Ghana’s National Health Insurance Scheme: Insights from Members, Administrators and Health Care Providers

Barimah, Kofi Bobi; Mensah, Joseph

doi:10.1353/hpu.2013.0144

Cited by 11 publications

(23 citation statements)

References 5 publications

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“…From 1998 to 2003, the sharp increase in income-based inequality in the use of SBAs could be a reflection of the poor outcome of previous health care financing policies implemented in Ghana [43, 44]. In the early 1980s, Ghana implemented the cost recovery (popularly known as “cash and carry”) health care financing policy in all government facilities that required users to pay upfront before receiving care.…”

Section: Discussionmentioning

confidence: 99%

“…In the early 1980s, Ghana implemented the cost recovery (popularly known as “cash and carry”) health care financing policy in all government facilities that required users to pay upfront before receiving care. This was meant to generate revenue and discourage ‘overuse’ of health services [43], but rather led to poor use of health services across the country. Moreover, income inequality has grown in Ghana since the late 1980s [45].…”

Section: Discussionmentioning

confidence: 99%

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Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 – 2008

Asamoah

Agardh

Pettersson

et al. 2014

BMC Pregnancy Childbirth

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BackgroundImproving maternal and reproductive health still remains a major challenge in most low-income countries especially in sub-Saharan Africa. The growing inequality in access to maternal health interventions is an issue of great concern. In Ghana, inadequate attention has been given to the inequality gap that exists amongst women when accessing antenatal care during pregnancy and skilled attendance at birth. This study therefore aimed at investigating the magnitude and trends in income-, education-, residence-, and parity-related inequalities in access to antenatal care and skilled attendance at birth.MethodsA database was constructed using data from the Ghana Demographic and Health Surveys (DHS) 1988, 1993, 1998, 2003, and 2008. The surveys employed standard DHS questionnaires and techniques for data collection. We applied regression-based Total Attributable Fraction (TAF) as an index for measuring socioeconomic inequalities in antenatal care and skilled birth attendance utilization.ResultsThe rural–urban gap and education-related inequalities in the utilization of antenatal care and skilled birth attendants seem to be closing over time, while income- and parity-related inequalities in the use of antenatal care are on a sharp rise. Income inequality regarding the utilization of skilled birth attendance was rather low and stable from 1988 to 1998, increased sharply to a peak between 1998 and 2003, and then leveled-off after 2003.ConclusionsThe increased income-related inequalities seen in the use of antenatal care and skilled birth attendance should be addressed through appropriate strategies. Intensifying community-based health education through media and door-to-door campaigns could further reduce the mentioned education- and parity-related inequalities. Women should be highly motivated and incentivized to attend school up to secondary level or higher. Education on the use of maternal health services should be integrated into basic schools so that women at the lowest level would be inoculated with the appropriate health messages.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 – 2008

Asamoah

Agardh

Pettersson

et al. 2014

BMC Pregnancy Childbirth

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“…There are reports of poor women being charged unofficial and non-legitimate fees for delivery and postnatal care services [29] (https://www.ghanabusinessnews.com/2016/04/23/ghanas-free-maternal-healthcare-policy-not-workingresearch/). Reports of poor women and their babies being forcibly kept in birthing hospitals until their bills are settled have also been published [29].…”

Section: Discussionmentioning

confidence: 99%

The influence of socioeconomic factors on choice of infant male circumcision provider in rural Ghana; a community level population based study

