An operational feasibility study on a districtwide mutual health scheme in the Juabeso-Bia District

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Health care financing in Africa, especially sub-Saharan Africa has been an issue of major concern to African governments since independence. The debate intensified in the 1980’s when it dawned on governments that they may not be able to continue to offer free treatment to their people. Cost sharing involving cost recovery efforts and self-financing schemes were thus recommended for adoption. In Ghana, a legislative Instrument 1313 (1985) established the introduction of user fees in the health facilities. In course of its implementation, there was a public outcry against the policy and a call was made on government to institute a more humane cost recovery mechanism. Health Insurance Scheme was suggested and was piloted in the Eastern Region in 1997 but could not be sustained. The Brong Ahafo, Eastern and Volta Regions, however, established and implemented Community-based Mutual Health Schemes in selected communities but they are saddled with some problems. Presently, it is the policy of government to implement a Health Insurance Scheme nation-wide and 45 districts including Juabeso-Bia have been selected to implement it with effect from 2002. The study focused on the assessment of the district health system, the disease pattern in the district, service utilization, the socio-economic and demographic conditions that determine patronage of health insurance, and the social support systems/solidarity links that offer opportunity for the establishment of mutual health schemes. Views on how much the people would be able and willing to pay were also solicited. A cross sectional study design was used and the approach was qualitative descriptive. Quantitative data were also collected. Secondary data were collected from existing literature. Findings of the study indicate that the district hospital and about fifty percent (50%) of the sub-district facilities are also poorly resourced in terms of medical personnel and equipment. About 50% of the health facilities are concentrated in the south-eastern part of the district. The northern sector is most deprived of health facilities. The deficiencies in the district health system, especially the inadequate and inequitable distribution of facilities, have encouraged the mushrooming of private non-professional practice in the district. The situation as it pertains, however, indicates a feasible condition for the establishment and implementation of the scheme in the district except that particular note must be taken of the deficiencies identified with the health system to ensure the scheme is sustained. The disease pattern in the district is not different from that of the entire nation. Socioeconomic and demographic conditions were found to be feasible for the establishment of the scheme. However, the seasonality of the income of the people exposes them to poverty much of the time, especially the period between April and September. The study therefore revealed that collection of premiums would be more effective during the cocoa harvesting and sales season, from middle of October to the end of March. The findings also revealed that people would prefer registering as families and to pay premium on yearly basis. Acceptability of the scheme was ninety-seven percent (97%) and social support system is firmly integrated in the culture of the people, thus providing a fair basis for the operation of a mutual health scheme. On their expectations with respect to the benefits package, the study showed that 46% of respondents are in favour of in-patient care. Thirty-seven percent (37%) also prefer both in-patient and outpatient services. Generally, the results offer hope for a successful implementation of the District-wide Mutual Health Scheme in the district.
A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of in Health Services Planning and Management, 2003