| Cost structure as a barrier |
Formal clinicians require cash payment in full before treatment is rendered, whereas traditional healers typically allow installation payment and payment in goods. |
“When you go to a hospital, they ask you to pay an advance before they start treating you. But with the herbalist…he starts your treatment until a certain duration…But in the hospital, if you don’t have that money, they don’t help.” |
| “The nurse is insisting that they will not be attended to if they don’t pay their deposit for bed fee first. This can cause a patient to die easily since they have not been administered any treatment.” |
| Severity assessment as a barrier or facilitator |
Care decisions are heavily influenced by responder evaluations of severity. |
“It depends the gravity of the injury. Because let’s say if the, if the oil…instead of falling on his leg, it fell on the whole of his body, we would have taken him to the hospital immediately. Immediately!” |
| “You cannot stitch a wound in the house, or a traditional doctor cannot stitch a wound, yes. Or things like, you fell and broke your leg. That is, you feel like the bones are scattered inside. You will just rush to the hospital.” |
| Source of health care belief as a facilitator |
Public health campaigns and advice were cited as influencing the decision-making process. Respondents focused more on advice content rather than expertise of the advice provider. |
“And education, [the hospital] gives you education. They educate us, they tell us, ‘this one [illness] isn’t fine’…they take their time to tell us how diseases spread so that we can control them. They help us.” |
| “Medical personnel train us. They tell us, ‘If there is an accident and you can’t get a motortaxi quickly, this is what you should give them before you take the person to the hospital.… [Give them] pepper before you take them to the hospital’.… They are trained for both [traditional and formal medicine]. I heard him say he knows both. These Ghanaians, they know plenty about medical herbs.” |
| Use of multiple forms of care as a barrier or facilitator |
Paradigms of care include an acceptance of multiple (sequential or concurrent) use of formal and informal care. Formal care will frequently be used for diagnosis, and then care will be transitioned to traditional medicine for treatment. |
“Both [treatments] are fine.… Yes. If there is time for the hospital, we will try the hospital, if it works for you, you are lucky. If there is time for the hospital and it doesn’t work for you, go for the native medicine. If it isn’t the right case for the native doctor, he won’t try, you’ll go to the hospital. Yeah, you jambox [ie, meld or mesh] the two side. Yes.” |
| “Well, I just take it maximally, for the hospital is the hospital and…the man in the hospital is doctor, this is to say, is a specialist. And native doctor too is a specialist of different domains.… Yeah, because the doctor can use small machines on you, but with the herbalist, he has his own way of doing his own thing, his own uh, treatment.” |