et al. 2017

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BackgroundThe influence of socio-economic determinants on choice of infant male circumcision provider is not known in areas with high population coverage such as rural Africa. The overall aim of this study was to determine the key socio-economic factors which influence the choice of infant male circumcision provider in rural Ghana.MethodsThe study investigated the effect of family income, distance to health facility, and cost of the circumcision on choice of infant male circumcision provider in rural Ghana. Data from 2847 circumcised infant males aged under 12 weeks and their families were analysed in a population-based cross-sectional study conducted from May to December 2012 in rural Ghana. Multivariable logistic regression models were adjusted for income status, distance to health facility, cost of circumcision, religion, maternal education, and maternal age.ResultsInfants from the lowest income households (325, 84.0%) were more likely to receive circumcision from an informal provider compared to infants from the highest income households (260, 42.4%) even after adjusting for religious affiliation (adjusted odds ratio [aOR] 4.42, 95% CI 3.12–6.27 p = <0.001). There appeared to be a dose response with increasing risk of receiving a circumcision from an informal provider as distance to a health facility increased (aOR 1.25, 95 CI 1.30–1.38 P = <0.001). Only 9.0% (34) of families in the lowest socio-economic quintile received free circumcision services compared to 27.9% (171) of the highest income families.ConclusionsThe Government of Ghana and Non-Government Organisations should consider additional support to poor families so they can access high quality free infant male circumcision in rural Ghana.

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“…In recent years, the NHIS in Ghana has attracted increasing academic attention, with studies focusing on NHIS enrolment and renewal and access to the scheme, 8,16 equity in coverage, 17,18 quality and efficiency issues 19,20 and fraud and abuse. 16,21,22 Countries including Bangladesh, Benin, Cameroon, Ethiopia, the Gambia, Malaysia, and Nigeria among others have visited Ghana to study the scheme.…”

Section: Introductionmentioning

confidence: 99%

“…16,21,22 Countries including Bangladesh, Benin, Cameroon, Ethiopia, the Gambia, Malaysia, and Nigeria among others have visited Ghana to study the scheme. However, measuring the success of a social protection programme such as the NHIS is not straightforward.…”

Section: Introductionmentioning

confidence: 99%

Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues

Fusheini

Marnoch

Gray

2016

Int J Health Policy Manag

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Background: Ghana’s National Health Insurance Scheme (NHIS), established by an Act of Parliament (Act 650), in 2003 and since replaced by Act 852 of 2012 remains, in African terms, unprecedented in terms of growth and coverage. As a result, the scheme has received praise for its associated legal reforms, clinical audit mechanisms and for serving as a hub for knowledge sharing and learning within the context of South-South cooperation. The scheme continues to shape national health insurance thinking in Africa. While the success, especially in coverage and financial access has been highlighted by many authors, insufficient attention has been paid to critical and context-specific factors. This paper seeks to fill that gap. Methods: Based on an empirical qualitative case study of stakeholders’ views on challenges and success factors in four mutual schemes (district offices) located in two regions of Ghana, the study uses the concept of policy translation to assess whether the Ghana scheme could provide useful lessons to other African and developing countries in their quest to implement social/NHISs. Results: In the study, interviewees referred to both ‘hard and soft’ elements as driving the "success" of the Ghana scheme. The main ‘hard elements’ include bureaucratic and legal enforcement capacities; IT; financing; governance, administration and management; regulating membership of the scheme; and service provision and coverage capabilities. The ‘soft’ elements identified relate to: the background/context of the health insurance scheme; innovative ways of funding the NHIS, the hybrid nature of the Ghana scheme; political will, commitment by government, stakeholders and public cooperation; social structure of Ghana (solidarity); and ownership and participation. Conclusion: Other developing countries can expect to translate rather than re-assemble a national health insurance programme in an incomplete and highly modified form over a period of years, amounting to a process best conceived as germination as opposed to emulation. The Ghana experience illustrates that in adopting health financing systems that function well, countries need to customise systems (policy customisation) to suit their socio-economic, political and administrative settings. Home-grown health financing systems that resonate with social values will also need to be found in the process of translation

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Ghana’s National Health Insurance Scheme: Insights from Members, Administrators and Health Care Providers

Cited by 11 publications

References 5 publications

Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 – 2008

Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 – 2008

The influence of socioeconomic factors on choice of infant male circumcision provider in rural Ghana; a community level population based study

Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues

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