Access to quality health care among the poor in Asante Mampong, Ghana: a prospective view through the National Health Insurance Scheme

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The introduction of the “cash and Carry’ system in 1992 compounded the problem of financial access to quality health care created financial barrier to quality health care and thus led to lo utilization of health services especially, by the poor. This led to deteriorating health status. To reduce this problem of financial access to health, Ghana government is committed, and has introduced a convenient, affordable and sustainable health financing arrangement to protect the people, especially the poor, through the National Health insurance Scheme (NHIS). Though laudable, little is known about the efficacy of the health insurance in improving access to quality health in developing countries with Ghana not being an exception. A cross-sectional analytic study design aimed at investigating whether the NHIS is a feasible option for improving access to quality health care, and to identify strategies to improve access to quality health care in Asante Mampong was undertaken between the periods. May- August 2005. A sample of 240; consisting of 200 community members (individual respondents) aged 18 years and above and 40 key informants also in the same age group were selected for the study. Data collection tools were pre-tested at Agona, with similar characteristics as Mampong before data collection. Data was collected mainly through quantitative means with structured questionnaire and face-to-face interviews with respondents while secondary data from the Sekyere West District Health Administration, District Assembly, and the National Health Insurance district office at Mampong were also used. Data was analysed by computer using Special programme for Social Science (SPSS) and Epi Info sofiwares as well as manual. Key findings from the study indicated that the NI-ITS has the potential of increasing access to quality health care. This was confirmed by the key informants all of whom have access to quality health care because they belong to the civil servants health insurance scheme. On the contrary, because the individual respondents do not belong to any form of health insurance (HI), their access to quality health care is low (2 1.5%). Financial barrier was identified as the major cause of access to quality health care. Access to quality health care was dominated by more married couples (69.8%) and Christians (88.4%). The dominant health care financing mechanism in Asante Mampong is the ‘cash and carry’ system, though unpopular. Notably, awareness of the NH1S was identified as high in Asante Mampong as public education and advertisements have gone to the grassroots level. Acceptability of the scheme was also noticed as high 90% for both respondents. Coverage was however low but promising for community members Informal sector respondents (1R) (40.5% but high for the K1-forflial sector (920%). The following strategies are suggested to improve access to quality health care through an improved coverage provision of quality health care; intensive public education; expedite implementation process; convenient premium paying mechanism; door-to door registration; compulsory membership for all residents in Ghana and stop politicising the scheme. The role of HI in improving access to quality of health care cannot be overemphasized. The establishment of a district-wide health insurance schemes nationwide is a welcome idea. Since the scheme is new in the country, there are bound to be challenges such as pertain in Asante Mampong. There are however, opportunities such as high level of awareness and acceptability of the NHIS in Asante Mampong. These should therefore be tapped and through proper scheme management and government continuous commitments, the full benefits of the NHIS could be realised. From all indications, the NHIS is capable of improving access to quality health care, despite the teething problems. It is therefore recommended that further studies into its sustainability should be undertaken.
A dissertation 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