Ghana’s Journey towards Universal Health Coverage: The Role of the National Health Insurance Scheme

Abstract

: Background: the main aim of the study is to find if the National Health Insurance Scheme (NHIS) in Ghana is achieving universal health coverage (UHC) or not. The study gives the trajectories of health policies in Ghana and their implications on long term health financing. NHIS in Ghana was implemented in 2004, with the aim of increasing subscribers’ access to health care services and reduce financial barriers to health care. On equity access to healthcare, it addresses two core concerns: (1) enrolling particular groups (persons exempted from annual premium payments) and (2) achieving UHC for all citizens and persons with legal residence. It utilizes a multifactor approach to the conceptualization of UHC. The research question: is Ghana’s NHIS on course to deliver or achieve universal health coverage? Methods: we used qualitative methods. In doing so, the study engaged participants in in-depth interviews, focus group discussions and direct observations of participants in their natural settings, like hospitals, clinics, offices and homes, with purposive and snowball techniques. This data triangulation approach aims to increase the reliability and validity of findings. Results: the empirical evidence shows NHIS performed relatively well in enrolling more exempt groups (particular groups) than enrolling all persons in Ghana (UHC). The biggest challenge for the implementation of NHIS from the perspectives of health insurance officials is inadequate funding. The health insurance beneficiaries complained of delays during registrations and renewals. They also complained of poor attitude of some health insurance officials and health workers at facilities. Conclusions: both health insurance officials and beneficiaries emphasized the need for increased public education and for implementers to adopt a friendly attitude towards clients. To move towards achieving UHC, there is a need to redesign the policy, to move it from current voluntary contributions, to adopt a broad tax-based approach to cover all citizens and persons with legal residence in Ghana. Also, to adopt a flexible premium payment system (specifically ‘payments by installation’ or ‘part payments’) and widen the scope of exempt groups as a way of enrolling more into the NHIS.

Transitioning from donor aid for health: perspectives of national stakeholders in Ghana

“… 21 In addition, Ghana is undergoing an epidemiological transition (a shift in the burden of disease from infectious diseases to NCDs), a demographic transition (eg, ageing of the population) and a number of obstacles in achieving universal health coverage. 22 These factors typify the challenges that LMICs face as they lose development assistance for health (DAH). In addition, given that Ghana has committed to achieving universal health coverage (UHC), 23 it is also important to explore if there are strategies available to Ghana to mitigate the risk of transition while progressing towards UHC.…”

Enrolment of informal sector workers in the National Health Insurance System in Indonesia: A qualitative study

“…We conducted in-depth interviews and focus group discussions (FGDs) among relevant stakeholders to deepen and confirm the obtained information. Similar qualitative studies have also been conducted in Ghana to explore the behaviours of informal sector workers in response to UHC [40,41]. Figure 2 describes the flow of the study's design and analysis.…”

Catching up with the constitution: An analysis of National Health Insurance in South Africa post-apartheid

“…Despite showing a statistical increase in access to healthcare, the NHI scheme implemented in Ghana has not reduced inequality due to it being a voluntary and not a tax-based system. An annual premium is required by the users, making healthcare unaffordable for 60% of the population (Kipo-Sunyehzi et al, 2020). This scheme highlights the importance of South Africa implementing a tax-based NHI, despite its inconvenience to the public, to combat poverty and encourage unity.…”

“…It highlights the benefits, both concerning the population's health and economically, of moving forward with UHC despite these challenges (World Health Organisation, 2016). Ghana is an example of an African country that has adopted the UHC standards and has improved access to healthcare since its NHI scheme implementation in 2004 (Kipo-Sunyehzi et al, 2020).…”