The challenges and prospects of community based health care financing schemes/mutual health organisations in Ghana: a case study of schemes in the Northern Region of Ghana.
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Date
2005-11-07
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Abstract
Health care financing all over the world is under severe strain, more so in Africa and other developing countries where the cost of health care is ever increasing. Over the years, calls have been made for communities in developing countries to plan, finance, organize and operate health care services but questions remain as to how and how much poor people in poor countries can and should be expected to contribute towards health care. The issue of primary health care and its finance matters most to poor people themselves. As a result, Community Based Health Insurance Schemes (CBHIS) have been developed by people in the rural and informal sectors in most developing countries to cater for their health care needs of which Ghana and the Northern Region in particular are no exception. The viability and sustainability of these schemes are however threatened as most schemes in the region stagnate and terminate at gestation. Also, little documentation exists on these financing mechanisms and, no body of evidence has emerged to enable a definitive evaluation to make about their viability and sustainability hence this study. The study was mainly a qualitative descriptive one and focused on 70 percent of functional schemes in the Northern Region. It relied on both secondary data through desk top studies and primary data through interviews with 30 key informants comprising Scheme Managers, Health and Development Workers and Focus Groups Discussions with Scheme Members, Non-Scheme Members and Previous Scheme Members.
The study revealed among others, that CBHIS have tremendous prospects given the availability of technical support, solidarity mechanisms that exist in communities and government commitment to such schemes. However, schemes are faced with tremendous challenges- They may not necessarily be appropriate in every circumstance and moreover their current small size, limited benefit cover and their inability to cover all sectors and groups of the population for example, the very poorest, may sometimes limit their efficacy as instruments for the sustainable financing of health care. Nonetheless, this study has shown that these problems are not necessarily inherent but are related to design and management weaknesses, for which adequate and feasible solutions exist, though their application may require the active role of government and other partners so as to enable CBHIS to realize their true potential. It was therefore recommended among others, that the design of schemes should incorporate attractive benefit packages, efficient payment mechanisms, mandatory reference system, contracting and negotiating with providers on commonly agreed standards and community participation. Also, technical, managerial and material support, are germane to sustainability and viability of CBHIS and hence are also recommended.
Description
A thesis submitted to the School of Postgraduate Studies of the Kwame Nkrumah University of Science and Technology, Kumasi, in partial
fulfilment of the requirement of the degree of Master of Science in Health Services Planning and Management, 2005