Implementation of public policy at the local level in Ghana: The Case of National Health Insurance Scheme in Sawla-Tuna-Kalba District
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Abstract Many developing countries have made efforts at improving welfare of their people by adopting number of health reforms, Ghana was not an exception in that endeavour. Many governments in Ghana adopted number of health reforms from free health care policy to user fees' and ultimately to health insurance initiatives from limited geographical coverage to nationwide. The study assesses the implementation of the National Health Insurance Scheme (NHIS) at the local level in Ghana, which compared two health care facilities one public (Sawla health Centre) and the other private (Sawla Friends Maternity Home Clinic) in one district. The purpose of the study is to examine the degree/extent of effectiveness in the implementation of the NHIS in terms of beneficiaries increase access to health care facilities and quality health care services. Also to ascertain if there are any significant differences between the public health care facility and the private health care facility with regard to financial, human resource endowment, implementation structure, staff knowledge (education and professional training) in administering NHIS forms, claims reports and treatment notes in performing their functional roles. The study was more qualitative; data was obtained from multiple sources (interviews, focus group discussions, observations and documentary reviews) and from different categories of persons (adults, aged, indigents and children under 18 years, staff of health care facilities and district health insurance secretariat). Winter's integrated model provided framework of analysis in identifying factors and actors perceived as responsible for implementation variations/differences between two health care facilities. Key factors such are program design, target group behaviour, socio-economic factors, policy instruments including resources and implementation structure were analyzed. The study concludes the performance of the two health care facilities have been impressive, findings have shown the two health care facilities have adequate knowledge of the goals and objectives of the NHIS due to high educational levels and professional training. Also resources, implementation structure/program design provided higher explanatory powers (implementation differences between the two health care facilities) more than target group behaviour and socio-economic conditions of beneficiaries. However the study identified that delays in the disbursement of central government funds to health care facilities posed a major obstacle towards effective implementation of NHIS at local level in Ghana.