Tobias Rinke de Wit, and Dr.
Nicole Spieker. Funding acquisition: DKA. Investigation: RKA. Methodology: RKA. Project administration: DKA. Resources: RKA. Software: RKA. Supervision: DKA. Writing — original draft: RKA. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background The introduction of the national health insurance scheme NHIS in Ghana in significantly contributed to improved health services utilization and health outcomes.
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Methods Electronic search was done for literature published between — on the NHIS and its sustainability in Ghana. Results Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Conclusions The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme.
Introduction Universal access to good quality health care remains a major concern of health systems globally.
Download: PPT. Study selection process and exclusion criteria The search did not include literature on health insurance in developed countries. Review process and literature selection The reviewers first assessed grey literature on the NHIS to inform the development of the review background.
Extraction and analysis Data extraction was done using an Excel spreadsheet and analysis done in the narrative form since the retrieved literature is a mixture of peer reviewed articles and grey literature. Results Following the electronic search using relevant search engines, a total of 4, publications including grey literature were found on health insurance in Ghana and Africa. Table 2. Recommendations to sustain the NHIS. Limitations The current review is limited by the type of literature retrieved for review.
Conclusions This paper reviewed relevant literature on sustainability challenges of the NHIS and suggested interventions to avert a collapse of the scheme. Supporting Information. S1 Table.
References 1. World Bank. ZS on 19th June, Ministry of Health MOH. Wholistic assessment of the health sector programme of work. Accra, Ghana. Health Systems Publications: Abuja Declaration. Strategies for sustainability and equity of pre-payment health schemes in Uganda, African Health Sciences, 9 s2 :s59—s65 View Article Google Scholar 5. Arhinful D. The solidarity of self-interest: social and cultural feasibility of rural health insurance in Ghana. In Research report African Studies Center, Leiden, Netherlands. Agyepong IA, and Adjei S. Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme, Health Policy and Planning, 23 2 — Providing free maternal health care: ten lessons from an evaluation of the national delivery exemption policy in Ghana, Global Health Action, 2 10 :1—13 View Article Google Scholar Ministry of Health MoH.
Ministry of Health, Accra, Ghana. Mensah S. Motivation and retention of health workers in developing countries: a systematic review, BMC Health Services Research, 8 :1—8. View Article Google Scholar Systematically reviewing qualitative and quantitative evidence to inform management and policy- making in the health field.
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Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review. Social Science and Medicine, 61 2 — Comparison of perceived and technical health care quality in primary health facilities: implications for a sustainable national health insurance scheme in Ghana. Effect of community engagement interventions on patient safety and risk reduction efforts in primary health facilities: evidence from Ghana. Efficiency of private and public primary health facilities accredited by the National Health Insurance Authority in Ghana. Assessing the impact of community engagement interventions on health worker motivation and experiences with clients in primary health facilities in Ghana: a randomized cluster trial.
Brugiavini A, and Pace N. Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care. Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients, International Journal for Equity in Health, 13 63 :1— Effect of removing direct payment for health care on utilization and health outcomes in Ghanaian children: A randomized controlled trial, PLoS Medicine, 6 1 :1—11 View Article Google Scholar Adu KO. Low participation in national health insurance scheme in Central Region OF Ghana: underlying reasons and health seeking behaviour of both insured and uninsured.
Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme—a systems approach, Health Research Policy and Systems, 12 35 :1— Social solidarity and willingness to tolerate risk- and income-related cross-subsidies within health insurance: experiences from Ghana, Tanzania and South Africa, Health Policy and Planning, , i55—i The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana, Health Economics Review, 2 13 :1— The financial protection effect of Ghana National Health Insurance Scheme: evidence from a studying two rural districts, International Journal for Equity in Health, 10 4 :1— Management of mutual health organizations in Ghana, Tropical Medicine and International Health, 11 5 — Rajkotia Y.
Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa, Health Policy and Planning, i46—i Association between health worker motivation and health care quality efforts in Ghana. Amporfu E. Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage, International Journal for Equity in Health, Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis, International Journal for Equity in Health, The roots of conflict in West Africa are much deeper and complex, and are embedded in the interplay of historical factors, socio-economic crisis, legacies of authoritarianism and the politics of exclusion, international forces, and local struggles Obi Admittedly, while the aforementioned constitute the broader causal factors, embedded within and related to them are bad governance and corruption, human rights violations, poverty, ethnic marginalization and small arms and light weapons proliferation among others , which continue to serve as triggers and drivers of violent conflicts in the sub-region.
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Even though there are several other specific causes of violent conflicts and civil strife in West Africa, the paper will focus on discussing the aforementioned. Post-colonial rule of West African countries has been fraught with several challenges. Elemental among them are the issues of bad governance and corruption.
Following independence, several regimes across the sub-region have mismanaged state resources and weakened governance institutions which has resulted in economic stalemate, political apprehensions and breakdown of social peace and stability. Today, these twin factors constitute a major cause of violent conflicts and civil strife in West Africa. Several scholarly works on conflicts in the sub-region have identified bad governance and corruption as the underpinning factors fuelling and renewing violence in West Africa. For instance, in the Sierra Leonean war, it was identified that bad governance, corruption and poverty were the root causes of the conflict Fithen Additionally, research conducted in Liberia by Patrick Vinck, Phuong Pham and Tino Kreutzer in indicated that majority of the population 64 per cent identified, among other factors, greed and corruption as the cause of the Liberian civil war Vinck et al Ironically, the Niger Delta region though blessed with the largest oil resource in Nigeria is also the poorest region in the country.
Reportedly, the majority of the perpetrators of corruption in Nigeria include senators, ministers, commissioners and individuals with higher connections in the political playground Ejibunu Likewise, in a small country like Guinea-Bissau, bad governance and corruption are deeply entrenched in the social, political, judicial and economic system leading to bitter pent-up feelings among the local population which are sometimes expressed through violence Voz di Paz and Interpeace Some citizens were quoted saying:.
The President steals. The Governor steals. The minister and even the Prime Minister steal. The administrator steals. Who will not steal? The country is being destroyed by the President. It was there that the destruction began.
If the President takes twenty-four billon CFA , what is left? Voz di Paz and Interpeace The health centres do not have anything; patients have no bed and no sheets. The leaders go to build buildings. It is not the people that are spoiling them. The people are united, but the State does not want our unity. They are pitting us against each other.
That lineage is not worth anything. Clearly if the above mentioned persists and remains unresolved it could increase the likelihood for more violent conflicts and civil strife rather than ending them and building sustainable peace in the sub-region. Incidences of human rights abuses and violations are numerous in West Africa and as such this forms the basis for the eruption and renewal of violent conflicts and civil strife in the sub-region.