National Health Insurance Scheme Research Articles

Predictors of food security status among informal caregivers of older adults residing in slums in Ghana

BackgroundInformal caregivers of older adults play a crucial role, positively influencing the physical, mental, and social well-being of their care recipients, while concurrently contributing to substantial cost savings in the healthcare sector. The significance of food security for these caregivers becomes paramount as it not only impacts their health but also influences the energy needed to fulfil their caregiving responsibilities. Nevertheless, there is a scant literature on the factors that predict food security status among informal caregivers of older adults residing in slum communities in Ghana. This study seeks to address this gap by examining the factors that predict food security status among informal caregivers.MethodsA sample of 458 informal caregivers of older adults residing in slum communities in the Greater Kumasi metropolis was used for the study. The Generalized Linear Regression Model was used to estimate factors that predict food security status among informal caregivers of older adults in slum communities. Beta values and standard errors were utilised, with a significance level of 0.05 or lower.ResultsThe analysis showed that 88.4% of the participants were females, 37.3% were aged 40–49 years, 72.7% were of Akan ethnicity, 81.4% were married, 45.4% had basic education, 96.3% did not receive pay for caregiving and 72.1% were enrolled in a national health insurance scheme. The study revealed that participants without formal education (β = 0.661, p <.05) and those aged 29 years or younger (β = 26.927, p <.001), 30–39 years (β = 27.453, p <.001), and 40–49 age group (β = 26.710, p <.001) statistically significantly exhibited an increased food security status compared to their counterparts. Additionally, participants identifying as Akan (β = -0.421, p <.05), Christians (β = -0.828, p <.001), married individuals (β = -0.500, p <.05), those who reported never being ill (β = -2.617, p <.001), those without chronic non-communicable diseases (NCDs) (β = -0.638, p <.001), and those not enrolled in the national health insurance scheme (β = -0.422, p <.01) statistically significantly experienced a decreased food security status compared to their counterparts.ConclusionConsidering these findings, policymakers are urged to integrate socio-economic and health characteristics of informal caregivers into food security policies. This inclusive approach is essential for enhancing the food security status of informal caregivers responsible for older adults in slum communities.

Cost-effectiveness and budget impact of covering Burkitt lymphoma in children under Ghana’s National Health Insurance Scheme

BackgroundChildhood cancer is not a high priority in health care financing for many countries, including in Ghana. Delayed care seeking and treatment abandonment, often due to the financial burden of care seeking to families, are common reasons for a relatively low overall survival (OS) in low-and middle-income countries. In this study, we analyzed the cost-effectiveness of extending health insurance coverage to children with Burkitt lymphoma (BL) in Ghana.MethodsWe developed a Markov model in Microsoft Excel to estimate the costs and effects of BL treatment when National Health Insurance Scheme (NHIS) was provided compared to the status quo where NHIS does not cover care for childhood cancer. The analysis was undertaken from the societal and health system (payer) perspective. Both costs (measured in $) and effects, measured using disability adjusted life years (DALYs), were discounted at a rate of 3%. The time horizon was a lifetime. Probabilistic sensitivity analysis was done to assess uncertainty in the measurement of the incremental cost-effectiveness ratio (ICER). A budget impact analysis was undertaken from the perspective of the NHIS.ResultsIn the base-case analysis, the intervention (NHIS reimbursed treatment) was less costly than current practice ($8,302 vs $9,558). The intervention was also more effective with less DALYs per patient than the standard of care (17.6 vs 23.33). The ICER was -$219 per DALY averted from societal perspective and $113 per DALY averted from health system perspective. The probabilistic sensitivity analysis showed that the intervention is likely to be both less costly and more effective than current practice in 100% of the 1,000 simulations undertaken.ConclusionProviding health insurance coverage to children with BL is potentially cost-effective. The effectiveness and cost-savings relating to this strategy is driven by its positive impact on treatment initiation and retention. Based on this evidence, there has been a policy change where Ghana’s NHIS has prioritized financing for cancer treatment in children.

