BackgroundGhana is attracting global attention for efforts to provide health insurance to all citizens through the National Health Insurance Scheme (NHIS). With the program’s strong emphasis on maternal and child health, an expectation of the program is that members will have increased use of relevant services.MethodsThis paper uses qualitative and quantitative data from a baseline assessment for the Maternal and Newborn errals Evaluation from the Northern and Central Regions to describe women’s experiences with the NHIS and to study associations between insurance and skilled facility delivery, antenatal care and early care-seeking for sick children. The assessment included a quantitative household survey (n = 1267 women), a quantitative community leader survey (n = 62), qualitative birth narratives with mothers (n = 20) and fathers (n = 18), key informant interviews with health care workers (n = 5) and focus groups (n = 3) with community leaders and stakeholders. The key independent variables for the quantitative analyses were health insurance coverage during the past three years (categorized as all three years, 1–2 years or no coverage) and health insurance during the exact time of pregnancy.ResultsQuantitative findings indicate that insurance coverage during the past three years and insurance during pregnancy were associated with greater use of facility delivery but not ANC. Respondents with insurance were also significantly more likely to indicate that an illness need not be severe for them to take a sick child for care. The NHIS does appear to enable pregnant women to access services and allow caregivers to seek care early for sick children, but both the quantitative and qualitative assessments also indicated that the poor and least educated were less likely to have insurance than their wealthier and more educated counterparts. Findings from the qualitative interviews uncovered specific challenges women faced regarding registration for the NHIS and other barriers such lack of understanding of who and what services were covered for free.ConclusionEfforts should be undertaken so all individuals understand the NHIS policy including who is eligible for free services and what services are covered. Increasing access to health insurance will enable Ghana to further improve maternal and child health outcomes.

Motivation: Governments in sub-Saharan Africa have rapidly expanded cash transfer programmes as part of their social protection strategy over the last decade. Currently 46 countries have a state-sponsored social protection programme, compared to just 25 countries in 2005, and the most common type of programmes are cash transfers, representing 51% of all social protection spending in the region.

Cost-sharing between governments and families remains a strategic part of many governments' post-secondary education funding policies in low-income countries. This shift to more cost-sharing raises questions about how households meet their contributions to post-secondary schooling costs. This study uses data from the World Bank's Global Financial Inclusion survey and World Development Indicators to examine how savings account ownership, cash transfers, and other forms of income shape families' decisions about education financing in 59 low and lower-middle-income countries. Results from generalized hierarchical linear modeling and logistic regression models show that individuals with savings accounts are more likely to dedicate resources to educational purposes than those without accounts. Other forms of income (cash transfers excepted) also predict an individual's likelihood of earmarking savings for education to a lesser degree. Our findings offer compelling evidence that greater access to formal savings services may provide a viable long-term strategy to help families prepare financially for their children's future education. These findings may inform future programs that promote financial inclusion and expand access to formal savings services to help individuals and families save for their children's education.

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