Socioeconomic Determinants and Barriers to Accessing Newly Commissioned District Hospitals in Ghana’s Ashanti Region: An Accessibility Dimensions Perspective

Access to healthcare is a multidimensional concept encompassing not only the individuals' ability to seek, access, afford, and utilise care. In Ghana, the commissioning of new district hospitals under the “Agenda 111” initiative marks a major step toward Universal Health Coverage (UHC). However, evidence on whether such infrastructure investments translate into equitable access remains limited. This study examined socioeconomic determinants and systemic barriers to accessing three newly commissioned district hospitals in the Ashanti Region, applying Penchansky and Thomas’s five dimensions of accessibility. A convergent mixed-methods design combined quantitative survey data from 1,192 healthcare seekers with qualitative insights from 15 key informants. Findings revealed that gender, age, education, employment status, income, and residential location significantly influenced access (p < 0.001). Respondents highlighted affordability as the most critical barrier, with many disagreeing that they had reliable means of payment (M = 1.84) or that healthcare costs were reasonable (M = 2.20). Despite widespread health insurance coverage, financial difficulties (M = 3.23) and lack of insurance (M = 3.23) continued to limit access, particularly in Bekwai District Hospital, which consistently recorded the lowest scores across accessibility dimensions. Strong intercorrelations between availability, accommodation, and acceptability underscored the interconnected nature of access challenges. Policy recommendations include expanding health insurance coverage, reducing out-of-pocket payments, strengthening staffing and diagnostics, improving transport infrastructure, and promoting culturally competent care. These findings highlight that infrastructure expansion alone is insufficient for achieving UHC and that multidimensional, equity-focused strategies are essential both in Ghana and in other low and middle-income countries (LMICs) undertaking similar health system investments.