The introduction of the National Health Insurance Scheme (NHIS) in Ghana was necessitated by these failings of the cash-and-carry system. The NHIS was introduced in 2003 under the National Health Insurance Act (Act 650), piloted on a small scale until 2004 when it was adopted countrywide in all public health facilities, privately owned hospitals and clinics accredited by the National Health Insurance Authority (NHIA) (Institute for Statistical, Social and Economic Research and UNICEF 2012). Challenges associated with the implementation of the NHIS necessitated a review of the delivery of services under the scheme which in 2012 resulted in the enactment of the NHIS Act 850. The policy reorientation of the NHIS aimed to achieve improvements in efficiency and quality of health service delivery. Specifically, the revised policy is aimed to achieve “improved access to quality health care delivery under NHIS and improved transparency and accountability in the financial management of NHIS”.

To help achieve the object of this pro-poor social policy, Ghana Integrity Initiative (GII), the local chapter of Transparency International undertook a two-year health project titled ‘Increasing Participation, Accountability, Responsiveness and Transparency (PART): focus on the National Health Insurance Scheme (NHIS) and other MDG-related interventions in the health sector in Ghana’.  The overall expected outcome of the project is to achieve improved transparency and accountability in the flow and utilisation of NHIS financial resources leading to improved health service delivery in selected deprived districts by December 2014. The original project was focused on three regions and was financially supported by STAR-Ghana, a multi-donor agency. In 2013, GII received further support from UNDP under a one year social accountability project with similar objectives.  This resulted in the increase of the project coverage to six regions; Central, Volta, Eastern, Western, Upper East and Upper West regions.