Towards a client-oriented health insurance system in Ghana


The main objective is to enhance and sustain health insurance participation in Ghana through improved client oriented quality of care.


In Ghana, six years ago a National Health Insurance Scheme (NHIS) was launched. This unique program in Africa aims to ensure access to quality basic health care to all citizens of Ghana. Although the NHIS reached major achievements so far, it faces various challenges, i.e. securing sustained qualityof health care, retention of clients in the insurance program and adequate claims handling systems; all these challenges cause potential risks to the (financial)sustainability of the program. Feedback from clients with respect to NHIS services is minimal and insufficiently reflected in the current implementation of the NHIS. Placing the client in a central position of this research implies that we attempt to understand the clients’ perception and practices of health care in the context of the community in which they live. The pivotal question in this proposal will be: what are the clients’ perceptions leading to continued willingness to remain insured through the NHIS? If Ghanaians do not consider the services of NHIS and the health service providers sufficiently attractive, what will then be their alternatives: return to out-of-pocket payments or purchase a private insurance (if affordable)? All of these options have implications for sustainability of the NHIS services and provide reasons to further explore clients’ perspectives on NHIS and provider services. In four interrelated subprojects the researchers assess the perceptions of clients (and providers) from socio anthropological, public health, biomedical and business Further, interventions will be defined and tested: a variety of targeted training, improvement trajectories and limited material capacity building for clients, providers and NHIA.

COHEiSION final dissemination meeting

Click here to view the report about the final dissemination meeting, 2-3 November 2015.


Name: COHEiSION: Towards a client-oriented health insurance system in Ghana
Status: Completed
Principal Investigator: Prof. dr. T.F. Rinke de Wit (Project Coordinator)
Dr. D.K. Arhinful (Project supervisor Ghana)
Departments(s): AMC Department of Global Health
Partners: Noguchi Memorial Institute for Medical Research
Amsterdam Institute for International Development (Dr. W. Janssens, Prof.dr. M. Pradhan)
University of Groningen (Prof.dr. I. Hutter)
Contact information: Project manager: Jolien van der Vaart
Duration: Start date: 1 January 2011
Duration: 48 months
End date: 1 January 2016
Funded by: NWO WOTRO
Countries: Ghana
  • Fenenga C.J.; Nketiah-Amponsah E.; Ogink A.; Arhinful D.K.; Poortinga W.; Hutter I. Social Capital and Active Membership in Ghana’s National health Insurance Scheme-A Mixed Study. International Journal of Equity in Healthcare. DOI: 10.1186/s12939-015-0239
  • Fenenga C.J.; Nketiah-Amponsah E.; Bailey A.; Hutter I. (2015). A Participatory Action Approach for Client-centered Health Insurance. Action Research. doi:10.1177/1476750314568209
  • Fenenga C.J.; Boahene, K.; Arhinful, D. K.;  Rinke de Wit, T.F.;  Hutter, I.  Do prevailing theories sufficiently explain perceptions and health seeking behavior of Ghanaians? International Journal of Health Planning and Management, 29(1):26-42
  • Duku, S.K., van Dullemen C.E., Fenenga, C.J. (2015). Does Health Insurance Premium Exemption Policy for Older People increase Access to Healthcare? Evidence from Ghana. Journal of Aging & Social Policy 27(4):331-347 doi: 10.1080/08959420.2015.1056650
  • Kaba Alhassan., R., Spieker, N., van Ostenberg, P., Ogink, A., Nketiah-Amponsah, E., Rinke de Wit, T.F. Association between health worker motivation and healthcare quality efforts in Ghana. Hum. Res. for Health 11, 37-48, 2013.
  • Alhassan RK, Duku SO, Janssens W, Nketiah-Amponsah E, Spieker N, van Ostenberg P, et al. (2015). Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana. PLoS ONE 10(10): e0140109. doi:10.1371/journal.pone.0140109
  • Alhassan RK, Edward Nketiah-Amponsah, Nicole Spieker, Daniel Kojo Arhinful, Tobias F. Rinke de Wit. Effect of systematic community engagement on patient safety in primary health facilities: evidence from Ghana. PLos ONE, in press 2015.
  • 10 manuscripts under review