The South African national health insurance: a revolution in health-care delivery!

Abstract Background To strengthen the implementation of the Community-based Health Planning and Services (CHPS) programme which is Ghana’s key primary health care delivery strategy, the CHPS+ Project was initiated in 2017. We examined community utilisation and satisfaction with CHPS services in two System Learning Districts (SLDs) of the project. Methods This community-based descriptive study was conducted in the Nkwanta South Municipality and Central Tongu District of Ghana. Data were collected from 1008 adults and analysed using frequency, percentage, chi-square, and logistic regression models. Results While the level of utilisation of CHPS services was 65.2%, satisfaction was 46.1%. Utilisation was 76.7% in Nkwanta South and 53.8% in Central Tongu. Satisfaction was also 55.2% in Nkwanta South and 37.1% in Central Tongu. Community members in Nkwanta South were more likely to utilise (AOR = 3.17, 95%CI = 3.98–9.76) and be satisfied (AOR = 2.77, 95%CI = 1.56–4.90) with CHPS services than those in Central Tongu. Females were more likely to utilise (AOR = 1.75, 95%CI = 1.27–2.39) but less likely to be satisfied [AOR = 0.47, 95%CI = 0.25–0.90] with CHPS services than males. Even though subscription to the National Health Insurance Scheme (NHIS) was just 46.3%, NHIS subscribers were more likely to utilise (AOR = 1.51, 95%CI = 1.22–2.03) and be satisfied (AOR = 1.45, 95%CI = 0.53–1.68) with CHPS services than non-subscribers. Conclusion Ghana may not be able to achieve the goal of universal health coverage (UHC) by the year 2030 if current levels of utilisation and satisfaction with CHPS services persist. To accelerate progress towards the achievement of UHC with CHPS as the vehicle through which primary health care is delivered, there should be increased public education by the Ghana Health Service (GHS) on the CHPS concept to increase utilisation. Service quality should also be improved by the GHS and other stakeholders in Ghana’s health industry to increase satisfaction with CHPS services. The GHS and the National Health Insurance Authority (NHIA) should also institute innovative strategies to increase subscription to the NHIS since it has implications for CHPS service utilisation and satisfaction.

Download Full-text

The Views of Public Service Managers on the Implementation of National Health Insurance in Primary Care

10.21203/rs.3.rs-515206/v1 ◽

2021 ◽

Author(s):

Shane Darren Murphy ◽

Shabir Ahmed Moosa

Keyword(s):

Health Insurance ◽

South African ◽

National Health Insurance ◽

National Health ◽

South African Government ◽

The South ◽

Top Down ◽

African Government ◽

Strategic Purchasing ◽

Universal Healthcare

Abstract Background The South African government is implementing National Health Insurance as a monopsony health care financing mechanism to drive the country towards Universal Health Coverage. Strategic purchasing, with separation of funder, purchaser and provider, underpins this initiative. The NHI plans contracting units for primary healthcare services to function as independent sub-district purchasers and District Health Management Offices to support and monitor these contracting units. This decentralised governance model to the operational unit of primary healthcare, the heartbeat of any universal healthcare system, is critical to programme success. The views of district-level managers, who are at the centre of the planned phased rollout will shed light on current policy implementation.ObjectivesThis is a qualitative study to explore district and sub-district managerial views on National Health Insurance and its implementation. Methods Purposive sampling was used to identify key respondents from a major urban district in Gauteng, South Africa, for participation in exploratory in-depth interviews. This study employed framework analysis within MaxQDA software for robust thematic analysis. Results Managers viewed National Health Insurance as a social and moral imperative but lacked clarity and insight into the National Health Insurance Bill and relevant implementation strategies. The majority of respondents had not received any engagement or had the opportunity to engage in policy formulation. District managers highlighted several pitfalls in current organisational operations. National and provincial government continue to function in a detached and rigid top-down hierarchy. The voices of coalface managers and workers, who live the reality of South African healthcare service provision, go unheard and unengaged. The findings of this study dishearteningly echo lessons already learned around established pillars of universal healthcare implementation such as human resources, multi-lateral stakeholder engagement and collaboration, devolution of governance with empowerment and capacitation of district managers. These findings imply that the South African Government has failed to anticipate and address these challenges and raises questions around reflective and experiential practices of the South African government. Conclusion It appears that strategic purchasing is not being operationalised in PHC. NHI policy implementation appears trapped in a rigid top-down hierarchy. District managers need to be engaged and capacitated to operationalise the planned decentralised purchasing-provision function of NHI.

Download Full-text

Factors Affecting Utilization of the National Health Insurance Scheme by Federal Civil Servants in Rivers State, Nigeria

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/00469580211017626 ◽

2021 ◽

Vol 58 ◽

pp. 004695802110176

Author(s):

Obelebra Adebiyi ◽

Foluke Olukemi Adeniji

Keyword(s):

Health Care ◽

Health Insurance ◽

National Health Insurance ◽

National Health ◽

National Health Insurance Scheme ◽

Health Workers ◽

Civil Servants ◽

Health Insurance Scheme ◽

Insurance Scheme ◽

Rivers State

The National Health Insurance Scheme (NHIS) of Nigeria was established in 2005. This study assessed the utilization of health care and associated factors amongst the federal civil servants using the NHIS in Rivers state. This was a descriptive cross-sectional study using self-administered questionnaires. Data were collated and analyzed using SPSS version 21.0. A Chi-square test was carried out. The level of Confidence was set at 95%, and the P-value ≤ .05. Out of a total of 334 respondents, 280 (83.8%) were enrolled for NHIS, 203 (72.5%) utilized the services of the scheme. Most 181 (82.1%) of the respondents who utilized visited the facility at least once in the preceding year. Although, 123 (43.9%) of the respondents made payments at a point of access to health care services, overall there was a reduction in out of pocket payment. Possession of NHIS card, the attitude of health workers, and patients’ satisfaction were found to significantly affect utilization P ≤ .05. Regression analysis shows age and income to be a predictor of utilization of the NHIS. Though utilization is high, effort should be made to remove payment at the point of access and improving the harsh attitude of some of the health workers.

Download Full-text

Patient’s Satisfaction With Quality of Care at a National Health Insurance Clinic at a Tertiary Center, South-South Nigeria

Journal of Patient Experience ◽

10.1177/2374373520981471 ◽

2021 ◽

Vol 8 ◽

pp. 237437352098147

Author(s):

Temitope Esther Olamuyiwa ◽

Foluke Olukemi Adeniji

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Quality Of Care ◽

Health Insurance ◽

National Health Insurance ◽

National Health ◽

Bivariate Analysis ◽

P Value ◽

Tertiary Center

Introduction: Patient satisfaction is a commonly used indicator for measuring the quality of health care. This study assessed patients’ satisfaction with the quality of care at the National Health Insurance Scheme (NHIS) clinic in a tertiary facility. Methods: It was a descriptive cross-sectional study in which 379 systematically selected participants completed an interviewer-administered, semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 23. Bivariate analysis was performed using Pearson χ2 with a P value set at ≤ .05. Results: The study found out that about half (193, 50.9%) of the respondents were satisfied with the availability of structure. Patients were not satisfied with waiting time in the medical records, account, laboratory, and pharmacy sections. Overall, 286 (75.5%) of the respondents were satisfied with the outcome of health care provided at the NHIS clinic. A statistically significant association ( P = .00) was observed between treatment outcome and patient satisfaction. Conclusion: There is a need to address structural deficiencies and time management at the clinic.

Download Full-text