A matter of trust

This participatory action research (PAA) concerns perceptions and experiences of clients of the National health Insurance Scheme (NHIS) in Ghana (2011-2014). It responses to the research question: What motivates healthcare clients to seek healthcare and health insurance services? The researcher conducts individual and group interviews among 223 healthcare clients and uses a structured questionnaire among 1903 households in their own community in Greater Accra and Western Regions. Data shows differences in notions (Explanatory Models - EMs) that clients, healthcare providers and the NHIS use on illness, need for care, quality of care, and perceived roles in care. Ignoring differences in EMs can lead to asymmetry in communication, misunderstanding and reduced trust. Also, the study demonstrates social capital* in a community positively influencing active participation in the NHIS. However, social capital is not static and varies between communities due to social development and also diversity in experienced healthcare and health insurance services. Trust is inextricably linked to EMs and social capital and fundamental in choices healthcare clients make. The participatory development and testing of the MyCare-intervention demonstrates that clients can have a valuable active role in monitoring and improving services. Results reveal that this can improve communication and reciprocal trust between clients, healthcare providers and NHIS. The PAA reveals essential in gaining insight in decision making processes and interaction of people in the complex context of healthcare. It also generates support for social change among stakeholders.

*Note: Horizontal social capital is based on social cohesion, that facilitates reciprocal trust, support and communal action. Vertical social capital is based on relations with formal institutions (i.e. healthcare providers, NHIS)

Dissertation: http://irs.ub.rug.nl/ppn/386045798