Presentation (CTI)

OBJECTIVES: Retention of health insurance coverage remains a critical challenge for health financing schemes, particularly where renewal processes impose time, cost, and access constraints on beneficiaries. In response, Ghana’s National Health Insurance Authority has expanded digital health interventions through two primary renewal pathways: in-person renewal at district offices and self-renewal via mobile application and USSD short code. This study examines the effectiveness of these renewal pathways in supporting coverage retention.
METHODS: Administrative NHIS data from 2020-2024 were analyzed descriptively to examine platform utilization by gender, age group, and region.
RESULTS: A total of 11,246,335 renewals were recorded in 2024. Platform utilization trends reveal a notable shift toward office renewals, which increased by nearly 12 percentage points, alongside a corresponding decline in mobile renewals. Despite this shift, mobile platforms remain the dominant renewal channel in most regions, particularly in Western, Ashanti, and Oti regions. Only the Upper West and Savannah regions recorded higher office-based than mobile renewals. Females had the highest use of both the mobile and office renewals across the five- year period. Ashanti had the highest use of mobile platform renewals. It was followed by the Greater Accra and Eastern regions. Oti and Savannah regions had the lowest use of the mobile renewal platform. Age-group analysis indicates that persons under 19 years constitute the largest share of both mobile and office renewals, representing approximately 45-48 percent of mobile platform use and over 60 percent of office renewals, reflecting NHIS exemption policies. The use of both platforms decreases with age.
CONCLUSIONS: These findings suggest that while digital renewal systems have supported improvements in NHIS coverage retention, progress toward UHC requires a balanced, equity-oriented renewal strategy. Strengthening mobile renewal usability while maintaining accessible brick-and-mortar offices is essential to sustaining coverage across diverse population groups and reducing disparities in effective NHIS participation.