Exploring the contribution of integrated healthcare practices to malaria control in Ghana: perspectives of medical herbalists

BackgroundThe integration of herbal and orthodox medicines has gained momentum in global health, ensuring improved management of infectious diseases like malaria. This study explored the experiences of medical herbalists working in Ghana’s diverse ecological zones to understand the contributions of integrated healthcare to malaria control.MethodsA phenomenological design was employed to conduct in-depth interviews with 19 purposively sampled medical herbalists. Framework analytical approach and Donabedian’s conceptual framework for quality of care were utilised in analysing the data.ResultsFindings revealed high awareness of integrated healthcare practices among participants. Medical herbalists perceived integrated care as instrumental in enhancing malaria management through factors such as improved quality assurance, increased accessibility to integrated health facilities, patient-centred care, follow-up practices, and opportunities for continuous professional development. However, structural and process-related challenges were identified, including inadequate healthcare personnel, medicines, and equipment. Additionally, limited promotional activities, non-comprehensive National Health Insurance Scheme (NHIS), and ineffective referral systems were recognised as barriers hindering the effectiveness of the integrated system and its potential contribution to malaria control.ConclusionAlthough national and health system-based challenges have thwarted the importance of integration on malaria control, medical herbalists feel optimistic about the intervention. To optimise the effectiveness of integrated healthcare in controlling malaria in Ghana would require policy modification and implementation. Future research could focus on developing healthcare frameworks, particularly for malaria, that prioritise quality service delivery within an integrated system.

Unlocking Vision Care Accessibility: Evaluating Caregivers' Willingness to Pay in Specialised Eye Clinics for Family Members With Intellectual Disabilities.

People with intellectual disabilities (IDs) require more vision care but encounter considerable challenges during eye examinations. Specialised clinics established specifically for people with IDs are generally limited. This study aims to evaluate primary family caregivers' willingness to pay (WTP) for specialised ophthalmology services designed for people with IDs. Between 15 August and 5 October 2023, we conducted a face-to-face survey targeting primary family caregivers of people with IDs in two local authorities in Taiwan. We obtained a probability sample through stratified random sampling. A total of 657 family caregivers completed this survey, with a response rate of 82.6%. WTP was evaluated using a contingent valuation method in a hypothetical ophthalmology clinic conceptualised through a qualitative study. Two-part models were estimated. The WTP for specialised ophthalmology services designed for people with IDs varied from NT$96.9 (US$3.2) to NT$217.7 (US$7.3) for the lowest-income group (p < 0.001) and from NT$513.0 (US$17.1) to NT$648.6 (US$21.6) for the highest-income group (p < 0.001). Factors such as family income, self-reported financial satisfaction and concern for the ocular health of family members with IDs significantly influenced WTP. Caregivers' WTP is low relative to the minimum operational costs of specialised ophthalmology clinics within the Taiwanese National Health Insurance scheme. This finding highlights the need for public funding to support such clinics and ensure that they can address the vision health disparity observed between people with and without IDs.

Determinants of healthcare utilization under the Indonesian national health insurance system – a cross-sectional study

BackgroundIndonesia has implemented a series of healthcare reforms including its national health insurance scheme (Jaminan Kesehatan Nasional, JKN) to achieve universal health coverage. However, there is evidence of inequitable healthcare utilization in Indonesia, raising concerns that the poor might not be benefiting fully from government subsidies. This study aims to identify factors affecting healthcare utilization in Indonesia.MethodsThis study analysed cross-sectional survey data collected by the “Equity and Health Care Financing in Indonesia” (ENHANCE) Study. Andersen’s behavioural model of health services use was adopted as a framework for understanding healthcare utilization in Indonesia. Sociodemographic variables were categorized into predisposing, enabling and need factors. Outcome measures included the utilization of primary and secondary health services. Multi-level logistic regression models were run to examine factors associated with each type of health service utilization.ResultsOf the 31,864 individuals included in the ENHANCE survey, around 14% had used outpatient services in the past month. Fewer than 5% of the study population had visited hospitals for inpatient care and about 23% used maternal and child health services in the past 12 months. Age, gender and self-rated health were key determinants of health services utilization. No significant differences in primary care utilization were found among people with different insurance status, but people who received subsidised premiums under the JKN were more likely to receive primary care from public health facilities and less likely from private health facilities. Compared to people who pay JKN insurance premiums themselves, the uninsured and those whose premiums were subsidised by the government were less likely to visit public and private hospitals when other factors were controlled.ConclusionThis study demonstrates that the distribution of healthcare utilization in Indonesia is largely equitable as predisposing factors (age and gender) and health need were found to greatly influence the utilization of different types of health services. However, enabling factors such as health insurance status were also found to be associated with inequity in utilization of hospital services. Further policy actions regarding resource allocation and health service planning are warranted to achieve a more equitable pattern of health service use in Indonesia.

