Frontline Workers’ Use of Discretion in the Implementation of National Health Insurance Scheme in Ghana

Abstract

The article examines frontline workers’ use of discretion in the implementation of the National Health Insurance Scheme in Ghana. It answers two questions: 1) how does discretion affect service delivery? 2) Whose interest does discretion serve in service delivery? The article provides three contributions. First, it brings a new direction in the use of discretion in organisations in a developing world context. Second, it adds to ‘how’ and ‘why’ frontline workers use discretion. Finally, it reveals whose interest the use of discretion serves. It utilises qualitative methods to reveal both positively motivated and negatively motivated discretion relationships that exist between frontline workers and clients. Most of the negatively inclined discretion is exercised largely by frontline workers in public organisations. It concludes that most of the frontline workers’ discretion serves the interest of their clients rather than service providers’ self-interest or the interest of their organisations.