Abstract
BackgroundBarely a decade after introduction of Ghana’s National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services. However, sustainability of the scheme is increasingly threatened by concerns on quality of health service delivery in NHIS-accredited health facilities coupled with stakeholders’ discontentment with the operational and administrative challenges confronting the NHIS. The study sought to ascertain whether or not Systematic Community Engagement (SCE) interventions have a significant effect on frontline health workers’ perspectives on the NHIS and its impact on quality health service delivery.MethodsThe study is a randomized cluster trial involving clinical and non-clinical frontline health workers (n = 234) interviewed at baseline and follow-up in the Greater Accra and Western regions of Ghana. Individual respondents were chosen from within each intervention and control groupings. Difference-in-difference estimations and propensity score matching were performed to determine impact of SCE on staff perceptions of the NHIS. The main outcome measure of interest was staff perception of the NHIS based on eight (8) factor-analyzed quality service parameters.ResultsStaff interviewed in intervention facilities appeared to perceive the NHIS more positively in terms of its impact on “availability and quality of drugs (p < 0.05)” and “workload on health staff/infrastructure” than those interviewed in control facilities (p < 0.1). Delayed reimbursement of service providers remained a key concern to over 70 % of respondents in control and intervention health facilities.ConclusionCommunity engagement in quality service assessment is a potential useful strategy towards empowering communities while promoting frontline health workers’ interest, goodwill and active participation in Ghana’s NHIS.
Highlights
A decade after introduction of Ghana’s National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services
Out of the 3,575 health facilities accredited by the National Health Insurance Authority (NHIA) as at 2012, 53.6 % were owned by government; 39.8 % by privatefor-profit; 5.8 % by mission/faith-based and 0.8 % by quasi-government facilities [1]
A significant proportion of the staff interviewed in intervention facilities worked in privately owned health facilities while majority of the staff interviewed in control health facilities worked in public/government owned facilities (p < 0.05)
Summary
A decade after introduction of Ghana’s National Health Insurance Scheme (NHIS), significant successes have been recorded in universal access to basic healthcare services. Sustainability of the scheme is increasingly threatened by concerns on quality of health service delivery in NHIS-accredited health facilities coupled with stakeholders’ discontentment with the operational and administrative challenges confronting the NHIS. Sustainable healthcare financing and universal access to healthcare are important health system goals of many countries globally. To promote attainment of these goals, many Lower and Middle Income Countries (LMICs) have resorted to Social Health Insurance (SHI) to finance healthcare. Ghana’s National Health Insurance Scheme (NHIS) is one such SHI policy introduced in 2003 (Act 650, 2003 amended Act 852, 2012). Outpatient visits per capita improved from 0.37 in 1997 to 1.16 in 2013; likewise, percentage of skilled deliveries improved from 44.5 % in 2006 to 55.0 % in 2013 [8]
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