Assessment of the sustainability of West Gonja Hospital Health Insurance Scheme in the West Gonja District, Damongo, Ghana
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Date
2002-11-14
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Abstract
Medical care after Independence was free for Ghanaians until the 1980’s when the Ministry of Health could no longer afford to provide such free services. As a result of the removal of subsidies, user fee was introduced to recover cost based on the advocacy of WHO, The World Bank and International Agencies.
The West Gonja Hospital, located In Damongo in the Northern Region, a facility of the Catholic Church also faced the problem of increasing cost in providing health services to the people. In 1995, the hospital management initiated a community health insurance scheme as an alternative means of financing the services.
This study assessed the sustainability of the scheme taking into consideration the management and performance of the scheme as well as perception of the communities on the scheme. A cross sectional descriptive study was carried out with variables such as service utilization, financial status, risk management, service satisfaction, membership, management/administration and perception as the basis of assessment. Primary and secondary data were collected and analyzed. Focus group discussion was also carried out as well as consultations with key informants and stakeholders of the schema. Purposeful sampling method was used to select the villages and individuals who were interviewed using structured questionnaire.
Data analysis and findings of the study revealed that people in the study area have fairly positive knowledge and perception about the scheme. It was, however, realized that the scheme has a high moral hazard and adverse selection as well as management problems which threaten its financial sustainability. The technical sustainability of the scheme is also at stake as the four staff on the scheme have no professional or expert training in management of health Insurance.
Weak community participation was also revealed despite the strong desire of the people to be involved in the management of the scheme to enhance its
sustainability.
Despite its increasing accessibility to health service utilization, it is concluded that though the scheme has increased accessibility to some extent to health service utilization the is facing sustainability crisis due its poor design and management problems.
The following are suggested as solutions to the sustainability problem:
- the community be actively involved in the management of the scheme
-some aspects of the design of the scheme should be reviewed to facilitate effective and efficient management. Areas of concern include the benefit package which has no limitations as regards treatment protocol and procedures level of financial package for the insured and number of times / days an insured person is entitled to when on admission
- the scheme staff be given technical and professional training in management of insurance scheme with special reference risk management and marketing.
Description
A thesis submitted to the Department of Community Health, School of Medical Sciences, College of Health Sciences
Kwame Nkrumah University of Science and Technology in partial
fulfilment of the requirements for the award of MSc.degree in Health Services Planning and Management, 2002