Ghana’s health service delivery is characterized by inadequate institutions and lack
of accountability. One of the reasons for the introduction of the National Health
Insurance Scheme (NHIS) in Ghana was to facilitate citizen participation and
ownership of the health service delivery system. Yet, this aspect of the scheme has
often been overlooked. We examine how the NHIS and its related institutions
perform the role of public oversight over frontline providers to ensure quality
services. The main findings are: (i) there is improvement in the purchasing power
of clients (policyholders use insurance card as a purchasing voucher to seek health
care);(ii) competition among frontline providers generated by the National Health
Insurance Authority’s accreditation procedures ensures institutionalization of
quality services for clients; and (iii) related institutions under the scheme, educate
and mobilize the people and build up communal power which ensures that
communities act jointly to demand quality services. We conclude that creating
institutional space for direct participation of users and citizens in general is a
robust means of concurrently empowering citizens and providing an avenue by
which providers may be sanctioned, thus making them more responsive to users.