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Healthcare 2017, 5(4), 80; https://doi.org/10.3390/healthcare5040080

Strengthening the Referral System through Social Capital: A Qualitative Inquiry in Ghana

1
Division of Graduate Studies and Asia Pacific Institute of Ageing Studies, Lingnan University, 8 Castle Peak Rd, Hong Kong, China
2
Department of Sociology and Social Policy, Lingnan University, Hong Kong, China
*
Author to whom correspondence should be addressed.
Academic Editor: Sampath Parthasarathy
Received: 12 June 2017 / Revised: 25 September 2017 / Accepted: 26 September 2017 / Published: 25 October 2017
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Abstract

The referral system in health care has been noted as very influential in determining which services are accessed and when. Nonetheless, existing studies have relied on specific measurable factors relating to health personnel, transportation and communication infrastructure, and finance to explain the challenges facing the referral policy in developing countries. While this is understandable, the role of social capital remains mostly uncharted even though it is implicit in the well-known lay referral system. Using various facets of the social capital concept, this paper empirically examines how the resources embedded in both structural and cognitive aspects of social relationships influence knowledge of, and adherence to, referral policy. This study is based on semi-structured in-depth interviews conducted with 79 adults in the Ashanti Region of Ghana in 2015. Of the 79 participants, 28 lived in urban areas and 51 in rural localities. Eight health personnel and eight community leaders also contributed to the study. Additionally, six focus group discussions were held. The findings indicated that both cognitive and structural forms of social capital considerably underpinned the ability and willingness of people to adhere to the referral process. Moreover, the role of social capital was double-barrelled. It contributed in a significant way to encouraging or dissuading potential patients from rightly embracing the policy. In addition, precepts of social capital reinforced both positive and adverse effects of the other determinants of the policy such as finance and transportation. However, the magnitude of such impact was linked to how ‘resourceful’ and ‘trustworthy’ one’s available social acquaintances were. The paper suggests that a cautious engagement with social capital will make it a potentially powerful tool for understanding the gaps in and improving the effectiveness of referral policy. View Full-Text
Keywords: health policy; healthcare; referral policy and pathways; social capital; Ghana health policy; healthcare; referral policy and pathways; social capital; Ghana
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Amoah, P.A.; Phillips, D.R. Strengthening the Referral System through Social Capital: A Qualitative Inquiry in Ghana. Healthcare 2017, 5, 80.

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