Is Ghana’s pro-poor health insurance scheme really for the poor? Evidence from Northern Ghana

Abstract

BackgroundProtecting the poor and vulnerable against the cost of unforeseen ill health has become a global concern culminating in the 2005 World Health Assembly resolution urging member states to ensure financial protection to all citizens, especially children and women of reproductive age. Ghana provides financial protection to its citizens through the National Health Insurance Scheme (NHIS). Launched in 2004, its proponents claim that the NHIS is a pro-poor financial commitment that implements the World Health Assembly resolution.MethodsUsing 2011 survey data collected in seven districts in northern Ghana from 5469 women aged 15 to 49 the paper explores the extent to which poor child-bearing age mothers are covered by the NHIS in Ghana’s poorest and most remote region. Factors associated with enrolment into the NHIS are estimated with logistic regression models employing covariates for household relative socio-economic status (SES), location of residence and maternal educational attainment, marital status, age, religion and financial autonomy.ResultsResults from the analysis showed that 33.9 percent of women in the lowest SES quintile compared to 58.3 percent for those in the highest quintile were insured. About 60 percent of respondents were registered. However, only 40 percent had valid insurance cards indicating that over 20 percent of the registered respondents did not have insurance cards. Thus, a fifth of the respondents were women who were registered but unprotected from the burden of health care payments. Results show that the relatively well educated, prosperous, married and Christian respondents were more likely to be insured than other women. Conversely, women living in remote households that were relatively poor or where traditional religion was practised had lower odds of insurance coverage.ConclusionThe results suggest that the NHIS is yet to achieve its goal of addressing the need of the poor for insurance against health related financial risks. To ultimately attain adequate equitable financial protection for its citizens, achieve universal health coverage in health care financing, and fully implement the World Health Assembly resolution, Ghana must reform enrolment policies in ways that guarantee pre-payment for the most poor and vulnerable households.

Determinants of enrolment in the NHIS for women in Ghana – a cross sectional study

“…In a study among women aged 15-49 years in the Upper East region of Ghana, it was observed that enrolment into the NHIS is influenced by household's socio-economic status and location of residence among others [48]. Perception of the quality of care at health facilities and perception of the NHIS are significant factors to enrolment.…”

Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana

“…The findings of this study have implications for reducing inequity in access to healthcare, especially in light of the ongoing challenges to improve NHIS coverage [23,45] and efforts to achieve Universal Health Coverage. The results suggest that enabling factors (wealth) were a strong predictor for the use of both public and private health facilities.…”

Oh, as for the Health Insurance…it’s good, but…: rural elders in Agate, Ghana, discuss the National Healthcare Insurance Scheme

“…Like Akazili et al 26 we found traditional African religious practitioners without insurance who saw illnesses as spiritually derived and saw little need for western medical practices. Other non-insured participants from a Christian sect saw God as healer and believed that illness was influenced or caused by sin.…”