Title : Power and partnership: PPPs in ghana’s national health insurance scheme and implications for universal health coverage
Abstract:
Universal health coverage (UHC) is a global action call and aspiration of governments worldwide to ensure that all people have access to essential health services they need, without financial hardships. In 2003, Ghana initiated its national health insurance scheme (NHIS), a form of public-private partnership (PPP) intended to drive the country’s UHC journey. This study examines power dynamics in PPPs under the NHIS and its impact on UHC. The study employed a qualitative case study using document review and interviews with key stakeholders, responsible for partnership activities under the NHIS. The findings suggest that the private sector is marginalised in key implementation decisions under the NHIS, with the government maintaining strong regulatory oversight, including over tariff setting, claims vetting, and reimbursement. Persistent reimbursement delays and the imposition of inadequate tariffs by government create an environment of significant disadvantage for the private sector. This dynamic undermines UHC efforts as the private sector adopts power control strategies such as directly charging NHIS users, disproportionately affecting the poor and vulnerable populations. A key implication is that power imbalance is a significant barrier to leveraging PPPs for UHC through the NHIS.
Keywords: Public-private partnerships, national health insurance scheme, power dynamics, universal health coverage.