Moving toward universal health coverage with a national health insurance program: A scoping review and narrative synthesis of experiences in eleven low- and lower-middle income countries.

Universal Health Coverage (UHC) aims to provide access to quality health services to all while avoiding financial hardship. Strategies can include establishing a national health insurance scheme (NHIS). However, variations in the progress exist among countries with an NHIS. This study assesses strategies adopted in low- and lower-middle-income countries (LLMICs) with an NHIS to expand UHC. The research entailed a descriptive, qualitative review of the literature on LLMICs that have implemented an NHIS. PRISMA guidelines were used to identify studies and reports. A total of 569 texts were identified from 4 databases. A total of 78 texts were included, spanning 7 countries from Sub-Saharan Africa and 4 from Asia. The search was conducted in March 2023 and updated in April 2024. An analytical framework was used to systematically collect, analyze, and synthesize key features to review healthcare financing mechanisms and coverage dimensions. Countries generate revenue through various public and private means, including taxes, premiums, and out-of-pocket payments. Some have consolidated revenue streams into a single pool for efficiency, while others maintain separate pools. Healthcare services are procured from public and private providers, differing by country. Fee-for-service is the prevalent payment method, but capitation systems have been attempted to control expenses. Population coverage depends on whether enrollment in an NHIS is mandatory or voluntary and on its enforcement. Service provision can be comprehensive and universal or can vary with specific schemes. Mechanisms to avoid financial hardship can involve premium exemptions or subsidies. Progressing toward UHC requires addressing issues of financial sustainability, cost-containment, enrollment expansion, financial protection, and health equity. While policy options are context-specific, this review showcased experiences for other LLMICs committed to UHC with an NHIS. Recommendations on health financing include increasing the allocation of tax revenues to the insurance scheme, merging risk pools, and adopting strategic purchasing.

Factors Influencing the Choice of Healthcare Providers among National Health Insurance Scheme Enrollees in Public and Private Health Facilities in South Western Nigeria: A Mixed Method Study

Objectives: The choice of healthcare facilities is determined by the interaction of several factors and the perceived quality of care provided in the facilities. This study aimed to assess the factors influencing the choice of service providers among NHIS enrollees in public and private health facilities in Southwestern Nigeria. Methods: A cross-sectional and mixed-method study design using both qualitative and quantitative data collection methods. Using a multistage sampling technique, 300 patients were enrolled. Four focus groups with eligible respondents were conducted in public and private health facilities. IBM SPSS was used to analyze the data, and a p-value of less than 0.05 was designated as the significance level. Qualitative data were collated and analyzed using detailed content analysis. Results: The study found that 50 (33.3%) public and 37 (24.7%) private health facilities respondents had ever changed their health care providers respectively, but this was not statistically significant (p=0.098). Determinants of choice of healthcare providers among the public and private health facilities enrollees include; use of facility before joining the scheme (p&lt;0.001), courteous/friendly hospital staff (p=0.042), adequate personnel and equipment (p=0.002), skills and expertise of personnel (p=0.03), use of health facility by majority of colleagues, (p&lt;0.001) and spending greater than 10 years in the scheme (p=0.007). Conclusion: Factors influencing the choice of healthcare providers among respondents in public and private health facilities, were mainly health facility related. Accredited healthcare providers seeking to improve the enrollment of new clients as well as retain their old clients should address these factors.

Effect of Covid-19 on maternal and child health services utilization in Ghana. Evidence from the National Health Insurance Scheme (NHIS).

