Bringing experiences to bear on the implementation and management of health insurance schemes: the case of Okwahuman Health Insurance Scheme in Kwahu South District of Ghana

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Access to quality health care is limited in developing countries due to high service cost, poor road network among others. Several efforts are underway to militate against these unacceptable conditions. Paramount among these efforts is the quest for a more community-friendly, humane and pro poor health financing mechanisms. The Government of Ghana stepped up the efforts by introducing the national Health Insurance programme. Following from this, the number and diversity of community – based health insurance scheme in Ghana have increase dramatically, aiming at improving access to good quality health care. Unfortunately, very little is known about the design, management, community’s perception and factors important for increasing coverage of health insurance scheme. To this end, it is relevant to incorporate, experience and lessons learnt from the exiting community-based scheme into the impending national Health insurance Programme. The research aimed at investigating whether lessons from Okwahuman Health Insurance Scheme could be incorporate into the national health insurance scheme An in-depth case study was carried out in the Kwahu South District in Eastern Ghana in May to August 2005 using qualitative and quantitative research methodologies with key informants-health workers, insurance managers, and community members. Key findings of the study were that community members have seen some appreciable levels of improvement in quality health care in terms of management (80%), patient-provider relations (75%), and payment of user fees (84%), waiting time (67%), and drugs availability (47%), in the health facilities. ‘Waiting time’ was found to have (30.3%) of yet to improve rata and this was attributed to high attendance and inadequate staff at the health facilities. The high level of “yet to improve rate” in relation to drug availability (52.6%) was due to delays in reimbursing the health facilities by the insurance scheme as a result of too much documentation and manual vetting of claims. Financial constraints were also found to be the major reason why people did not join the piloted scheme (59%). Computerisation of the health system will help to curb delays in reimbursing as well as reducing waiting time at the health facility. Regarding the acute staff, more Medical Assistants and health Aid could be trained to augment the situation. Existing human resource at health facility should be strengthened to improve patient-provide relationship. Payment by installment, door-to-door registration, and registering at harvest time should form integral part of management of the national health insurance scheme to increase coverage. Also, an imprest system could be used to ensure drug availability in the health facilities. For sustainability and community ownership of the health insurance scheme, committees should be formed at the community level to support management of the scheme. More and intensive community education (74%) on the benefit of the scheme through community durbars, the preferred medium of communication in the community should be undertaken. It is recommended that further studies be undertaken to investigate the background experiences of staff; in terms of financial management, health, insurance, human relations, imbibing community participation and ownership skills to clients
A thesis presented 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 in Health Services Planning and Management, 2005