Identifying the Strengths and Weaknesses of the Administrative and Organizational Structures of the National Health Insurance Scheme, Using Pru and Bawku West Districts

The ability of each country’s health insurance to be able to mobilise sufficient funds to finance health care, to allocate these funds and organise health care delivery to produce the much needed health benefits from majority of the people and how to control the cost of health care services depend by and large on identifying the strengths and weaknesses of the administrative and organizational structure of the National Health Insurance Scheme (NHIS). That is the focus of this paper, to explore the strengths and weaknesses of Ghana’s Health Insurance Scheme and to advice the way forward. Multi-stage sampling was used, the study areas are first divided into identified communities, where the sample of communities were selected from these clusters, from which sampled households were drawn from each identified community through a sample frame. The survey method of data collection was used, with the questionnaire as the principal instrument designed to collect relevant information from 200 respondents. The primary data was collected through interviews from both closed-ended and open-ended questions, and discussions with key informants such as the scheme managers, as well as management of provider facilities from a special questionnaire that was designed for them. The following strengths were identified in the Insurance Scheme, incentives regime through exemptions for the very young and the aged subsidized through government taxes, allowing for continuous payment of premium by instalments and registration phases across the years, identification of vertical linkages to the Regional and National Health Insurance and horizontal linkages with service provides. On the weaknesses threatening the scheme, the staff situation show the need for more skilled training, poor community participation and poor flow of information also threaten the scheme.