Covid-19 has had devastating effect on health systems and health utilization globally. Maternal and newborn care were adversely affected but little or nothing is known about the impact it has caused to it. This study seeks to determine the effect of Covid-19 on healthcare utilization with specifics on Antenatal, Postnatal, Deliveries and Out-patient attendance. The study uses secondary data obtained from the four (4) Claims Processing Centres of the National Health Insurance Authority. Through the use of convenient sampling, a total of 502 facilities were selected for inclusion in the research. The study used a longitudinal claims submitted from a cross-section of health facilities namely Community-Based Health Planning and Services, Maternity Homes, Health Centers, Clinics, Primary, Secondary, and Tertiary Hospitals for Antenatal, Postnatal, Out-patient consultations and Delivery attendances from January 2018 to December 2021. Data before and during the Covid-19 pandemic were compared. Segmented regression analysis as an interrupted time series analysis was employed to assess the effect of the pandemic on utilization of services. The results indicate that Covid-19 had a significant impact on healthcare utilization in Ghana. Month-on-month, antenatal and out-patient utilization decreased by 21,948.21 and 151,342.40, respectively. Postnatal and delivery services saw an insignificant monthly increase of 37.76 and 1,795.83 from the onset of the covid-19 pandemic and the introduction of movement restrictions. This decline was observed across all care levels, except for Community-Based Health Planning and Services, which showed a slight increase. Also, the results indicate projected average misses of scheduled antenatal, postnatal, out-patient reviews, and deliveries at 21,037.75, 6,428.23, 141,395.30 and 4,745.63 patients respectively. The study reveals that Covid-19 led to a decrease in utilization of healthcare which affected pregnant women and newborn care as well. It was evident from the results that community-based healthcare is more resilient and efficient in delivering healthcare amidst the pandemic. In our quest to achieve Universal Health Coverage by 2030, Ghana's health system should improve on the community-based healthcare system and include technology in its healthcare delivery for the people.

Evaluating access to National Health Insurance Scheme Services

Access to health insurance is vital for achieving Universal Health Coverage, yet barriers such as high costs, inadequate coverage, and systemic inefficiencies often impede access to necessary health care. This study evaluated access to the National Health Insurance Scheme-provided services among enrollees at the outpatient department (OPD) of Levy Mwanawasa University Teaching Hospital (LMUTH) in Lusaka, Zambia, chosen for its role as a pioneering NHIS-accredited facility and its significance as a major publicly funded referral hospital. Data were collected in May 2024 from 270 systematically sampled NHIS enrollees at the OPD of LMUTH using an interviewer-administered questionnaire. Descriptive analysis revealed a balanced gender distribution, with most respondents aged 35 and above, married, holding tertiary education, and earning a monthly Zambian Kwacha (ZMW) of 20,000 or less. The thematic analysis using NVivo uncovered positive and negative experiences with NHIS services, highlighting issues such as medical service availability, drug shortages, service delays, technological problems, communication challenges, equity in service delivery, and coverage gaps. The key policy implications for improving access to NHIS services include enhancing supply chains, digital infrastructure, coverage to rural areas, staff training, public awareness of the NHIS, and information technology systems.

PP102 Sustaining Ghana’s National Health Insurance Scheme: Leveraging The Role Of Priority-Setting Tools In Benefit Package Reviews

IntroductionEnsuring the National Health Insurance Scheme’s (NHIS) sustainability is essential to achieve Universal Health Coverage in Ghana. However, numerous addition requests to the Benefit Package (BP) places the scheme in precarious situations, necessitating evidence-based prioritization. Our objective is to conduct a situational analysis on the role of health technology assessment and priority-setting within the National Health Insurance Authority (NHIA).MethodsQualitative methods were used to assess the current NHIS BP review process. Desk reviews of policy documents and key informant interviews to establish the mandate of the NHIA in BP reviews were conducted. Finally, a mapping of the alignment of evidence from HTAs conducted by the Ministry of Health (MOH) with recent BP review and inclusion decisions of the NHIA was carried out.ResultsFindings validate the legal mandate of the NHIA to carry out BP reviews with processes spelled out in operating guidelines. Actuarial analysis determines the scheme’s capability to fund additional service, but no explicit priority-setting criteria are used. This leaves the NHIA open to external pressures for inclusion and presents risks to the financial sustainability of the scheme. An HTA on antihypertensive treatments in 2017 influenced reimbursement pathways of the NHIA. Similarly, the cost-effectiveness of extending existing medications on the NHIS Medicines List to cover Burkitt lymphoma corroborated the decision of the NHIA to cover childhood cancer in 2021.ConclusionsThe NHIA uses actuarial evidence in BP inclusion decisions. It, however, lacks an explicit priority-setting criteria to guide decisions on coverage. HTA evidence has been leveraged for sustainable coverage decisions. The development of an explicit priority-setting framework for reviews can guide inclusion decisions as well as clarify how the NHIA aligns with the HTA generation body.

