A Participatory Action Approach for Client Centered Health Insurance

This methodological paper describes systematically the steps towards exploring client perceived barriers to enroll in a National Health Insurance Scheme in Ghana. To unravel clients’ motives we adopt a Participatory Action Approach, which allows inquiring deeply in clients’ assumptions and root causes of the barriers to health insurance enrolment, while transferring learning among multiple stakeholders in the system: the client, the healthcare provider and the insurer. We employ a linked trajectory of qualitative and quantitative methods to gather in depth- individual views and interpretations, followed by two stakeholder validation meetings to capture emic concepts arising from group interaction. To obtain generalizeable knowledge the data is used for the design of a survey. Based on all data interventions were developed that engage all stakeholders. Data was collected in 2011 and 2012 among clients in their local communities in two regions in Ghana. This paper aims to add to the existing literature by describing and reasoning the scientific contribution of the Participatory Action Research. We claim that this participatory approach leads to reliable, rich data and evidence based interventions, aiming at client centered services and increased enrolment in the health insurance.