Migration, homelessness and health: a study among a vulnerable community in Accra, Ghana

Abstract

Homelessness is an increasingly prevalent social problem that presents complex challenges worldwide. Irrespective of the type and duration, people who experience homelessness are vulnerable to poor health, and engage in health risk behaviours related to their living environment. In spite of their greater health needs, they are usually disengaged from primary health care, and rely heavily on emergency services, putting a substantial burden on the acute health care system. In Ghana, a steady urban population increase partly due to internal migration (rural-urban & inter-regional) has worsened the existing limited housing situation, resulting in expanding informal settlements and an increasing prevalence of homelessness. Attracting more migrants than any city in Ghana, Accra has a high housing deficit and a large homeless population, mostly in the city’s Central Business District and slums areas. Despite the high prevalence of urban homelessness in Ghana and the susceptibility of people who experience homelessness to experience poor health, there is limited knowledge of this social and public health problem. The homeless population is diverse – individuals differ in terms of the type of homelessness experienced (including drivers and pathways), their health, and health care utilisation. This thesis was designed to increase our understanding of the homelessness problem in a Ghanaian context and explore its complexity (including the role of migration). The thesis assessed the health, health service utilisation and associated factors among people who experience homelessness in Ghana’s capital city, Accra. In addition, this thesis explored how people experiencing homelessness interact with the health care system, including the role of stigma and discrimination in health care utilisation. The thesis findings have addressed key evidence gaps regarding the urban homeless population in Ghana, a marginalised population with a severe lack of support but vulnerable to different health problems. These findings have implications for future research, policy, and practice to address the urban homelessness problem in Ghana and improve the health and wellbeing of the homeless population. Specific implications of this thesis include the need to reduce the growth of the urban homeless population by addressing the factors driving internal migration. The thesis also suggests the need to address urban homelessness through multisectoral collaborations to shelter the homeless population, address health problems including substance use, and address the health care accessibility and utilisation problems.

Date of Thesis submission	2023
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Elizabeth Conroy (Supervisor) & Brahm Marjadi (Supervisor)