based model of dengue surveillance and outbreak response in Latin America and Asia. BMC Public Health, 13(1):607.


Blanchet, N.J., Fink, G., & Osei-Akoto, I. (2012). The effect of Ghana’s national health insurance scheme on health care utilisation. Ghana Medical Journal, 46(2):76-84.


Boateng, S. (2020). Examining the health-seeking behaviours of migrant female head porters in the Kumasi Metropolis, Ghana. Social Education Research, 1(1):27-38.


Boateng, S., Amoako, P., Poku, A., Baabereyir, A., & Gyasi, R. (2017). Migrant female head porters’ enrolment in and utilisation and renewal of the National Health Insurance Scheme in Kumasi, Ghana. Journal of Public Health, 25(6):625-634.


Büchter, R.B., Weise, A., & Pieper, D. (2020). Development, testing and use of data extraction forms in systematic reviews: A review of methodological guidance. BMC Medical Research Methodology, 20(1):259.


Chambers, D., Simpson, L., Hill-Briggs, F., Neta, G., Vinson, C., Chambers, D., et al. (2016). Proceedings of the 8th annual conference on the science of dissemination and implementation: Washington, DC, USA. 14-15 December 2015. Implementation Science, 11(Suppl 2):100.


Cookson, R., Asaria, M., Ali, S., Ferguson, B., Fleetcroft, R., Goddard, M., et al. (2016). Health equity indicators for the English NHS: A longitudinal whole-population study at the small-area level. In: Health Services and Delivery Research. Vol. 4. Southampton, UK: NIHR Journals Library.


Cooper, W.O., Spain, D.A., Guillamondegui, O., Kelz, R.R., Domenico, H.J., Hopkins, J., et al. (2019). Association of coworker reports about unprofessional behavior by surgeons with surgical complications in their patients. JAMA Surgery, 154(9):828-834.


Dauvrin, M., & Lorant, V. (2014). Adaptation of health care for migrants: Whose responsibility? BMC Health Services Research, 14(1):294.


De Sanctis, V., Soliman, A.T., Daar, S., Di Maio, S., Elalaily, R., Fiscina, B., et al. (2020). Prevalence, attitude and practice of self-medication among adolescents and the paradigm of dysmenorrhea self-care management in different countries. Acta Bio Medica: Atenei Parmensis, 91(1):182.


Dick, E., & Schraven, B. (2018). Regional Migration Governance in Africa and Beyond: A Framework of Analysis. Discussion Paper.


Doshi, M., Lopez, W.D., Mesa, H., Bryce, R., Rabinowitz, E., Rion, R, et al. (2020). Barriers and facilitators to healthcare and social services among undocumented Latino (a)/Latinx immigrant clients: Perspectives from frontline service providers in Southeast Michigan. PLoS One, 15(6):e0233839.


Dzúrová, D., Winkler, P., & Drbohlav, D. (2014). Immigrants’ access to health insurance: No equality without awareness. International Journal of Environmental Research and Public Health, 11(7):7144-7153.


Eliason, S., Awoonor-Williams, J.K., Eliason, C., Novignon, J., Nonvignon, J., & Aikins, M. (2014). Determinants of modern family planning use among women of reproductive age in the Nkwanta district of Ghana: A case-control study. Reproductive Health, 11(1):65.


Etiaba, E., Onwujekwe, O., Uzochukwu, B., & Adjagba, A. (2015). Investigating payment coping mechanisms used for the treatment of uncomplicated malaria to different socio-economic groups in Nigeria. African Health Sciences, 15(1):42-48.


Farmer, D.B., Berman, L., Ryan, G., Habumugisha, L., Basinga, P., Nutt, C., et al. (2015). Motivations and constraints to family planning: A qualitative study in Rwanda’s Southern Kayonza District. Global Health Science and Practice, 3(2):242-254.


Fayehun, O., Ajisola, M., Uthman, O., Oyebode, O., Oladejo, A., Owoaje, E., et al. (2022). A contextual exploration of healthcare service use in urban slums in Nigeria. PLoS One, 17(2):e0264725.


Ferdous, M., Goopy, S., Yang, H., Rumana, N., Abedin, T., & Turin, T.C. (2020). Barriers to breast cancer screening among immigrant populations in Canada. Journal of Immigrant and Minority Health, 22(2):410-420.


Floyd, A., & Sakellariou, D. (2017). Healthcare access for refugee women with limited literacy: Layers of disadvantage. International Journal for Equity in Health, 16(1):195.


