Universal Healthcare Coverage in Ghana: The Importance of Including the Needs and Voices of the Poor to Achieve this National Goal

Introduction: Ghana's government passed the National Health Insurance Act (NHIA) to establish universal healthcare. Three health insurance options were available for Ghanaians through the NHIA, but the poorest Ghanaians would access to healthcare through community-financed healthcare plan (CFHP). These CFHPs require the poor's financial contribution and confidence it will provide healthcare access if and when needed.

Methods: In-depth interviews and focus groups were conducted with some of the poorest community members living in the Nima-Maamobi village within the capital city of Accra. Qualitative research methods included: open/focused coding, theme development, mini-interpretation assigning, and conceptual frameworks/integrative memos creation.

Results: Participants vocalized their expected health needs, concerns and fears of contributing to a CFHP to access health care. Issues raised included the need for the CFHP to be: participatory, user-friendly, high quality, accessible, pro-poor and sustainable. Also expressed was a need for culturally and linguistically appropriate healthcare and health education, cost recovery mechanisms (i.e. roll-over funds), and the importance of distancing the CFHP from the government to create trust and legitimacy in order for the poor to contribute and participate.

Conclusion: Universal healthcare is a monumental step for Ghana. Yet Ghana's poorest, with the least to contribute, must give their already-limited funds to a CFHP to access care. The poor lack confidence the CFHP will serve their needs until basic but crucial aspects of the CFHP are incorporated and implemented. The health financing experts and health programmers must take the poor's needs into consideration if a CFHP serving them is to succeed.