University of Ghana|University of Ghana|University of Amsterdam
background government ghana introduced national health insurance scheme nhis 2004 goal achieving universal coverage within 5 years evidence however shows expanding nhis coverage especially retaining members remained challenge multilevel perspective employed conceptual framework methodological tool examine enrolment retention nhis remains low methods household survey conducted 20 months educational promotional activities aimed improving enrolment retention rates 15 communities central eastern regions ers ghana observation indepth interviews informal conversations used collect qualitative data forty key informants community members health providers district health insurance schemes dhiss staff purposely selected two casestudy communities central region cr interviewed several community members health providers dhiss staff also engaged informal conversations five communities region also four staff ministry health moh ghana health service ghs national health insurance authority nhia engaged indepth interviews descriptive statistics used analyse quantitative data qualitative data analysed using thematic content analysis results results show factors influence enrolment retention nhis multidimensional cut across stakeholders people enrolled renewed membership nhis benefits health providers positive behaviour barriers enrolment retention included poverty traditional risksharing arrangements influence people enrol renew membership need healthcare dissatisfaction health providers behaviour service delivery challenges conclusion given multidimensional nature barriers enrolment retention suggest nhia engage dhiss health providers stakeholders develop implement intervention activities eliminate corruption shortage drugs health facilities enforce compulsory enrolment stated nhis policy move scheme towards universal coverage