Obstacles in the process of establishing a sustainable national health insurance scheme: insights from Ghana
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World Health Organization
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3 p.
This technical brief examines the experience of Ghana in establishing and implementing a National Health Insurance Scheme (NHIS) as a mechanism to improve access to health services and strengthen social health protection, particularly for poor and disadvantaged populations. The document describes the origins, design principles, financing arrangements and early achievements of the scheme, which was introduced in 2004 to replace the “Cash and Carry” user-fee system. It highlights the NHIS emphasis on equity, risk sharing and financial protection, and summarizes evidence showing increased enrolment, greater utilization of formal health services and improved access to care among insured populations. Drawing on Ghana’s experience, the brief identifies major obstacles to establishing and sustaining a national health insurance programme. These include barriers to enrolment among poor and rural populations, difficulties in identifying and exempting indigent groups, weaknesses in health service delivery and referral systems, limited managerial and technical capacity, geographical inequities in infrastructure and financing, and challenges to long-term financial sustainability. The publication emphasizes the need for coordinated action across sectors, stronger health system performance and continuous monitoring to ensure that health insurance reforms achieve their intended objectives and remain sustainable over time.
This technical brief examines the experience of Ghana in establishing and implementing a National Health Insurance Scheme (NHIS) as a mechanism to improve access to health services and strengthen social health protection, particularly for poor and disadvantaged populations. The document describes the origins, design principles, financing arrangements and early achievements of the scheme, which was introduced in 2004 to replace the “Cash and Carry” user-fee system. It highlights the NHIS emphasis on equity, risk sharing and financial protection, and summarizes evidence showing increased enrolment, greater utilization of formal health services and improved access to care among insured populations. Drawing on Ghana’s experience, the brief identifies major obstacles to establishing and sustaining a national health insurance programme. These include barriers to enrolment among poor and rural populations, difficulties in identifying and exempting indigent groups, weaknesses in health service delivery and referral systems, limited managerial and technical capacity, geographical inequities in infrastructure and financing, and challenges to long-term financial sustainability. The publication emphasizes the need for coordinated action across sectors, stronger health system performance and continuous monitoring to ensure that health insurance reforms achieve their intended objectives and remain sustainable over time.