Improving health insurance coverage in Ghana: a case study

Ghana is one of the first sub-Saharan African countries to introduce national health insurance to ensure more equity in access to health care. The response of the population has been disappointing, however. This study describes and examines an experiment with so called ‘problem-solving groups’ that try to resolve mutual miscommunication and build trust among community members, health workers and health insurance staff. The problem-solving groups consist of representatives of these three stakeholders. The author closely followed the setting-up, meetings and group dynamics of problem-solving groups in seven local communities and analysed the results of the intervention. The research was part of a larger randomised trial involving more than 3000 households in the Central and Eastern Region. The overall project revealed some improvement in insurance membership thanks to the work of problem-solving groups. This anthropological case study has thrown light on the more hidden complexities of promoting health insurance. The most pressing one is that the poor, for whom health insurance is most urgent, were the least enrolled due to poverty and inadequate exemption.