Ganle, J.K., Otupiri, E., Obeng, B., Edusie, A.K., Ankomah, A., & Adanu, R. (2016). Challenges women with disability face in accessing and using maternal healthcare services in Ghana: A qualitative study. PLoS One, 11(6):e0158361.


Ghana Statistical Service. (2013). 2010 Population and Housing Census: National Analytical Report. Ghana: Ghana Statistics Service.


Ghana Statistical Service. (2021). Ghana 2021 Population and Housing Census. General Report. Vol. 3E.


Ghana Statistical Service. (2023). Ghana 2021 Population and Housing Census. Thematic Report.


Gyasi, R.M., Asante, F., Yeboah, J.Y., Abass, K., Mensah, C.M., & Siaw, L.P. (2016). Pulled in or pushed out? Understanding the complexities of motivation for alternative therapies use in Ghana. International Journal of Qualitative Studies on Health and Well-being, 11:29667.


Hjelm, K., Albin, B., Benato, R., & Sourtzi, P. (2012). Migration and health. Nursing Research and Practice, 2012:1-2.


Jakič, M., & Pavlič, D.R. (2016). Patients’ perception of differences in general practitioners’ attitudes toward immigrants compared to the general population: Qualicopc Slovenia. Zdravstveno Varstvo, 55(3):155-165.


Joanna Briggs Institute. (2015). The Joanna Briggs Institute Reviewers’ Manual 2015: Methodology for JBI Scoping Reviews. Adelaide: The Joanna Briggs Institute, pp.6-22. Available from: uploads/2020/10/Scoping.pdf [Last accessed on 2023 Feb 26].


Kharitonov, S.A. (2012). Religious and spiritual biomarkers in both health and disease. Religions, 3(2):467-497.


Lattof, S. (2017). Migration and Health: A Mixed-Methods Study among Female Migrants in Accra. Ghana: Ghana London School of Economics and Political Science.


Lattof, S.R. (2018). Health insurance and care-seeking behaviours of female migrants in Accra, Ghana. Health Policy and Planning, 33(4):505-515.


Markova, V., & Sandal, G.M. (2016). Lay explanatory models of depression and preferred coping strategies among Somali refugees in Norway. A mixed-method study. Frontiers in Psychology, 7:1435.


Meyer-Weitz, A., & Komesuor J. (2023). Factors associated with mental health of internal migrants (Kayayei) in Agbogbloshie-Ghana. BMC Womens Health, 23(1):449.


Molyneux, S., Atela, M., Angwenyi, V., & Goodman, C. (2012). Community accountability at peripheral health facilities: A review of the empirical literature and development of a conceptual framework. Health Policy and Planning, 27(7):541-554.


Moyer, C.A., McLaren, Z.M., Adanu, R.M., & Lantz, P.M. (2013). Understanding the relationship between access to care and facility-based delivery through analysis of the 2008 Ghana demographic health survey. International Journal of Gynecology and Obstetrics, 122(3):224-229.


Munemo, P., Boateng, A., & Dako-Gyeke, M. (2021). Sociocultural and institutional constraints to family planning uptake among migrant female head porters in Madina, a Suburb of accra, Ghana. Affilia: Journal of Women and Social Work, 36(4):612-628.


National Health Insurance Regulations. (2004). Government of Ghana. National Health Insurance Regulations (L. I.1809). Accra, Ghana: GoG.


Nyarko, S.H., & Tahiru, A.M. (2018). Harsh working conditions and poor eating habits: Health-related concerns of female head porters (Kayayei) in the Mallam Atta Market, Accra, Ghana. BioMed Research International, 2018:6201837.


Okoro, R.N. (2019). Comparative analysis of private retail community pharmacies’ participation in the national health insurance scheme of Nigeria and Ghana: Implications for access to essential medicines. Ethiopian Journal of Health Sciences, 29(3):401-408.


Otu, E. (2019). Seasonal Geographical Access to Healthcare in Cross River State, Nigeria. England: The University of Sheffield.


Owusu, L., & Yeboah, T. (2018). Living conditions and social determinants of healthcare inequities affecting female migrants in Ghana. GeoJournal, 83(5):1005-1017.


Owusu-Ansah, F.E., Tagbor, H., & Togbe, M.A. (2016). Access to health in city slum dwellers: The case of Sodom and Gomorrah in Accra, Ghana. The African Journal of Primary Health and Family Medicine, 8(1):e1-e7.


Peters, M.D.J., Godfrey, C.M., McInerney, P., Soares, C.B., Khalil, H., & Parker, D. (2015). The Joanna Briggs Institute Reviewers’ Manual 2015: Methodology for JBI Scoping Reviews. Australia: The Joanna Briggs Institute.


