Factors Associated with Continued Use of Mission Health Facilities in Ghana: A Facility-Exit Survey of User...

Partnerships between the state and faith-based providers, such as the Christian Health Association of Ghana (CHAG), are crucial for expanding healthcare coverage in lower-middle-income countries. However, limited evidence exists on how communities perceive these services and what factors are associated with continued use among those who access them. We conducted a quantitative cross-sectional facility-exit survey among 799 current and past users recruited at CHAG facility exits across four regions between October and December 2024. Data were collected using a structured questionnaire guided by the Sustainability of Innovation Framework. Descriptive statistics, chi-square tests, and exploratory multivariable logistic regression evaluated factors associated with continued use of CHAG facilities among existing users. Among this facility-exit sample, continued use was remarkably high (94.1%) and 95.1% preferred mission facilities over alternatives. Geographic access and socioeconomic status were not significantly associated with continued use patterns (p>0.05), though this finding reflects the sampling strategy that over-represents users and should not be interpreted as community-level prevalence. Perceptual factors dominated the exploratory regression analysis: positive self-rated health (AOR=3.88, 95% CI: 1.98-7.63), perceived service quality (AOR=7.48, 95% CI: 3.46-16.18), and feeling safe at the facility (AOR=9.12, 95% CI: 4.36-19.08) were exploratorily associated with continued use. These effect sizes should be interpreted with caution given the near-complete separation in the outcome (94% users) and the small number of non-users (n=47), which may inflate odds ratios in logistic regression. Objective factors, paying fees and medication stock-outs were not significant in the adjusted model (p>0.05). Among non-users (n=47), key barriers were high cost and service unavailability. Continued use of state-faith-based partnership facilities are exploratorily associated with trust rooted in perceived quality, safety, and responsiveness. Persistent challenges with medication stock-outs and costs highlight areas for systemic strengthening. Future community-based research is needed to identify determinants of non-utilization and test generalizability.