Abstract
BackgroundThe effort to expand access to healthcare and reduce health inequalities in many low income countries have meant that many have adopted different levels of social health protection mechanisms. Ghana introduced a National Health Insurance Scheme (NHIS) in 2005 with the aim of removing previous barriers created by the user fees financing system. Although the NHIS has made health accessible to some category of people, the majority of Ghanaians (60 %) are not enroled on the scheme. Earlier studies have looked at various factors that account for this low uptake. However, we recognise that this qualitative study will nuance the depth of these barriers to enrolment.MethodsMinimally structured, qualitative interviews were conducted with key stakeholders at the district, regional and national levels. Focus group discussions were also undertaken at the community level. Using an inductive and content analytic approach, the transcripts were analyzed to identify and define categories that explain low uptake of health insurance.ResultsThe results are presented under two broad themes: sociocultural and systemic factors. Sociocultural factors identified were 1) vulnerability within certain groups such as the aged and the disabled groups which impeded access to the NHIS 2) cultural and religious norms which discouraged enrolment into the scheme. System-wide factors were 1) inadequate distribution of social infrastructure such as healthcare facilities, 2) weak administrative processes within the NHIS, and 3) poor quality of care.ConclusionsMapping the interplay of these dynamic relations between the NHIS, its clients and service providers, the study identifies critical factors at the policy-making level, service provider level, and client level (reflective in household and community level institutional arrangements) that affect enrolment in the scheme. Our findings inform a number of potential reforms in the area of distribution of health resources and cost containment to expand coverage, increase choices and meeting the needs of the end user.
Highlights
The effort to expand access to healthcare and reduce health inequalities in many low income countries have meant that many have adopted different levels of social health protection mechanisms
Ghana’s response to the call for universal coverage was the introduction of a National Health Insurance Scheme (NHIS) in 2005 with the aim of removing previous barriers created by the user fees financing system and in an effort to expand access to healthcare and reduce health inequalities
For the key informant interviews, the initial set of stakeholders was identified by literature review and grouped into broad categories such as the Ghana Health Service (GHS), Non-Governmental Organisations (NGOs), Civil Society Organisations (CSOs), health providers and NHIS managers
Summary
The effort to expand access to healthcare and reduce health inequalities in many low income countries have meant that many have adopted different levels of social health protection mechanisms. In 2005, the World Health Assembly resolution 58.33 called for a global situation in which “everyone should be able to access health services and not be subject to financial hardship in doing so” [1]. This call followed from the recognition by the WHO in the year 2000 that prepayment of healthcare services was the best form of. Ghana’s response to the call for universal coverage was the introduction of a National Health Insurance Scheme (NHIS) in 2005 with the aim of removing previous barriers created by the user fees financing system and in an effort to expand access to healthcare and reduce health inequalities.
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