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Towards a client-oriented health insurance system in Ghana

Target Country: 
In Ghana, six years ago a National Health Insurance Scheme (NHIS) was launched. This unique program in Africa aims to ensure access to quality basic health care to all citizens of Ghana. Although the NHIS reached major achievements so far (65% enrolment by December 2009), it faces various challenges, i.e. securing sustained quality of health care, retention of clients in the insurance program and adequate claims handling systems; all these challenges cause potential risks to the (financial) sustainability of the program. Feedback from clients with respect to NHIS services is minimal and insufficiently reflected in the current implementation of the NHIS. The NHIS is keen on results of clients? perceptions and ready to implement improvements to its system, based on the results generated through this study.
Placing the client in a central position of this research implies that we attempt to understand the clients? perception and practises of health care in the context of the community in which they live. The pivotal question in this proposal will be: what are the clients? perceptions leading to continued willingness to remain insured through the NHIS? If Ghanaians do not consider the services of NHIS and the health service providers sufficiently attractive, what will then be their alternatives: return to out-of-pocket payments or purchase a private insurance (if affordable)? All of these options have implications for sustainability of the NHIS services and provide reasons to further explore clients? perspectives on NHIS and provider services. 
In four interrelated subprojects the researchers assess the perceptions of clients (and providers) from socio-anthropological, public health, biomedical and business perspective and verify these with providers and NHIS medical and actuarial data and vice versa (fig 1). The clients? perceptions are shared with providers and NHIA, by adopting a participatory research approach and creating conversational space by organising dialogues and applying visual methods. Further, interventions will be defined and tested: a variety of targeted training, improvement trajectories and limited material capacity building for clients, providers and NHIA. All interventions aim at improved client-oriented services. At level of the client, interventions focus on awareness raising on the clients? role in improving health care. At the level of health care providers, interventions focus on client oriented services, medical services and administration. At the level of the NHIA, interventions focus on public relation and marketing. Successful interventions will be recommended to policy makers of Ghana NHIS, MOH and Ghana Health Services. 

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