Background: In Ghana close to 70% of the economy is dominated by informal sector, and being the first ever to initiate a nationwide implementation of the National health insurance scheme, funding of the scheme, attractiveness of the benefit package, and the quality of health service delivery remain threats to the sustainability of the health insurance scheme. The study sought to find out the factors that influence sustainability of the national health insurance scheme in Ghana with reference to the Nadowli District scheme in northern Ghana.
Methods:The study was a descriptive cross-sectional in design aimed at eliciting information on views of community members, the health facility, and the scheme regarding premium levels, benefit package and quality of health care service provided to members. The study employed questionnaires for households, health facilities and scheme manager. A sample size of 260 respondents comprising registered and non- registered members were randomly selected. 10 Health facilities managers and the scheme Manager were purposively included. Univariate analysis using tables and diagrams and content analysis of key informant interviews was used to summarize results.

Results:The study revealed that, the Nadowli District health insurance scheme has prospects given the availability of technical support, the various measures introduced to check insurance markets risks, quality of care for drugs and supplies (65.0%), generous benefit package (95.0%) disease conditions covered, solidarity that exists in communities (75.1%), Development partners and government commitment to the scheme as well as increasing community recognition that the scheme is a convenient means to increasing access to health care. However, the scheme some challenges such as its limited benefit cover and the design weakness (“fee-for-service”) payment system are a treat and can hamper the scheme’s sustainability.
Conclusion: The problems identified are not necessarily inherent but are related to design and management weaknesses, for which adequate and feasible solutions exist, though their application may require the active role of government and other development partners so as to enable the scheme to realize their true potential.