Healthcare quality in Ghana Improving healthcare quality and health worker motivation to promote sustainable health insurance

This thesis is about promoting a sustainable National Health Insurance Scheme (NHIS) in Ghana through improved client-centred quality care and effective community engagement in quality care assessment.
The thesis comprises of two main parts. Part one reports on findings from baseline surveys conducted in 2012 among 324 health workers in 64 primary health facilities in the Greater Accra and Western regions of Ghana. Moreover, baseline household surveys were conducted in 1,903 households in the two regions. Baseline surveys explored health worker motivation levels and associations with healthcare quality efforts, efficiency in health service delivery, and comparison of perceived and technical quality healthcare. Part two of the thesis comprises of impact evaluation studies conducted in 2014, after implementing community engagement interventions in 2013. The interventions were designed to promote a more client-centred healthcare and insurance services. Positive impact of the interventions was observed on clinic staff motivation levels, perceptions on the NHIS, and efforts toward patient safety and risk reduction.
The thesis concludes that client and community engagement in healthcare quality improvement efforts could augment existing quality improvement strategies of the Ministry of Health and National Health Insurance Authority. This innovative approach will help increase trust in the NHIS and the healthcare system, needed to attain universal health coverage.