Community concepts of poverty: an application to premium exemptions in Ghana’s National Health Insurance Scheme

Abstract

BackgroundPoverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana’s National Health Insurance Scheme.MethodsWe employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty.ResultsCommunity defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community.ConclusionThe in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care.

Concept of Poverty in a Rural Community: A Qualitative Study of the Views of Magobbo Smallholder Farmers in Zambia’s Mazabuka Distric

“…The findings are also similar or consistent with findings from several other studies elsewhere which have clarified the multi-dimensionality of poverty and reflects the broader work carried out by the 'Voices of the Poor' exercises across several countries, where poverty or ill-being was identified as being complex and interwoven, including a material lack and need for shelter, assets, money and often characterized by hunger, pain, discomfort, exhaustion, social exclusion, vulnerability, powerlessness and low self-esteem (Narayan et al, 2000;Aryeetey et al, 2013). In this context, and as reflected through other literature, poverty was identified as a composite of both personal and community life situations where on the personal level, poverty is reflected in an inability to gain access to basic community services (Francis et al, 1997;Batse et al, 1999).…”

“…Lack of social capital, or social exclusion, has also been highlighted as a significant characteristic of poverty during some studies (Narayan, 1997;Aryeetey et al, 2013;Kay et al, 2003). Support from family networks was found to be varied, including accommodation, food, money and other resources to initiate enterprises.…”

“…Several qualitative assessments of poverty in most developing countries have revealed that the poor are characterized both in terms of their occupation and their lack of access to assets and social services (Aryeetey et al, 2013;Narayan, 1997). Physical capital assets, such as housing type, sanitation, sources of drinking water and cooking are often used as proxy indicators of household well-being.…”

“…Ill-health was the most commonly identified manifestation of poverty in rural areas. Furthermore, the studies identified physical and psychological ill-health as both, in-part, cause and consequence of poor well-being or poverty (Kunfaa, 1999;Narayan et al, 2000;Aryeetey et al, 2013). Whilst those who descend into (or remain in) poverty as a consequence of ill-health are clearly likely to remain in this physical or mental state, lacking the resources to seek assistance, the implication of ill-health as an outcome of poverty also implies that poverty caused by other factors (lack of financial capital, poor or no employment etc.)…”

The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation

“…There is also the observation that spatial inequalities in health and socioeconomic development between Southern and Northern Ghana and between rural and urban areas 34 are still a major problem and wider in the regions of Northern Ghana compared to Southern Ghana. 40 …”