# Achieving universal coverage of childhood cancers in Ghana via the National Health Insurance Scheme: A stakeholder analysis

## TL;DR

This study examines how Ghana can improve childhood cancer care by analyzing stakeholder roles and challenges in integrating cancer treatment into the national health insurance scheme.

## Contribution

The paper provides a stakeholder analysis to guide policy integration of childhood cancer management into Ghana's health insurance system.

## Key findings

- Key stakeholders include the Ministry of Health, NHIA, and healthcare providers, who have high influence and interest in childhood cancer policies.
- Burkitt’s Lymphoma constitutes 30–35% of childhood cancer cases in Ghana, but treatment is hindered by low reimbursement and high costs.
- Improved universal coverage requires enhanced stakeholder collaboration and investment in pediatric oncology capacity.

## Abstract

Childhood cancers present a significant health problem and contribute to global child mortality. Low- and middle-income countries experience higher rates of childhood cancers with survival rates between 10% and 50%. In Ghana, about 2,500 children are diagnosed with cancer annually. Despite availability of effective management strategies, childhood cancers are not fully integrated into the NHIS, leaving patients and caregivers to make out-of-pocket payments leading to delayed diagnosis and treatment abandonment. Although stakeholders have made efforts to address the issue, the various stakeholders in childhood cancer management and their roles are still unclear. The study sought to identify and analyze stakeholders involved and challenges in childhood cancer management and financing in Ghana. A stakeholder analysis was conducted which included a rapid review of policy documents and a stakeholder engagement workshop. 21 stakeholders were purposively selected and focus group discussions were held with an interview guide at a one-day stakeholder engagement meeting. Stakeholders were categorized using Mendelow’s power-interest grid, and their roles, interests, and influence on childhood cancer policies were assessed. Key stakeholders identified included the Ministry of Health, NHIA, healthcare providers, NGOs, WHO, and patient advocacy groups. The Ministry of Health, NHIA, and healthcare providers were primary drivers with high interest and influence. The burden of Burkitt’s Lymphoma constituted 30–35% of all childhood cancer cases. Ghana has adapted treatment protocols with some inclusion on the NHIS. However, NHIS tariffs remain low. Challenges in managing Burkitt’s Lymphoma included inadequate reimbursement rates, high treatment costs, treatment abandonment, limited access to paediatric oncology specialists and indirect costs such as transportation and accommodation. Achieving universal health coverage through management and financing of childhood cancers in Ghana requires comprehensive policies, equitable financial coverage under the NHIS, enhanced stakeholder collaboration and increased investments in building capacity of paediatric oncologists in Ghana.