Towards a client-oriented health insurance system in Ghana


The main objective is to enhance and sustain health insurance participation in Ghana through improved client-oriented quality of care.


Six years ago a National Health Insurance Scheme (NHIS) was launched in Ghana. This unique program in Africa aims to ensure access to quality basic health care to all citizens of Ghana. Although the NHIS has had major achievements so far, 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. 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 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. Furthermore, interventions will be defined and tested: a variety of targeted training, improvement trajectories and limited material capacity building for clients, providers and NHIA.

AIGHD Research Lead

Prof. T.F. Rinke de Wit


Noguchi Memorial Institute for Medical Research
Amsterdam Institute for International Development (Dr. W. Janssens, Prof. M. Pradhan)
University of Groningen (Prof. I. Hutter)