PROSPECTS AND CHALLENGES OF THE MUTUAL HEALTH INSURANCE SCHEME IN TAMALE METROPOLIS

Abstract

The research was developed to identify the challenges and prospects of the Tamale Metropolitan Health Insurance Scheme to improve sustainability. The study focused on a case study and descriptive cross - sectional in design aimed at eliciting information about perceptions community members, the health facility, and the scheme about premium levels, benefit package, quality of service, funding, dependency of exempted registrants on the scheme. The study employed questionnaires administered to households, health facilities and scheme managers. The study revealed that, the Tamale Metropolitan Health Insurance Scheme had tremendous prospects given the availability of technical support, quality of care at some facilities, solidarity that exists in communities, development partners and government commitment to this scheme as well as increasing community recognition that "the scheme is a convenient means to increasing access to health care. However, the scheme is faced with some challenges. Inadequate staffs, political interference, poor coverage of community members and abuse of the health insurance system by unscrupulous clients and continuous link failure are potential threats and can hamper sustainability of the scheme. The study on discovering these challenges had proposed comprehensive recommendations all geared towards helping stakeholders to overcome the aforementioned challenges of the scheme. It therefore recommended among others that they should be increase publicity in the rural communities, increase community participation; scheme officials should practise good professional ethics, prompt settlement of claims by the NHIA, and also the scheme should devise a more efficient way of printing I D cards to avoid delays.