Achieving Universal Health Care Coverage in a Developing African Country: The Requirement of a Health Information System

Background: Ghana's government passed the National Health Insurance Act (NHIA) establishing a plan for universal healthcare coverage. The government designed three health insurance options to fit the finances and needs of each Ghanaian, but this great stride toward universal coverage would fall short without a health information system (HIS) implemented to support Ghanaian hospitals and health clinics.

Methods: In-depth interviews with key health administrators and health providers were held to determine financial and administrative needs of hospitals and health clinics. Open/focused coding, mini-interpretation assigning, and conceptual frameworks/integrative memos creation were used to analyze data.

Results: Without a HIS whereby identification of insured members was available, members could share cards with non-members which could potentially bankrupt the scheme. Additionally the lack of a HIS with a centralized database shared between regions could prevent Ghanaians from accessing treatment in another region(s) without paying out-of-pocket should illness occur when away from one's own local health facilities. Lastly, maintaining electronic records is extremely important both for facilitating record keeping by health service providers, and facilitating members' ease of accessing services.

Conclusions: Ghana's NHIA for universal coverage was a monumental step for this developing West African country, yet short-sighted regarding technological requirements for universal coverage to succeed long-term. Options exist to overcome challenges until a HIS can be developed and implemented. Steps to mitigate problems could include: membership cards with identification photographs so members could obtain services without paying out-of-pocket and insurance schemes would not run the risk of bankruptcy. Verifying membership by telephone to administrative record keepers would be another possibility. Health providers could be given updated listings of members each month ensuring membership records are kept current. These steps would mitigate problems until the government could develop and implement a national HIS to support the universal coverage proposed.