A Stakeholders Analysis of The Capitation Pilot Under Ghana's Watch National Health Insurance Scheme in The Ashanti Region

ABSTRACT 

Ghana established the National Health Insurance Scheme (NHIS) through the enactment of Act 650 in 2003 which was to secure the provision of basic healthcare services to a person resident in the country. Since the implementation of NHIS in 2004, the Fee-for-service (FFS) has been used for the payment of drugs and some other services until 2008 when the Ghana Diagnostic-Related Groups (G-DRGs) was introduced to pay providers on the basis of claims made by them to the District Mutual Health Insurance Scheme (DMHIS). In January 2012, the NHIA initiated the pilot implementation of the capitation policy in the Ashanti Region. The aim of the study was to undertake a stakeholder analysis of the capitation pilot under Ghana’s National Health Insurance Scheme pilot in Ashanti Region to investigate the stakeholders’ position, power and interest during the piloting of the policy. This is a single case study design using qualitative data collection and analysis methods Data were collected using an interview guide for regional level actors and a Focus Group Discussion guide for clients. The study area was Kumasi Metropolitan Assembly, Ejisu Juabeng Municipal Assembly and Atwima Nwabiagya District Assembly all in the Ashanti Region. Twenty (20) stakeholders were purposively selected and interviewed. Two Focus Group Discussions were held. Data analysis was done manually using thematic analysis. Stakeholder tools like tables, matrices and force field analysis were used to present findings. vi One of the key findings of this study was that though stakeholders were generally aware of the capitation policy and its pilot implementation there were lots of misinterpretations of some parts of the policy especially at the pre-implementation phase which led to opposition from some primary stakeholders like the clients and staff of the District Mutual Health Insurance Scheme. However, as these stakeholders begun to get a better understanding of the policy, their position changed. The general position of stakeholders (both primary and secondary) is that capitation payment system is a good idea. However, a critical attention must be given to the contentious aspects of the policy in order to facilitate effective scaling-up implementation. Measures such as reviewing the capitation rate and implementing an alternative provider payment method for smaller facilities such as Health centres, CHPS compounds and maternity homes should be considered.