Supply-side factors influencing national health insurance uptake, access and use of primary health care: Evidence from the Upper West Region, Ghana

Supply-side factors, such as the availability of health facilities, equipment, practitioners, and drugs, are crucial for improving global healthcare systems. However, systematic evidence of how these factors affect health insurance clients’ access to primary healthcare (PHC) services in Ghana is lacking. This study addresses this gap by examining the impact of these factors on insured individuals' access to PHC services in Wa Municipality. An explanatory sequential mixed-methods design was employed, involving a quantitative survey of 413 insured individuals randomly selected from 40 communities and 47 healthcare facilities. Purposive sampling was used for qualitative interviews with 17 healthcare providers and 20 key insured informants. Quantitative data were analysed using descriptive statistics, correlation, independent t-tests, and binary logistic regression, while qualitative data were thematically analysed to provide insight into the quantitative findings. Result from quantitative data showed that Community-Based Health Planning and Services (CHPS) were more accessible than hospitals, diagnostic centres, and health centres. Proximity to health facilities influenced access to PHC services and National Health Insurance Scheme (NHIS) uptake. Perceived availability and functionality of healthcare equipment also affected NHIS uptake. Qualitatively, health facilities reported a shortage of human resources, such as midwives and nurses, for PHC service delivery. Triangulating quantitative and qualitative results show that healthcare supplies and skilled professionals are essential for NHIS uptake and access to PHC services. This study recommends that Government of Ghana prioritise expanding healthcare facilities, recruiting and retaining skilled practitioners, procuring medical equipment, and equitably distributing essential medications to improve access to essential healthcare services in underserved areas. • Health insurance is a critical component of the overall healthcare system in any country. • Health insurance provides individuals and families with access to needed medical services that may otherwise be cost-prohibitive without insurance coverage. • Supply-side factors—availability and functionality of healthcare facilities, availability of equipment, availability of health professionals, and drug supplies influence the availability, access, affordability and use of services. • Studies examining these supply-side factors and their relationship with access and use of primary healthcare in the context of a national health insurance policy are sparse in Ghana.