Abstract

This article aims to examine the National Health Insurance Scheme (NHIS) policy from the perspective of local communities. Qualitative data from 9 key informant interviews and 72 community respondents in 9 focus group discussions were analyzed using a thematic network approach. The focus-group discussions took place in seven different communities in seven regions of Ghana. The findings noted a disconnection between NHIS policy and community life. More so, the findings showed an explicit link between equity and access with its impacts on health outcomes. The qualitative results indicated lack of voice and understanding as the features limiting people from accessing the NHIS facilities. Understanding of equity as a key theme revealed, first, lack of stakeholder engagement and consultation or participation in the NHIS decision-making process. Second, it was established that while the policy indicated a will to include all the core poor for an equitable NHIS, there is lack of willingness to implement this aim fully. Finally, despite being a pro-poor intervention by name, practical management of the NHIS is transmitted down vertical silos from the national level, with the lack of joined-up government at the center undermining local partnerships. Thus, not only are national expectations being dashed locally, local expectations are dashed nationally. This article proposes that community viewpoints should be given higher priority given that NHIS has since its inception been associated with medical treatments and biomedical paradigm. Promoting community participation, understanding, and voices should be recognized to shape the future NHIS policy and practice.

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