The experience of Ghana’s National Health Insurance Scheme holds important lessons for low- and middle-income countries seeking to implement universal health coverage. A new HFG case study, “Building on Community-based Health Insurance to Expand National Coverage: The Case of Ghana,” describes how Ghana developed its current system and what can be learned from this process.

The case study traces the evolution of Ghana’s health financing from a strictly cash-and-carry system to one in which a third of the population is covered by the national insurance plan. An important intermediate step in this process was the rise of local mutual health organizations, which provided limited insurance coverage to small pools of enrollees.

The case study explains how the government drew upon the experience and expertise of these mutual health organizations in creating the National Health Insurance Scheme, which was launched in 2003. The creation of the system was also heavily influenced by electoral politics. The case study demonstrates how important elements of the current system, such as the earmarking of value-added taxes to pay for coverage and the absence of cost-sharing, were shaped by political considerations.