Mixed Methods Research for Health Policy Development in Africa: The Case of Identifying Very Poor Households for Health Insurance Premium Exemptions in Ghana

Despite the utility of applying mixed methods research to understand complex phenomenon, few studies have applied this approach to health policy and in Africa. This article illustrates the application of mixed methods research to inform health policy in Ghana with the intent of complementarity. Through an exploratory sequential mixed methods research design involving 24 focus group interviews and 417 household surveys, we developed criteria for identifying very poor households for health insurance premium exemptions in Ghana. The qualitative procedures identified communities' concerns regarding being very poor: food insecurity, lack of seeds to sow, compromised access to education, financial insecurity, and status as unemployed widows with children. The survey findings illustrated the distribution and predictors of poverty in the Kassena-Nankana District. Based on these findings, the authors proposed a four-question survey for the Kassena-Nankana District Health Insurance Scheme to administer to determine extreme poverty. Based on these recommendations, the local government has a unique opportunity to increase the very poor's access to and utilization of health care services.