19Background 20 Ghana's National Health Insurance Scheme is a demand side programme where the 21 governing authority registers clients and purchases health care services for them from public 22 3 39 of the households' ranked attitudes of Scheme staff as positive. The study found the NHIS 40 card facilitates access to facility based health care. Satisfaction levels with use of the card 41 were mixed and contextual among discussants. However, 90% of households reported their 42 cards were readily accepted at health facilities. Expired card (51.4%) and health facility had 43 stopped accepting NHIS cards (14.3%) were mentioned as reasons for non-acceptance. 44