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Hayibor, K.M.* ; Kenu, E.* ; Bandoh, D.A.* ; Owusu-Arthur, B.* ; Odikro, M.A.* ; Mensah, G.I.* ; Awalime, D.* ; Asante-Poku, A.* ; Ivanova, O.* ; Rachow, A. ; Hanson-Nortey, N.N.*

Barriers and facilitators of implementing public–private mix approaches for active tuberculosis case finding and health insurance access in at-risk populations in Ghana: A qualitative study.

Front. Health Serv 5:1738753 (2026)
Publ. Version/Full Text Research data DOI PMC
Open Access Gold
Creative Commons Lizenzvertrag
BACKGROUND: In Ghana, although free tuberculosis (TB) services are provided at public facilities, the TB case detection rate is still lower than anticipated. To enhance TB case detection, private community healthcare providers and the National Health Insurance Scheme (NHIS) have been involved using a Public-Private Mix (PPM) model, which includes active case finding (ACF) and access to insurance. This study examines the facilitators and barriers to implementing a PPM model that aims to expand ACF and provide health insurance to newly diagnosed TB patients among at-risk populations in two Ghanaian cities. METHODS: This was an exploratory qualitative study based on 54 TB patient exit interviews, key informant interviews from seven sub-metro TB coordinators and 44 facility-level TB coordinators, and six focus group discussions were held, comprising four with health workers (n = 53) and two with volunteers (n = 18). We conducted a thematic content analysis and, based on the key themes identified, we applied the Consolidated Framework for Implementation Research (CFIR) to structure the themes across five domains. RESULTS: Implementation of the PPM model was facilitated by strong stakeholder collaboration, adaptable screening procedures, adequate diagnostic resources, and effective supervision. However, delays in NHIS reimbursements, limited registration logistics, weak intersectoral communication, and high staff turnover constrained implementation. While community engagement and the integration of TB screening into routine care enhanced uptake, persistent financial and operational barriers limited the program's sustainability. CONCLUSION: The PPM model increased TB case detection and expanded insurance coverage but was limited by structural inefficiencies, especially within NHIS operations. Future efforts should address systemic misalignments, support healthcare workers, and improve NHIS-private provider collaboration. Recognizing facilitators and barriers can help policymakers, TB program managers, NHIS officials, and partners plan more effective PPM models to boost active case finding in Ghana and similar settings.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Active Case-finding ; Community-based Screening ; Facilitators And Barriers ; Health Insurance ; Public-private Mix ; Tuberculosis; Care; Interventions; Framework; Providers
ISSN (print) / ISBN 2813-0146
e-ISSN 2813-0146
Journal Frontiers in Health Services
Quellenangaben Volume: 5, Issue: , Pages: , Article Number: 1738753 Supplement: ,
Publisher Frontiers Media S.A.
Publishing Place Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
Institute(s) Research Unit Global Health (UGH)
Grants German Academic Exchange Services (DAAD) through the Higher Education Excellence in Development Co-operation Program
Federal Ministry for Economic Cooperation and Development (BMZ)
TB REACH initiative of the Stop TB Partnership Wave 6 - CIHLMU Center for International Health