Evaluating Healthcare Access in Tema, Ghana : An Analysis of Perceived and Objective Access.

This study examines the mismatch between perceived and objective access to healthcare in Tema, Ghana, using the 5A Framework: Availability, Accessibility, Affordability, Acceptability, and Accommodation. While much research on healthcare access focuses on structural indicators or patient satisfaction in isolation, this study investigates how user perceptions align or diverge from actual service conditions and how these mismatches influence bypass behaviour. Data were collected from 306 residents across selected communities in Tema using a modified PAHQ questionnaire, supplemented with facility-level data and spatial mapping of service locations. Perceived and objective access scores were computed across the five dimensions, and mismatch scores were derived at individual and community levels. Results reveal that mismatch is widespread but uneven: affordability and accommodation were commonly overestimated, particularly among older and low-income groups, while availability was often underestimated in low-capacity areas. Bypass behaviour was prevalent (89.5%) and not always linked to facility functional limitation, suggesting that expectations, dissatisfaction, and perceived inconvenience play a role in healthcare decision-making. The findings demonstrate that healthcare access is socially and spatially patterned and shaped not only by the presence of services but also by how they are experienced. The study contributes a multidimensional framework for evaluating urban healthcare access and offers policy insights for aligning service delivery with community expectations, particularly in rapidly urbanizing African contexts.