Assessing the Role of Frontline Providers in Shaping the Implementation of Capitation Pilot at Komfo Anoke Teaching Hospital

Abstract

Over the years, health care financing in Ghana has evolved from free health care to cash and carry (out of pocket) at point of use. Due to the economic burden of cash and carry on citizens, the National Health Insurance Scheme was formed in 2003 through Act 650. This was to provide an alternative form of health care financing to ease the burden of rising cost of health care on citizens. The scheme commenced with itemized fee for service and subsequently Ghana Diagnostic Related Groups Provider Payment Methods. Challenges of cost escalations with these provider payment methods led to the pilot of capitation in NHIS accredited facilities in Ashanti Region. The pilot was introduced in January 2012. The aim of the study was to assess the role of frontline providers in shaping the implementation of capitation pilot in Komfo Anokye Teaching Hospital (KATH), Ashanti Region. The study was an exploratory cross sectional study using qualitative data collection and analytical methods. Data was collected through key-informant indepth interview, focus group discussions, observations and document review. Data collection tools were an interview and focus group discussion guide, notebooks and tape recorders. Study setting was the polyclinic directorate of KATH. Thirty (30) health workers were purposively selected using snowball technique. Two focus group discussions were done. Interviews and focus group discussions were recorded and transcribed into Microsoft word. Tools such as tables and matrices were used to present findings. Data sets were analyzed based on thematic content analysis. A key finding indicated, various categories of frontline providers had their own level of knowledge on the capitation pilot and its implementation design. They had some misconceptions on certain aspects of the policy. Factors such as, knowledge level and availability of resources determined the extent to which the policy was implemented. In order to implement the policy health workers developed coping mechanisms such as copayment to keep the flow of health care delivery. Generally, the frontline workers were of the perception capitation was good but it should be reviewed improve health care delivery. Policy makers should visit the facilities to review the successes and failures of the policy design. Finally, the policy should be extended nationwide for every facility to appreciate how constrained they were.