It also recommends improvement in the areas of networking, communication, client centeredness, service management and exemptions in the scheme.

The report says, “There is also the need to intensify client education and balanced commitment to technical and perceived quality improvement effort and this will help enhance client confidence in Ghana’s healthcare system, stimulate active participation in the national health insurance, increase health care utilisation and ultimately improve public health outcomes”.

Speaking at a two-day dissemination workshop in Accra, Dr Daniel Kojo Arhinful of the Epidemiology Department, Noguchi Memorial Institute for Medical Research (NMIMR), said the research was conducted because of feedback from clients that NHIS services were minimal and insufficient, which did not reflect in the current implementation of the NHIS.

The research was titled, “Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

The workshop, which provided the opportunity for participants comprising Ghana Health Service and health insurance experts, providers and users of the services, was organised by the Client Oriented Health Insurance (COHEiSION) Project to discuss policy direction towards sustaining the NHIS in Ghana.

The COHEiSION project was initiated in 2011 in Western and Greater Accra to help identify some of the critical barriers to enrolment and retention of membership in the insurance programme in order to design and implement interventions to address them.

It is a collaborative research between the NMIMR, Amsterdam Institute for Global Health and Development (AIGHD) of the University of Amsterdam, University of Groningen, and the Vrije University of Amsterdam.

The project is also implemented in partnership with the National Health Insurance Authority (NHIA) of Ghana; Ministry of Health (MoH)/ Ghana Health Service (GHS) and the Christian Health Association of Ghana (CHAG) with financial support from The Netherlands Government.

Dr Arhinful explained that the research looked at the differences in perceptions of clients and health staff on quality healthcare and determined if the perceptions were associated with technical quality proxies in health facilities.

Dr Arhinful who was also the Co-Project Investigator, said although the NHIS reached major achievements of 65 per cent enrolment by 2009, it faced various challenges, which included securing sustained quality of health care, retention of clients in the insurance programme and adequate claims handling systems.

These challenges, he said, posed potential risks to the financial sustainability of the programme.

He said him, “Placing the client in a central position of this research implies that we attempt to understand the clients’ perception and practices of health care in the context of the community in which they live.”

The Research, he said, has shown that the NHIS was keen on results of clients’ perceptions and ready to bring about improvements to its system.

The report thus recommends that the Ministry of Health should mandate the National Health Insurance Authority to exempt the aged from payment of annual registration fees and should be registered at registration centers, just as is being done for pregnant women under the free maternal health policy.

Ms Adelaide Akowuah-Bunatal, a Deputy Director, Provider and Clients Relations Department of the NHIS, said the NHIS had acknowledged the challenges and was working at reducing the bottlenecks which confronted the smooth operation of the scheme.

She explained that NHIS, which was introduced in Ghana in 2003 to improve access to quality healthcare services for the entire population, although reached major achievements with almost 70 percent cumulative enrolment rate by December 2010, was facing challenges.

She listed some of the challenges as retaining clients in the insurance programme; cumbersome claims handling systems; too generous benefit package; and ensuring good quality of health care; which had led to potential risk to the sustainability of the programme.

“To ensure that clients get optimum service, the NHIS will by December this year deploy some staff members to investigate some facilities to ensure that they are doing the right things,” she said.



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