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Ghanaians are generally satisfied with the performance of the National Health Insurance Scheme (NHIS), a survey report released by the National Development Planning Commission (NDPC) said on Thursday in Accra. The 95-page report indicated that 59 per cent of all households who were insured under the scheme had said they were satisfied with another 31. 7 per cent saying they were "very satisfied" with the scheme's performance. The report, launched by Dr Ebenezer Appiah-Denkyira, Director, Human Resource, Ministry of Health on behalf of the sector Minister indicated an increasing level of registration under the scheme with a total subscription increasing from a low of 1,797,140 in 2005 to 12,518,560 in 2008 though significant variations in registration existed across geographical and socio-economic groups. The survey however indicated that although more than half of Ghanaians were enrolled in the scheme, a large portion of the population remained uninsured with 41 per cent of households not registering any member at all. Analysis of the NHIS subscription by socio-economic groups revealed that about seven out of 10 people in the lowest socio-economic group had not registered with the scheme. The NDPC in ensuring the implementation of the Growth and Poverty Reduction Strategy (GPRS II 2006-2009), conducted the 2008 Citizens' Assessment of the National Health Insurance Scheme on the theme: "Towards a Sustainable Health Financing Arrangement that Protects the Poor". The survey conducted between September and November 2008 in collaboration with the Ghana Statistical Service, Ghana Health Services, Ministry of Health and the National Insurance Authority was to find out whether the NHIS was providing an affordable health care financing arrangement that protected the poor as envisaged under the GPRS II. The findings revealed substantial positive effect of the scheme on several aspect of health care delivery in Ghana, indicating that the proportion of those who consulted skilled health care providers for general health conditions had risen from 45 per cent to about 62 per cent between 2005 and 2008, during the implementation of the scheme. The result also noted an increase of 72 per cent of babies delivered with the assistance of skilled personnel. "This suggests that the scheme has significantly improved access to health care by pregnant women or women in labour, with positive implication for maternal mortality and complications associated with child birth. The report noted that the greatest expectation of Ghanaians about the scheme was to reduce the burden of health care cost on households, with the survey suggesting that households registered with the scheme benefited in terms of out-of-pocket expenditure reductions at health care facilities than those who were not registered. Poorer households who were not insured suffer even more and would find it more difficult to access health care. It therefore recommended further improvement in the exemption policy, which was necessary to adequately serve the health needs of the poor, adding that women who benefited from the policy of free medical care for pregnant women should be encouraged to subscribe to the scheme even after delivery. Dr Regina O. Adutwum, Director-General, NDPC said the survey focusing on the NHIS after four years of implementation provided the opportunity for citizens to share their views on the various aspects of the scheme, with the view of obtaining feedback to improve its implementation. "As government undertakes a review of the NHIS our hope is that this report and the subsequent discussions on the subjects will contribute to strengthening its implementation and the achievement of its objectives", she added. Dr Appiah-Denkyira urged the private sector to come on board to help expand the health infrastructure by establishing more health centres to help in providing quality health care for the people. Dr Kwabena Opoku-Adusei, Vice-President, Ghana Medical Association stressed the need for the sustainable improvement of the NHIS since "it is one of the best health systems that has ever happened in Ghana". Mr K. Kamalideen Resident Manager, United Nations Development Programme who sponsored the survey said such research would help identify lapses in the scheme and so stakeholders, particularly, government should accept its recommendations and work towards improving on the service.