Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

R.K. Alhassan, S.O. Duku, W. Janssens, E. Nketiah-Amponsah, N. Spieker, P. Van Ostenberg, D.K. Arhinful, M.P. Pradhan, T.F. Rinke de Wit

Research output: Contribution to JournalArticleAcademicpeer-review


Background: Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurancesustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. Purpose: To examine the differences in perceptions of clients and health staff on quality healthcareand determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. Methods: This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. AWilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used toascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Results: Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to qualityimprovement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone willnot necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. Conclusion: There is the need to intensify client education and balanced commitment to technical andperceived quality improvement efforts. This will help enhance client confidence in Ghana's healthcare system, stimulate active participation in the national health insurance, increasehealthcare utilization and ultimately improve public health outcomes.
Original languageEnglish
Pages (from-to)e0140109
Number of pages19
JournalPLoS ONE
Issue number10
Publication statusPublished - 2015


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