Is mobile renewal enough? A qualitative study exploring stakeholders’ perspectives on mobile phone-based add-ons for national health insurance uptake in Ghana

Background: The Mobile Renewal System (MRS) has increased insurance renewal rates among Ghana’s National Health Insurance Scheme (NHIS) subscribers. However, population coverage with active NHIS membership remains insufficient for Universal Health Coverage (UHC) ambitions, especially among informal workers. This qualitative study aimed to explore stakeholders‘(technical experts and informal workers) perspectives on the implementation and use of mobile renewal system (MRS) add-on(s) to improve NHIS uptake in Ghana. Methods: Technical experts were interviewed in depth based on their experience and ability to provide information on developing and implementing mobile health technology, and 17 focus group discussions were held with informal workers in Accra and Kumasi between March and August 2022. Thematic analysis was used to identify recurring themes and categories. Results: Participants (13 technical experts and 96 informal workers) suggested several add-ons to improve the use of the MRS. These included reminders to renew, mobile registration of new members, an automatic renewal option, a savings wallet, and a facility locator. These add-ons could potentially encourage more people to use the MRS and further increase insurance uptake. For implementing and utilizing the MRS and these add-ons, reliable technological infrastructure, stakeholder involvement, adequate funding, training, and awareness campaigns were considered crucial. Barriers to using MRS and add-ons may arise from concerns regarding data protection, transparency, and potential taxes on digital transactions resulting in additional costs. In addition, individual factors such as experience with mobile phone transactions and knowledge about insurance influenced participants’ willingness to use the MRS and the suggested add-ons. Conclusion: Different mobile phone-based technologies can potentially increase NHIS coverage in Ghana. Implementation should address insurance literacy and build communities’ trust in mobile technology.