The COVID-19 experience among international migrant workers in the Republic of Korea: knowledge and awareness of treatment and immigration policies

IntroductionThe COVID-19 pandemic has exposed various health risks and inequities experienced by international migrant workers. The number of migrant workers in the Republic of Korea (ROK) is rapidly growing and is expected to continue growing. Health related research on migrant workers in ROK is limited, especially among undocumented migrant workers who were more vulnerable to the pandemic. This study aims to examine the experiences of migrant workers and their knowledge and awareness of treatment and immigration policies during the pandemic.MethodsWe used data from the International Migrant Workers’ COVID-19 Health Literacy and Access to Medical Care project, a cross-sectional survey conducted with international migrant workers residing in ROK in 2021 (n = 537). Descriptive statistics and multivariable regression models were employed to understand different demographic, occupational, and immigration factors affecting migrant workers’ knowledge and awareness of treatment and immigration policies.ResultsUndocumented migrant workers had a longer length of residence in ROK and earned less compared to workers with work visa status. None of the undocumented migrant workers had access to health insurance since they were ineligible to enroll in the national health insurance scheme. In the early days of the pandemic, most undocumented migrant workers experienced a decrease in their average income. After adjusting for demographic differences and language proficiency, undocumented migrant workers (AOR: 0.41, 95% CI: 0.21, 0.78) were less likely to be aware of the policy allowing foreigners, including undocumented individuals, to access COVID-19 testing and treatment without the risk of deportation. Workers with a longer length of residence (AOR: 1.29, 95% CI: 1.09, 1.53) were more likely to be aware of this policy.ConclusionUndocumented migrant workers were often less informed about COVID-19 policies. While most of the survey respondents were knowledgeable about governmental policies regarding COVID-19 treatment and immigration, our results reveal multiple occupational and health insurance vulnerabilities of undocumented migrant workers living in ROK. More attention is needed to understand healthcare service barriers and how to provide adequate resources for this vulnerable population.

Experiences of women living with cervical cancer in Ghana: challenges and coping strategies

BackgroundCervical cancer is a leading cause of morbidity and mortality among women globally. The condition is both preventable and treatable yet remains a leading cause of cancer death in Ghana. This study aims to explore the unique experiences of women living with cervical cancer with a focus on the challenges and coping strategies.MethodsThe study employed a qualitative approach with an exploratory, descriptive design. This study was conducted among women with cervical cancer aged 18 years and above who have been diagnosed with the disease for at least 3 months. A total of 16 participants were purposively sampled based on the eligibility criteria and individually interviewed using a semi-structured guide. The six-step technique for qualitative analysis by Braun and Clarke guided data analysis.ResultsMost participants resorted to self-medication, over-the-counter drugs and herbal preparations as a first line of defense against the disease. The presence of cervical cancer affected participants’ physical and mental well-being. Other challenges included financial burden and frequent equipment breakdowns which affected patients’ treatment. Participants adopted different coping strategies such as taking blood tonic, increased rest and sleep, spiritual prayers and recreational activities. Family members, friends, the church and health workers provided support in the area of finance, advice, meal preparation and house chores, prayers and counseling to participants.ConclusionsCervical cancer affects the quality of life of many women and their significant others. The condition puts a lot of financial burden on its victims and there is the need for a system to reduce the burden on patients. It is recommended that the treatment of cervical cancer should be covered by the National Health Insurance Scheme to ease the financial burden on patients. There is a need for expansion of access to cervical cancer treatment across the country to reduce patients’ burden and relieve the pressure on the few pieces of equipment at the current treatment centres.

Assessment of Married Men Involvement in Family Planning Practices: A Qualitative Study of Akure South Local Government Area of Ondo State, Nigeria

The non-accommodation of men in the family planning programs has been identified as one of the contributory factors for the low utilization of FP methods in this male-dominated society like Nigeria. Male involvement can lead to uptake in acceptance and prevalence rate of family planning methods and practices in Nigeria.This paper aimed to study the involvement of married men in the family planning practices in Akure South Local Government Area of Ondo State, Southwestern Nigeria. The primary data were collected from 250 married informants who satisfied the eligibility criteria and were assessed througha self-administered questionnaire and selected from the sample population across 11 political wards in the Akure South Local government area using a multi-stage random sampling technique. The secondary data were generated from government publications, journals, newspapers, and relevant internet materials. The presentation and analyses of data were done using descriptive statistics (frequency table, percentage and numbers). The study’s findings revealed that married men’s knowledge about family planning practices is high while exhibiting low involvement in FP and low utilization of the FP methods. However, the number of children, socio-cultural beliefs, financial status, education and religion are discovered to be among conditional factors that influence contraceptive use among married partners. The study therefore recommended increased health promotion and education of family planningprogrammes among the residents and involvement of men as a target in all FP programmes and introduction of family planning services in National Health Insurance Scheme in order to reduce associated misconceptions about contraceptives methods and increase the usage.

