BackgroundQuality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge.PurposeTo examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed.MethodsThis is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman’s rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare.ResultsNegative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities.ConclusionThere is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana’s healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes.

Abstract:We present qualitative data from a study in Ghana (2011), where the National Health Insurance Scheme (NHIS) was introduced to improve access to health care. In 2011 membership enrolment and retention in the scheme was stalling. To obtain better insights into socio-cultural factors that influence utilization of healthcare services and the NHIS this study compared Explanatory Models of healthcare clients with those of primary healthcare providers and the NHIS regarding illness, the need for, the quality of, and the control over healthcare and health insurance services. We found critical disparities in socio-cultural beliefs and perceptions of healthcare and health insurance between these three stakeholder groups, such as the clients' holistic view on illness versus healthcare providers' bio-medical view; the clients' inter-relational focus in perceiving quality of services versus the providers' medical technical focus. These differences are leading to misconceptions, blame practice, poor services, non-adherence and low trust. The findings increase our understanding of clients' behavior and that of their service providers. We conclude with key messages for policy leaders and operational managers that can guide them in improving services and facilitating client trust and interest to participate in health insurance and utilize healthcare services.

While access to and uptake of modern family planning (FP) in Ghana has steadily risen over the last decade, the modern Contraceptive Prevalence Rate (mCPR) among all women reached only 22% in 2019 with 30% of women still reporting unmet need. To increase FP uptake via mitigation of cost barriers among women with unmet need, the Government of Ghana is seeking to integrate claims-based FP services into the National Health Insurance Scheme benefits package. The impact of these activities has the potential to be significant with the proportion of women accessing modern FP shifting dramatically to public facilities over the past decade. The Ghana Ministry of Health, the National Health Insurance Authority, Marie Stopes International Ghana, and the Population Council launched a pilot in nine districts from 2018–20. This report uses data from pilot activity to model four scenarios involving implementation of cost removal, demand generation, and long-acting reversible contraceptives training to estimate impact on mCPR. These are input into the Health Policy Project’s ImpactNow tool to obtain estimates of health and economic benefits, intended to inform decisions regarding scale-up of these activities across the country.