Abstract
In 2018, the government of Ghana, through the National Health Insurance Authority (the NHIA), introduced a mobile health (m-health) insurance renewal intervention (mobile renewal service). This electronic government (e-government) intervention seeks to improve public service delivery in the area of healthcare by eliminating existing National Health Insurance membership renewal bottlenecks that emanate from administrative and operational inefficiencies associated with the membership renewal process.
This research involved a micro-, meso-, and macro-level evaluation of Ghana’s m-health insurance renewal intervention from the perspective of multiple stakeholders. Key stakeholders of the project, including the government (Ministry of Health), the implementation agency (the NHIA), and the users (members/subscribers) of the intervention, were identified and categorised into macro, meso, and micro stakeholders to facilitate a thorough understanding and assessment of the planning and implementation of this e-government intervention. The purpose of this thorough evaluation and assessment was to unearth insights and recommendations that are vital for the sustainability of the intervention.
To achieve the study’s objectives, the researcher adopted a qualitative case study research design and utilised theoretical frameworks, including systems theory, the design-actuality gap model, and Rogers’ diffusion of innovations theory to assess the intervention’s multifaceted policy formulation, implementation, and user adoption processes. Primary data, collected by means of semi-structured interviews and focus group discussions with a total of 66 participants, provided valuable qualitative data, which were recorded and transcribed for analysis. Additionally, national digital health policies, articles, books, and strategies, were used to obtain significant secondary data. The data collected were analysed using thematic analysis and the codes and themes that emerged were interpreted and presented using constructs from the theory applied at each level of analysis.
The findings of the study revealed that although the m-health insurance renewal intervention has improved accessibility and reduced renewal bottlenecks, several policy gaps and implementation challenges need to be resolved to enhance the sustainability
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and effectiveness of the intervention. This study makes unique contributions to the digital governance discourse by adopting multi-level analysis to comprehensively evaluate Ghana’s m-health insurance renewal service. The findings emphasise the need for the government of Ghana to strengthen the policy foundations of future national e-health interventions by reviewing its National E-Health Strategy (2010) to align it with current technological advancements and the United Nations’ Sustainable Development Goals. Additionally, the study recommends that the NHIA should reduce its overdependence on third-party vendors and invest in its own technical infrastructure, and strengthen its public sensitisation to better educate citizens about the mobile renewal service.