Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues
Background Ghana’s National Health Insurance Scheme (NHIS), established by an Act of Parliament (Act 650), in 2003 and since replaced by Act 852 of 2012 remains, in African terms, unprecedented in terms of growth and coverage. As a result, the scheme has received praise for its associated legal re...
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| Format: | Article |
| Language: | English |
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Kerman University of Medical Sciences
2017-05-01
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| Series: | International Journal of Health Policy and Management |
| Subjects: | |
| Online Access: | http://www.ijhpm.com/article_3280_4d52bf7e0b54425ce326f48c80ce01a1.pdf |
| _version_ | 1819051374746271744 |
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| author | Adam Fusheini Gordon Marnoch Ann Marie Gray |
| author_facet | Adam Fusheini Gordon Marnoch Ann Marie Gray |
| author_sort | Adam Fusheini |
| collection | DOAJ |
| description | Background
Ghana’s National Health Insurance Scheme (NHIS), established by an Act of Parliament (Act 650), in 2003 and since replaced by Act 852 of 2012 remains, in African terms, unprecedented in terms of growth and coverage. As a result, the scheme has received praise for its associated legal reforms, clinical audit mechanisms and for serving as a hub for knowledge sharing and learning within the context of South-South cooperation. The scheme continues to shape national health insurance thinking in Africa. While the success, especially in coverage and financial access has been highlighted by many authors, insufficient attention has been paid to critical and context-specific factors. This paper seeks to fill that gap.
Methods
Based on an empirical qualitative case study of stakeholders’ views on challenges and success factors in four mutual schemes (district offices) located in two regions of Ghana, the study uses the concept of policy translation to assess whether the Ghana scheme could provide useful lessons to other African and developing countries in their quest to implement social/NHISs.
Results
In the study, interviewees referred to both ‘hard and soft’ elements as driving the “success” of the Ghana scheme. The main ‘hard elements’ include bureaucratic and legal enforcement capacities; IT; financing; governance, administration and management; regulating membership of the scheme; and service provision and coverage capabilities. The ‘soft’ elements identified relate to: the background/context of the health insurance scheme; innovative ways of funding the NHIS, the hybrid nature of the Ghana scheme; political will, commitment by government, stakeholders and public cooperation; social structure of Ghana (solidarity); and ownership and participation.
Conclusion
Other developing countries can expect to translate rather than re-assemble a national health insurance programme in an incomplete and highly modified form over a period of years, amounting to a process best conceived as germination as opposed to emulation. The Ghana experience illustrates that in adopting health financing systems that function well, countries need to customise systems (policy customisation) to suit their socio-economic, political and administrative settings. Home-grown health financing systems that resonate with social values will also need to be found in the process of translation. |
| first_indexed | 2024-12-21T12:02:56Z |
| format | Article |
| id | doaj.art-a8485a5c0af342d7b89b95850c01fa4b |
| institution | Directory Open Access Journal |
| issn | 2322-5939 2322-5939 |
| language | English |
| last_indexed | 2024-12-21T12:02:56Z |
| publishDate | 2017-05-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-a8485a5c0af342d7b89b95850c01fa4b2022-12-21T19:04:46ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392322-59392017-05-016527328310.15171/ijhpm.2016.133Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation IssuesAdam Fusheini0Gordon Marnoch1Ann Marie Gray2Centre for Health Policy/MRC Health Policy Research Group, and School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaSchool of Criminology, Politics and Social Policy, Faculty of Social Sciences, University of Ulster, Jordanstown, UKSchool of Criminology, Politics and Social Policy, Faculty of Social Sciences, University of Ulster, Jordanstown, UKBackground Ghana’s National Health Insurance Scheme (NHIS), established by an Act of Parliament (Act 650), in 2003 and since replaced by Act 852 of 2012 remains, in African terms, unprecedented in terms of growth and coverage. As a result, the scheme has received praise for its associated legal reforms, clinical audit mechanisms and for serving as a hub for knowledge sharing and learning within the context of South-South cooperation. The scheme continues to shape national health insurance thinking in Africa. While the success, especially in coverage and financial access has been highlighted by many authors, insufficient attention has been paid to critical and context-specific factors. This paper seeks to fill that gap. Methods Based on an empirical qualitative case study of stakeholders’ views on challenges and success factors in four mutual schemes (district offices) located in two regions of Ghana, the study uses the concept of policy translation to assess whether the Ghana scheme could provide useful lessons to other African and developing countries in their quest to implement social/NHISs. Results In the study, interviewees referred to both ‘hard and soft’ elements as driving the “success” of the Ghana scheme. The main ‘hard elements’ include bureaucratic and legal enforcement capacities; IT; financing; governance, administration and management; regulating membership of the scheme; and service provision and coverage capabilities. The ‘soft’ elements identified relate to: the background/context of the health insurance scheme; innovative ways of funding the NHIS, the hybrid nature of the Ghana scheme; political will, commitment by government, stakeholders and public cooperation; social structure of Ghana (solidarity); and ownership and participation. Conclusion Other developing countries can expect to translate rather than re-assemble a national health insurance programme in an incomplete and highly modified form over a period of years, amounting to a process best conceived as germination as opposed to emulation. The Ghana experience illustrates that in adopting health financing systems that function well, countries need to customise systems (policy customisation) to suit their socio-economic, political and administrative settings. Home-grown health financing systems that resonate with social values will also need to be found in the process of translation.http://www.ijhpm.com/article_3280_4d52bf7e0b54425ce326f48c80ce01a1.pdfPolicy TranslationNational/Social Health InsuranceSuccess DriversPolicy ReformsGhanaImplementation |
| spellingShingle | Adam Fusheini Gordon Marnoch Ann Marie Gray Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues International Journal of Health Policy and Management Policy Translation National/Social Health Insurance Success Drivers Policy Reforms Ghana Implementation |
| title | Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues |
| title_full | Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues |
| title_fullStr | Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues |
| title_full_unstemmed | Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues |
| title_short | Stakeholders Perspectives on the Success Drivers in Ghana’s National Health Insurance Scheme – Identifying Policy Translation Issues |
| title_sort | stakeholders perspectives on the success drivers in ghana s national health insurance scheme identifying policy translation issues |
| topic | Policy Translation National/Social Health Insurance Success Drivers Policy Reforms Ghana Implementation |
| url | http://www.ijhpm.com/article_3280_4d52bf7e0b54425ce326f48c80ce01a1.pdf |
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