Community participation in health financing - a case study of the community health Insurance scheme, Nkoranza District
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Date
1994-09-04
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Abstract
That the health needs of people are vital for any meaningful socio-economic development is an unquestionable fact. This is because good health properly channeled through productive activities is an asset to development. it is for this reason that the quest for improving the health status of the people has attracted the attention of governments worldwide - Unfortunately, with the increasing decline in the Global economy, developing countries in general have been hardest hit to the extent that the need to provide enough health facilities cannot be entirely met by governments alone -
In Ghana in particular , the fluctuating prices of the exportable items like cocoa, minerals and timber have not yielded enough revenue to match her ever increasing import bills or oil, spare parts, drugs and essential equipment to mention only a few Similarly, local revenue mobilization has not yielded much returns. In effect, national revenue has not kept pace with growing demand for essential services like food, shelter, education and health. Consequently, the need to involve the beneficiaries and other development actors in the provision of socio-economic facilities is seen by many as a necessary venture. Community/people - s participation has the advantage of cutting down cost, making the people identify themselves with the facility and thereby see to its operation, maintenance and sustenance - in the health sector. Community participation has taken the form of the provision of physical infrastructure like health posts, health centres dressing stations, as well as payment of all drugs issued by private and government health institutions. The introduction of health insurance as a health financing strategy is relatively new in the country and even only few private insurance companies operate such a scheme. The Nkoranza health insurance scheme is, thus, an attempt at involving an entire district community in financing their health needs through the payment of a yearly premium. The objective is to improve the accessibility of the people to admission at the district hospital when the need arises.
Analyses of the scheme were based on data collected through the use of formal questionnaire, key informant Interviews, observation and review of secondary data. Prom the analyses, it came out that participation in the scheme was appreciable during the first two years of operation but this declined in I94. Registration targets have not been met for 3 years running. In addition, registration tends to be positively skewed towards Nkoranza and its immediate surroundings. Unfortunately, the enthusiasm initially expressed for the scheme seems to have evaporated and reasons for this include inadequate benefits, unsustained and inadequate educational campaigns, frequent abuses, mistrust and low morale of insurance field workers. On the other hand, hospital admission has been increasing since the scheme started with most of them being insured patients. In a sense therefore, the scheme has increased hospital accessibility for insured patients. Once again, the insured people in the Nkoranza zone dominate patients who go on admission. Thus, participation in the scheme and utilization of its benefits tend to relate to distance and population. To improve on the performance of the scheme various recommendations have been made and these include:
1. Intensive and all year round educational campaigns
2. Fairness in the selection of patients for admission
3. Prompt refund of hospital bills to patients referred to other hospitals.
4. Adequate motivation and logistic support for insurance workers.
5. Introduction of incentives for members
6. Transparency and frugality in the use of insurance funds
In sum, it is expected that with the massive participation of the people in the scheme backed by the implementation of the recommendations made, the financial barrier to hospitalization will be removed and thereby enhance the peoples access to prompt and adequate medical care which is necessary for socio-economic development.
Description
A Thesis submitted to the Board of Postgraduate Studies, University of Science and Technology, Kumasi in partial fulfilment of the requirements for the Degree of Master of Science in Development Planning and Management,1994.