Rizwan, L., Malagón, M., & Richter, S. (2022). Understanding the influence of Ghanaian women’s migration patterns on access to health care. Women, 2(1):30-43.


Robertshaw, L., Dhesi, S., & Jones, L.L. (2017). Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: A systematic review and thematic synthesis of qualitative research. BMJ Open, 7(8):e015981.


Rodney, A.M., & Hill, P.S. (2014). Achieving equity within universal health coverage: A narrative review of progress and resources for measuring success. International Journal for Equity in Health, 13(1):72.


Saeed, B.I.I., Yawson, A.E., Nguah, S., Agyei-Baffour, P., Emmanuel, N., & Ayesu, E. (2016). Effect of socio-economic factors in utilization of different healthcare services among older adult men and women in Ghana. BMC Health Services Research, 16(1):390.


Sahile, Y., Yitayih, S., Yeshanew, B., Ayelegne, D., & Mihiretu, A. (2019). Primary health care nurses attitude towards people with severe mental disorders in Addis Ababa, Ethiopia: A cross sectional study. International Journal of Mental Health Systems, 13(1):26.


Shamsu-Deen, Z., & Adadow, Y. (2019). Health-seeking behaviour among migrant female head porters in the City of Accra, Ghana. Ghana Journal of Development Studies, 16(2):138-138.


Sorensen, J., Norredam, M., Suurmond, J., Carter-Pokras, O., Garcia-Ramirez, M., & Krasnik, A. (2019). Need for ensuring cultural competence in medical programmes of European universities. BMC Medical Education, 19(1):21.


Sznajder, K.K., Winchester, M.S., Biney, A.A.E., Dodoo, N.D., Letsa, D., & Dodoo, F.N.A. (2020). The migration experience and differential risks to sexual and reproductive health in Ghana. Health Education and Behavior, 47(5):718-727.


Teye, A. (2019). Migrants’ and Non-Migrants’ Access and Use of Health Care in Ghana. University of Ghana, Legon, Accra. Unpublished Doctoral dissertation. gh/handle/123456789/36224 [Last accessed on 2024 Jul 09].


Thomson, M.S., Chaze, F., George, U., & Guruge, S. (2015). Improving immigrant populations’ access to mental health services in Canada: A review of barriers and recommendations. Journal of Immigrant and Minority Health, 17(6):1895-1905.


Tricco, A.C., Lillie, E., Zarin, W., O’Brien, K., Colquhoun, H., Kastner, M., et al. (2016). A scoping review on the conduct and reporting of scoping reviews. BMC Medical Research Methodology, 16:15.


UNICEF. (2018). Ghana Multiple Indicator Cluster Survey 2017/2018. United States: UNICEF.


United Nations High Commissioner for Refugees. (2017). Global Trends: Forced Displacement in 2016. Switzerland: UNHCR.


Unterrainer, H.F., Lewis, A.J., & Fink, A. (2014). Religious/ spiritual well-being, personality and mental health: A review of results and conceptual issues. Journal of Religion and Health, 53(2):382-392.


Van Bortel, T., Martin, S., Anjara, S., & Nellums, L.B. (2019). Perceived stressors and coping mechanisms of female migrant domestic workers in Singapore. PLoS One, 14(3):e0210717.


Wickramage, K., & Annunziata, G. (2018). Advancing health in migration governance, and migration in health governance. The Lancet, 392(10164):2528-2530.


Woofter, R., & Sudhinaraset, M. (2022). Differences in barriers to healthcare and discrimination in healthcare settings among undocumented immigrants by deferred action for childhood arrivals (DACA) status. Journal of Immigrant and Minority Health, 24:937-944.


World Health Organization. (2015). Tracking Universal Health Coverage: First Global Monitoring Report. Switzerland: World Health Organization.


World Health Organization. (2018). Maternal Health Care: Policies, Technical Standards and Services Accessibility in Eight Countries in the Western Pacific Region. Europe: WHO Regional Office for the Western Pacific.


Yiran, G.S.A., Teye, J.K., & Yiran, G.A.B. (2015). Accessibility and utilisation of maternal health services by migrant female head porters in Accra. Journal of International Migration and Integration, 16(4):929-945.


Ziblim, S.D. (2013). Travelling without goodbye: Coping strategies nexus of female independent migrants in Ghana. Research on Humanities and Social Sciences, 3(5):170-178.

Conflict of interest
The authors declare that there are no conflicts of interest regarding the publication of this paper.
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