1. Towards a client-oriented health insurance system in Ghana ” “ Towards a client-oriented health insurance system in Ghana ” Knowledge Translation Network (KTNet) Africa Annual Partners’ Meeting, 27-29 th, January 2015 Addis Ababa, Ethiopia. Edward Nketiah-Amponsah Stephen Duku Christine Fenenga Robert Kaba Alhassan Tobias Rinke de Wit Inge Hutter Menno Pradhan Daniel Arhinful 1

2. Brief overview of the project Title – “Towards a client-oriented health insurance system in Ghana” What is your project about? – An RCT project aimed at promoting uptake and retention of NHIS membership through improved client-oriented quality care Start and end date – January 2011-December 2014 (budget neutral extension till the end of 2015) 2

3. Policy Relevant Questions  What are the main perceived barriers of health care clients to re-enroll in the NHIS?  Which are the most effective interventions that address these barriers? 3

4. Progress At what stage is the research process? – [stages = Start phase, data collection, analysis, dissemination, winding-up ] Post intervention data analysis ongoing – One PhD student completed(January 15, 2015). – Two remaining PhD students expected to defend their theses by September 2015 – Writing of project peer-reviewed articles/Policy Briefs ongoing – Final dissemination of project findings scheduled for October/November 2015 4

5. Stakeholders Engagement Who are the main stakeholders for the research questions/study processes/ findings/ recommended actions? At what stages of the project have these stakeholders been involved? Kindly provide names and contact details (e-mail & telephone numbers) of institutions charged with the responsibility of packaging and disseminating research in your country, if any.

6. Stakeholders Engagement Main Stakeholders – National Health Insurance Authority (NHIA) – Ghana Health Service (GHS) – Christian Health Association of Ghana (CHAG) – Universities in Ghana and the Netherlands These stakeholders have been involved in the project since its inception. 6

7. Institutions Responsible for Packaging and Disseminating Research in Ghana Universities (Public and Private) and other Tertiary Institutions National Research Institutes – Centre for Scientific and Industrial Research (CSIR) – Ghana Atomic Energy Commission (GAEC) – Ghana Academy of Arts and Sciences (GAAS) – Ghana Health Service (GHS) – Center for Scientific research into Plant Medicine – National Development Planning Commission (NDPC) Quasi-Private Institutions: CHAG Other Private entities like KPMG, Research International NGOs/CSOs: IMANI, IEA, CEPA, IDEG, CDD Media 7

8. Stakeholder engagement strategies What strategies has your project used to engage your key stakeholders? Involvement in conception of the study design; inputs in draft questionnaires Feedback and review sessions with stakeholders Invited presentation by stakeholders at Reviews, Seminars and workshops Presentations at Local and International Conferences Joint Authorship Participation of stakeholders in Project Annual Review meetings 8

9. What research findings/implications is your team advancing for stakeholder actions? Research Findings’ Implications Key findings supporting implications Include perception of client quality in quality of care Clients’ views of health care quality is largely based on inter-relational factors (fair queuing system, attitude of staff, punctuality, avenues for complaint lodging etc). This contrasts with providers views, which relates quality to medical technical aspects (qualification of staff, availability of medical logistics, adherence to treatment protocol etc), creating a gap between perceptions of clients and providers Include Client-Centered Care in the curricular of health training/Improving interpersonal relations and information sharing at the health facilities (community level). We found a positive association between enrolment in the NHIS (formal institution) and trust factors such as information provision, reliable delivery of benefit package, client perceived quality of services and facility to file suggestions or complaints 9

10. Research Findings Implications vs Key messages Research Findings’ ImplicationsKey findings supporting implications Essentials tool could be a complementary assessment tool for quicker pre-accreditation assessment over shorter time Essentials tool positively correlate with the NHIA accreditation scores suggesting the former could be a complementary assessment tool for quicker assessment over shorter time by the NHIA Regular post accreditation monitoring is imperative to ensure quality care standards are maintained after facilities are given accreditation. Overall quality situation per Essentials and NHIA accreditation data in sampled facilities is generally low even though all these facilities are accredited 10

11. What KT related challenges has your project encountered? – As researchers tend to prioritize rigour and scientificity more than tailoring evidence for policy makers. – Lack the right approach to dialogue and communicate evidence to the policy maker – Lag in the uptake and implementation of research findings 11

12. Challenges and Opportunities? How has your project overcome these challenges? Engagement with key stakeholders to share and discuss findings Dialogue with the press on how to report key findings Collaboration with KTNET to train policy makers, press and providers What opportunities does your project envisage to overcome these challenges? Continuous Dialogue with the press on how to report key findings Final Dissemination workshop Policy dialogue with policy makers and key stakeholders 12

13. What KT products/activities has your project generated or accomplished so far? COHEiSION PROJECT -Dissemination workshops at various levels involving key stakeholders Baseline findings Intervention findings Joint training workshop for researchers and media with KTNET Briefings and presentations at Senior Managers Meeting (NHIA) and GHS KTNET: Completion of KT Capacity tools, blog contribution, joint abstract presentation, joint training workshop in Accra (with ACCELERATE) 13

14. What additional KT products and activities does your coalition plan to undertake during 2015 and beyond? Writing and Dissemination of Policy Briefs Media Briefs Policy Dialogue Dissemination at the grassroots Live Media Discussion Joint publications with the KTNET team Explore KT and research collaboration with other coalitions; small grants etc 14

15. What support will your project require to produce and execute the planned KT products and activities? Capacity building/Technical Support Policy Briefs Information sharing on best practices in knowledge translation. Financial support to execute the planned knowledge translation activities. 15