Investigating Informal Sector Workers Preferred Health Insurance Design Features: A Pivotal Position for Engagement in Health Purchasing Decisions in Ghana Using the Q-sort Methodology: A Research Protocol

Globally, health insurance has been recognized as a pragmatic health financing option to achieve Universal Health Coverage particularly for the poor and vulnerable. However, the implementation of such programs are at times cumbersome, saddled with and reinforcing existing health inequities. Empirical evidence has shown that the uptake of health insurance is low among informal sector workers. To facilitate the uptake of health insurance, it is important to actively engage healthcare consumers and providers in health purchasing decisions. However, there is a paucity of evidence on the mechanisms employed to engage healthcare consumers and providers in healthcare purchasing decision making which reflects their interests and concerns. This research will therefore seek to identify health insurance design features which will enhance enrollment of informal sector workers unto the Ghana National Health Insurance Scheme from the perspective of informal sector workers, health care providers, and health and policy stakeholders. To facilitate addressing the research objectives highlighted, this study will use a Q-sort methodology. Q-sort methodology combines the strength of qualitative and quantitative methods for the systematic exploration of subjectivity; peoples perspective, opinion, and beliefs. Study participants are expected to rank different statements under each health insurance feature. The attached weights are analysed, and the prominent statements are highlighted, interpreted, with the support of qualitative interviews. The study will be conducted in La Nkwantanang Madina and Ashaiman, two districts of the Greater Accra Region of Ghana. Purposive and snowball sampling will be used to identify the study participants. The findings of this research supplements existing efforts to improve engagement between communities, key stakeholders within the health and local government systems to improve primary health outcomes. Empirical evidence from this research will reinforce advocacy for and the formulation of policies specific to improving informal sector workers uptake and use of health insurance.