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Ghana

In August 2003, the Government of Ghana passed the National Health Insurance Act, mandating the creation of district-level mutual health organizations (MHOs). Implementation of the resulting national health insurance scheme (NHIS) began in 2004. That same year, the PHRplus project (the predecessor to Health Systems 20/20) in cooperation with the Health Research Unit (HRU) of the Ghana Health Service, conducted a study on health services utilization and household expenditures for health care to serve as a baseline for a future evaluation of the NHIS. Health Systems 20/20 and the HRU are now planning for a follow-on household survey to compare to the baseline study.

The household survey will be conducted in two districts where the baseline was conducted (Nkoranza and Offinso), and a patient exit survey will be conducted in an additional four districts (Kwahu South, Savelugu, Ahanta West, Ajumako). The study will assess the impact of the NHIS on social inclusion, utilization of health services, and household income protection, using the baseline data as a comparison. Other planned activities include interviews with district scheme managers and focus group discussions with health care providers, to gain insights into NHIS implementation and its impact on service provision at the district level. Health Systems 20/20 expects to work with the HRU to create an advisory group, comprised of government health officials and health providers, to guide the evaluation process and increase local ownership of the study.