Perspectives of patients with type 1 and type 2 diabetes on barriers to diabetes care: a qualitative study

BackgroundDiabetes care incorporates multiple integrated elements like self-care practices, patient education and awareness, societal support, equitable access to healthcare facilities and trained healthcare professionals, commitment from the diabetes associations and government policies. There is a dearth of research exploring the barriers experienced by both People with Type 1 diabetes (PwT1D) and People with Type 2 diabetes (PwT2D) in accessing the holistic elements of diabetes care. This study thus aimed at exploring the perceived barriers among PwT1D and PwT2D in accessing diabetes care services in urban and rural areas of Nepal.MethodThis study was a qualitative research using phenomenological approach where an in-depth interview with 23 participants on insulin was conducted. This included 15 PwT1D and 8 PwT2D, residing in the capital and rural areas and attending the hospitals and clinic in the urban and semi-urban regions in Nepal. A semi-structured questionnaire was used for the interview. The interviews were transcribed verbatim and deductive thematic analysis was done.ResultsMajority were female participants and most had received a formal education and were visiting the hospitals located in capital city. Mean age for PwT1D was (27.86 ± 1.85) years whereas the median age for PwT2D was [47.5 (IQR, 16.5)] years. Seven themes were generated from the study representing key barriers from patient’s perspective. These were: Theme (1) Double stigma: Diabetes diagnosis and insulin use, Theme (2) Non-adherence to insulin and Self-Monitoring of Blood Glucose (SMBG), Theme (3) Logistic challenges in rural areas: Scarcity of healthcare professionals and other healthcare facilities, Theme (4) Dissatisfaction with healthcare services, Theme (5) Patients seeking alternative treatment strategies over allopathic treatment, Theme (6) Limitations of health insurance scheme and Theme (7) Limited role of national diabetes organizations.ConclusionThere is a need in raising awareness among general public especially on T1DM to address the issue of diabetes stigma. An effort in implementation of policies supporting diabetes care and refinement of National Health Insurance Scheme is equally essential. Similarly, strengthening of Health Care System by ensuring availability of insulin, laboratory facilities and trained healthcare professionals in rural areas should be focused to address the inequity in access to healthcare in rural and urban sectors.

Diagnostic Challenges in Hematological Malignancies in Nigeria and their Impact on Treatment Outcome

Haematological magnificence constitutes a major public health disease burden globally due to the degree of mortality and morbidity they cause. Aim: This review was aimed at exploring and reporting some of the difficulties that hinder early/accurate diagnosis and management of haematological malignancies in Nigeria emphasizing a single centre experience and to further highlight how they affect treatment outcome. Methodology: Google scholar, Pubmed and African Journals online sites were explored in July 2024. Relevant articles were selected. The most senior consultant haematologist in the single centre in South South Nigeria being studied was interviewed and account was documented. Results: The difficulties encountered in the prompt/proper diagnosis and management of haematological malignancies reported by the studies and the clinician interviewed include, visiting orthopaedic and other specialists as well as herbalists and spiritualists for several months before reporting to the haematology clinic, mis – and/or missed diagnosis due to inadequate diagnostic equipment and techniques like use of morphological studies alone for Rowmanawsky stained blood picture examination and histological diagnosis without cytogenetics, immunophenotyping, polymerase chain reaction fluorescent insitu hybridization, poverty, cultural and religious beliefs. Poor treatment outcome as a result of these challenges were also reported. Conclusion: Enlightenment campaigns on the benefits of early diagnosis and prompt presentation to the hospital should be encouraged. Provision of up-to-date advanced technologies for early/accurate diagnosis and sub classification of haematologiacl malignancies should be made in main health facilities across the country. Diagnosis and treatment of haematological malignancies should be built into the National Health Insurance scheme to strengthen the system in this regard.

