Coordinator: Dr R.M.P.M. Baltussen (Radboud University Nijmegen Medical Centre)
Co-applicant: Dr. I.A. Agyepong (Ghana Health Service, Office of the Regional Director of Health Services, Regional Coordinating Council Office)
Programme outline
Health insurance is increasingly seen as an important alternative financing mechanism for health care in developing countries, and has the potential to increase utilization and better protect people against (catastrophic) health expenses. The Government of Ghana has passed a national Health Insurance Act in 2003 to set up mutual health organizations (MHO) in every district in Ghana, and is thereby the first country in Africa to implement MHO nation wide. As of January 2007, more than seven million people have enrolled in MHO, which equals coverage of more than 35% of the total population. The Ghanaian government regards national health insurance as one of the instruments to reach the Millennium Development Goals.
However, community participation is low, especially among the poor. Many barriers to enrolment exist in the interplay between communities, MHO and health provider. Moreover, the poor are formally entitled to premium exemptions but very few actually benefit because of implementation problems. These are urgent and vexing issues in a time that the Ghanaian government is implementing MHO across the whole country. Failure to reach the poor may undermine the successful implementation of MHO in Ghana.
Against this background, this program aims to design and evaluate interventions to stimulate MHO enrolment, with special focus on the poor. Project 1 analyses the impact, costs and process of problem solving programs to remove barriers to enrolment at the level of the community, MHO and health provider, in a cluster-randomised trial. Project 2 analyses the impact and costs of different approaches to identify the poor in order to target premium exemptions, in two different communities. In addition, project 3 evaluates the impact of enrolment on health care utilization, with special reference to the poor, in a cross-sectional analysis. All projects are carried out in both rural and urbanized communities in Ghana.
All projects have distinct research questions but will be carried out in an integrated overall study design in a four-year period. The research program uses a multidisciplinary approach including anthropologic and health economics techniques. The study will result in a set of recommendations for health insurance policy and program development in Ghana, and feed into World Bank and WHO programs on health insurance.
