245034 Universal Healthcare Coverage in Ghana: The Importance of Including the Needs and Voices of the Poor to Achieve this National Goal

Monday, October 31, 2011

Pammie Gabrielle Renee Crawford, MPhil, SM , International Health, Health Systems Division/Department of Health Information Systems, Johns Hopkins University Bloomberg School of Public Health/Johns Hopkins University School of Medicine, Baltimore, MD
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.

Learning Areas:
Assessment of individual and community needs for health education
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health administration or related administration
Public health or related research

Learning Objectives:
Describe importance of community needs and expectations when planning to use a community-financing approach to health care Assess the requirements of poor communities in order to build trust in a community-financed health care plan Identify key features of a community-financed healthcare plan to serve poor and marginalized communities

Keywords: International Health, Community Health Programs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I collected and analyzed the data through my Master's in Public Health Program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.