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With the exigencies of health-care service quality to actualize sustainable socio-economic and developmental aspirations, in both peripheral and core countries, this paper aims to provide empirical evidence on health-care service quality and its precursor – patients’ satisfaction, and continuous service utilization.

A total of 398 screened questionnaires were analyzed from selected hospitals of the Koforidua, Ghana. Findings from the structural equation modeling showed a significant association among perceived quality, patients’ satisfaction and tangibility. Contrary to the expectations, the results did not show a significant association among the constructs – perceived quality, safety and empathy. Again, the model fit indices collaboratively showed that the hypothesized model overwhelmingly “fit” the sample data, and further proved the predictive robustness of the model.

The results of the analysis demonstrate that patients were discontent with empathy and safety measures at the hospitals. However, tangible and perceived quality were identified as significant predictors of patients’ satisfaction.

There is a dearth of empirical investigations on the assessment of health-care service quality and patients’ satisfaction in developing economies such as Ghana. Therefore, the implication of the study will equip the top hierarchy of the Health System of Ghana in achieving their mission, and objectives in line with quality service delivery. In particular, MoH and GHS can embark on a routine exercise to audit the hospitals for re-accreditation, and provide CCT cameras to improve safety and security conditions at the hospitals, while enforcing the culture of receptive hospital environment to improve empathy.

Drawing upon the institutional theory, the present study investigated whether or not small and medium-sized enterprises (SMEs) in East Africa benefit from the Belt and Road Initiative (BRI), and how the latter influences the internationalization of the former.

An in-depth interview was conducted by using 26 SME managers/owners who are engaged in international activities in the “Belt and Road” countries. The sample was chosen from four East African countries across three industries. The theoretical framework emerged from the grounded theory analysis of the primary data.

The authors found that the BRI as a formal institutional force generates both direct and indirect influences on SMEs' internationalization. Three key driving forces, namely partnerships, specialized services and innovativeness underpin the internationalization of SMEs. Additionally, sectoral analysis of the similarities and differences in responses reveals no remarkable differences in the drivers and impact of the BRI on SMEs in all the three industries investigated.

The internationalization process of East African SMEs could be augmented through formal institutions like the BRI, and the internationalization of SMEs along the “Belt and Road” countries mimic an integrative approach. The theoretical framework demonstrates significant potential for further benefits that SMEs may obtain through the BRI by taking advantage of certain BRI opportunities and adopting crucial strategies to internationalize rapidly.

This is the first study to employ a qualitative approach to study the influence of the BRI at the firm-level. Specifically, the paper covered the hub of BRI countries in East Africa. Hence, the study makes substantial theoretical and policy contributions to the literature.