The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003. Its main goal was and still is to ensure healthcare access and bridge the inequality gaps in healthcare. Ghana s NHIS is unique in the sense that it is a hybrid of Social Health Insurance and Community Based Health Insurance schemes. This study is about the implementation of the District-wide Mutual Health Insurance Scheme (DMHIS) in Ga West Municipality. Furthermore, there are gaps and challenges which include inadequate medical facilities, escalating cost, and difficulty in reimbursement of providers, which have not only emerged in the process of the implementation of the scheme but have also threatened its sustainability. The study recommends the development of a comprehensive computerization system that will help in an effective processing of claims to minimize the fraud and corruption associated with the manual system. It is also strongly recommended that more and well trained permanent staff be recruited to ensure a smooth operation of the Ga West Scheme.