Abstract
BackgroundDespite universal population coverage and equity being a stated policy goal of its NHIS, over a decade since passage of the first law in 2003, Ghana continues to struggle with how to attain it. The predominantly (about 70 %) tax funded NHIS currently has active enrolment hovering around 40 % of the population. This study explored in-depth enablers and barriers to enrolment in the NHIS to provide lessons and insights for Ghana and other low and middle income countries (LMIC) into attaining the goal of universality in Universal Health Coverage (UHC).MethodsWe conducted a cross sectional mixed methods study of an urban and a rural district in one region of Southern Ghana. Data came from document review, analysis of routine data on enrolment, key informant in-depth interviews with local government, regional and district insurance scheme and provider staff and community member in-depth interviews and focus group discussions.ResultsPopulation coverage in the NHIS in the study districts was not growing towards near universal because of failure of many of those who had ever enrolled to regularly renew annually as required by the NHIS policy. Factors facilitating and enabling enrolment were driven by the design details of the scheme that emanate from national level policy and program formulation, frontline purchaser and provider staff implementation arrangements and contextual factors. The factors inter-related and worked together to affect client experience of the scheme, which were not always the same as the declared policy intent. This then also affected the decision to enrol and stay enrolled.ConclusionsUHC policy and program design needs to be such that enrolment is effectively compulsory in practice. It also requires careful attention and responsiveness to actual and potential subscriber, purchaser and provider (stakeholder) incentives and related behaviour generated at implementation levels.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1758-y) contains supplementary material, which is available to authorized users.
Highlights
Despite universal population coverage and equity being a stated policy goal of its National Health Insurance Scheme (NHIS), over a decade since passage of the first law in 2003, Ghana continues to struggle with how to attain it
This study aimed to understand why enrolment within the NHIS has stagnated at the current levels and the implications for NHIS policy and program design and implementation towards universal population coverage
From a more analytic perspective of organizing our data to help provide answers to the “why” of observed enrolment patterns we found it more useful to reorganize the purchaser and provider factors into those predominantly influenced by national policy and program arrangements and those more influenced by peripheral implementation arrangements of frontline purchaser and provider staff
Summary
Despite universal population coverage and equity being a stated policy goal of its NHIS, over a decade since passage of the first law in 2003, Ghana continues to struggle with how to attain it. Universal Health Coverage (UHC) is a means to an end rather than an end in itself Very it strives to “ensure that all people have access to needed, quality health services without suffering financial hardship” [2]. The policy objectives of the Ghana National Health Insurance Scheme (NHIS) were stated as: “(...) to assure equitable and universal access for all residents of Ghana to an acceptable quality package of essential healthcare” [3]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
