{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:15:47Z","timestamp":1791936947806,"version":"4.3.4"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Ghana, although free tuberculosis (TB) services are provided at public facilities, the TB case detection rate is still lower than anticipated. To enhance TB case detection, private community healthcare providers and the National Health Insurance Scheme (NHIS) have been involved using a Public-Private Mix (PPM) model, which includes active case finding (ACF) and access to insurance. This study examines the facilitators and barriers to implementing a PPM model that aims to expand ACF and provide health insurance to newly diagnosed TB patients among at-risk populations in two Ghanaian cities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was an exploratory qualitative study based on 54 TB patient exit interviews, key informant interviews from seven sub-metro TB coordinators and 44 facility-level TB coordinators, and six focus group discussions were held, comprising four with health workers (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200953) and two with volunteers (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918). We conducted a thematic content analysis and, based on the key themes identified, we applied the Consolidated Framework for Implementation Research (CFIR) to structure the themes across five domains.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Implementation of the PPM model was facilitated by strong stakeholder collaboration, adaptable screening procedures, adequate diagnostic resources, and effective supervision. However, delays in NHIS reimbursements, limited registration logistics, weak intersectoral communication, and high staff turnover constrained implementation. While community engagement and the integration of TB screening into routine care enhanced uptake, persistent financial and operational barriers limited the program's sustainability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The PPM model increased TB case detection and expanded insurance coverage but was limited by structural inefficiencies, especially within NHIS operations. Future efforts should address systemic misalignments, support healthcare workers, and improve NHIS-private provider collaboration. Recognizing facilitators and barriers can help policymakers, TB program managers, NHIS officials, and partners plan more effective PPM models to boost active case finding in Ghana and similar settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2025.1738753","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T07:57:33Z","timestamp":1768204653000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Barriers and facilitators of implementing public\u2013private mix approaches for active tuberculosis case finding and health insurance access in at-risk populations in Ghana: a qualitative study"],"prefix":"10.3389","volume":"5","author":[{"given":"Kenneth Mawuta","family":"Hayibor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Kenu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delia Akosua","family":"Bandoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedicta","family":"Owusu-Arthur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalene Akos","family":"Odikro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria Ivy","family":"Mensah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dziedzorm","family":"Awalime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adwoa","family":"Asante-Poku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olena","family":"Ivanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Rachow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nii Nortey","family":"Hanson-Nortey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"B1","volume-title":"Global Tuberculosis Report 2022","year":"2022"},{"key":"B2","doi-asserted-by":"publisher","first-page":"876","DOI":"10.2471\/BLT.06.029983","article-title":"Hard gains through soft contracts: productive engagement of private providers in tuberculosis control","volume":"84","author":"L\u00f6nnroth","year":"2006","journal-title":"Bull World Health Organ"},{"key":"B3","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1016\/S1473-3099(24)00007-0","article-title":"Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021","volume":"24","year":"2024","journal-title":"Lancet Infect Dis"},{"key":"B4","volume-title":"Systematic Screening for Active tuberculosis: Principles and Recommendations","year":"2013"},{"key":"B5","doi-asserted-by":"publisher","first-page":"289","DOI":"10.5588\/IJTLD.12.0797","article-title":"Systematic screening for active tuberculosis: rationale, definitions and key considerations [state of the art series. 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