Managing the civil servants health insurance scheme: the case of Ejura/Sekyedumase District in the Ashanti Region

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Economic problems in most Sub-Saharan African countries have made it difficult for governments to provide adequate resources for the effective and efficient management of the health sector. In response to this need, WHO, NGOs and some Health Economists have advocated for health insurance schemes as an alternative form of financing health care. Since the 1990s, community health insurance schemes have emerged in Ghana. Noted amongst these include the Nkoranza and Damango schemes in the Brong-Ahafo and Northern Regions respectively. It is however worth noting that these are all mutual health organisations. In 2001, the Ashanti Region Civil Servants Association in conjunction with the Ministry of Health in the region established the first ever social health scheme for their employees, making it the first formal sector scheme in the country. This scheme has since become operational in every district of the Ashanti Region. Each district operates independently of the others. The Ejura/Sekyeredumase scheme is one such scheme. This study looked at the performance of the management processes of the scheme in an attempt to unearth the lapses and weaknesses in its operation so as to make it a more viable one. The assessment focused on the variable concepts of planning, organizing, leading and controlling. Apart from obtaining data through questionnaires and discussions, interviews were conducted for beneficiaries, providers and the managers of the scheme. ‘- The study has confirmed among other things, that the Ejura/Sekyerdumase health insurance scheme was popular amongst civil servants in the district but only had problems with its management. The first and foremost factor responsible for this state of affairs was the non-functionality of the District Medical Care Committee which was one of the two committees supposed to have been put in place. An important recommendation based on the findings of this study is that all proposed structures according to the guidelines setting up a scheme be put in place before its commencement. This committee which was never made functional was supposed to function alongside the District Executive Committee. The former was to have authority over the latter whose responsibility was the day-to-day management of the scheme. Its presence would have complemented the efforts of the District Executive Committee and enhanced the performance of the scheme.
A thesis submitted to the Department of Community Health, College of Health Sciences in partial fulfilment of the requirements for the degree of Master of Science in Health Services Planning and Management, 2005