Building on the strengths of the mobile renewal system to increase health insurance uptake in Ghana: A qualitative study focusing on potential add-ons

Abstract

Background: The Mobile Renewal System (MRS) has increased insurance renewal rates among Ghana's National Health Insurance Scheme (NHIS) subscribers. However, population coverage with active NHIS membership remains insufficient for Universal Health Coverage (UHC) ambitions, especially among informal workers. This qualitative study aimed to understand the potential of additional mobile-phone-based tools (add-ons) to further increase NHIS enrolment and renewal rates. Methods: In-depth interviews were conducted with 13 technical experts involved in the development and implementation of the MRS and 17 focus group discussions were held with 96 informal workers in Accra and Kumasi between March and August 2022. Thematic analysis was used to identify recurring themes and categories. Results: Several add-ons were suggested by participants to improve the use of the MRS. These included reminders to renew, mobile registration of new members, and an automatic renewal option. Savings wallet and facility locator. Participants saw these add-ons as beneficial as they could encourage more people to use the MRS and further increase the uptake of the insurance. For implementing and utilizing the MRS and these add-ons, a reliable technological infrastructure, stakeholder involvement, adequate funding, training, and awareness campaigns were considered crucial. Barriers to utilization of the MRS and add-ons may arise from concerns regarding data protection, transparency, and potential taxes on digital transactions. In addition, individual factors such as experience with mobile phone transactions and knowledge about insurance influenced participants' willingness to use the MRS and the suggested add-ons. Conclusion: Different mobile phone-based technologies can potentially increase NHIS coverage in Ghana. Implementation should address insurance literacy and build communities’ trust in mobile technology.