Policy Design and Implementation Nexus in Africa: The Experience of National Health Insurance Scheme in Sawla-Tuna-Kalba District of Ghana

Abstract

The paper focuses on policy design and implementation linkage in Africa. It specifically examines the linkage between policy design (National Health Insurance Scheme-NHIS) and its implementation with some experiences of policy implementers and the beneficiaries in the SawlaTuna-Kalba District in Ghana. The theoretical argument is that. policy design factors may facilitate or impede implementation This study thereby seeks to find out what the situation is in a rural setting of an African state-Ghana. This is the reason for the choice of the qualitative comparative case analysis to solicit the views, opinions, and experiences of policy implementers and beneficiaries on the design and implementation process factors. The implementers are the public and private health providers, while the policy beneficiaries are NHIS subscribers. The implementers’ understanding of the policy goalsintent and delivering them to subscribers in terms of access to healthcare services in the rural district and the quality of the services (to address their health needs). Data were obtained through in-depth interviews, review of documents, and on-site direct observations. The findings showed that policy beneficiaries/subscribers have more access to healthcare facilities (healthcare services) due to the involvement of public and private health providers in the district. Also, the findings revealed an improved revenue for both public and private health providers/facilities due to the increased attendance of NHIS subscribers/beneficiaries. It found that the behaviour of health providers was a key determinant of subscribers’ choice of health facility. It, therefore, recommends that health providers sho uld treat their clients with utmost care and kindness.