Does access to and use of primary healthcare services influence health insurance uptake? A mixed-methods study in the Wa Municipality, Ghana

ABSTRACT Purpose This study explored access to quality primary healthcare services under Ghana's National Health Insurance Scheme (NHIS), its impact on NHIS enrolment, and the implications for attaining Universal Health Coverage (UHC). Methods A sequential explanatory mixed-method research design was employed using a multistage sampling technique. We collected data from 413 insured individuals and 47 healthcare facilities for quantitative community-level analysis using questionnaires. Purposive sampling was used to select 17 healthcare providers and 20 insured key informants for qualitative investigation using interview guides. Quantitative data were analyzed using descriptive statistics, independent t-tests, and binary logistic regression. Qualitative data were thematically analyzed to explain the quantitative findings. Results The results indicated a positive association between outpatient and inpatient services, maternal healthcare, and laboratory testing. Maternal healthcare and laboratory diagnostics positively influenced the renewal of NHIS membership. Binary logistic regression revealed that access to, and utilization of PHC services significantly increased the likelihood of NHIS membership renewal, influenced by healthcare system factors such as service availability, acceptability, and affordability. Conclusion Our findings suggest that policymakers must enhance the NHIS with improved service delivery to attain UHC in Ghana.

Factors Influencing Patient Satisfaction with Zambia's National Health Insurance Scheme: A Systematic Literature Review using Empirical Evidence from Nigeria and Ghana

Factors Influencing Patient Satisfaction with Zambia's National Health Insurance Scheme: A Systematic Literature Review using Empirical Evidence from Nigeria and Ghana

Financial strain and resilience: a qualitative exploration of parental perspectives on caring for children with sickle cell disease in Ghana

BackgroundIn Ghana, nearly one in four (25%) of the population are sickle cell disease carriers. Furthermore, 2% of all babies born (20 for every 1000 live births) has sickle cell disease. However, little is known about how parents negotiate the financial challenges facing parents of a child with sickle cell disease. This study explores the financial difficulties of parents and children living with sickle cell disease.MethodsThe study adopted a qualitative approach. Twenty-seven parents were purposively selected from a sickle cell clinic in Accra, Ghana. Data collection was through an in-depth, face-to-face interview, using an interview guide based on the research objectives, and analyzed using thematic analysis.ResultThe findings showed that parents faced multiple financial difficulties (both direct and indirect) as they met the direct cost of medications, routine laboratory investigations, and hospital admissions. The National Health Insurance scheme does not wholly cover these costs. Families also describe more indirect costs, such as those associated with maintaining their child’s well-being alongside those connected to their caring responsibilities, including the impact of giving up work and reducing working hours. Findings highlight the most pressing challenge, including the lack of access to financial support and a more general lack of understanding of the difficulties they faced on the part of policymakers.ConclusionSupporting sickle cell parents’ financial needs would improve their emotional and social well-being, enabling them to be more effective family carers.

The ‘STRICT’ framework for promoting effective malaria control in Ghana

BackgroundMalaria remains a significant public health burden, necessitating evidence-based strategies to reduce prevalence and associated morbidity. This study explores the potential of integrated healthcare, encompassing both modern and traditional herbal medicine (THM), for malaria control in Ghana.MethodsEmploying a qualitative approach, semi-structured interviews were conducted with medical doctors, pharmacists, and THM providers. Thematic analysis approach was utilized to inductively analyse interview data and integrate participants’ lived experiences and suggestions.ResultsSix themes emerged: Standardization of THM practice; Training on THM broadened; Research on THM expanded; Increasing awareness of THM integration hospitals and inclusion of THM in national health insurance scheme; Constant supply of certified herbal medications; and Tax relief provision. These recommendations form the ‘STRICT’ framework for developing functional health system for promoting an effective malaria control through integrated healthcare in Ghana.ConclusionIt was evident that the ‘STRICT’ framework can potentially transform healthcare delivery and improve service quality for malaria patients. Policymakers, healthcare providers, and managers can utilize these insights to advocate for and implement integrated healthcare strategies, ultimately enhancing service delivery for all Ghanaians, particularly those suffering from malaria.

Cure Rate Analysis of National Health Insurance Scheme Claims Payment Survival Times in Ghana: The Case of Pru District

Cure Rate Analysis of National Health Insurance Scheme Claims Payment Survival Times in Ghana: The Case of Pru District