Predictors of enrollment in a health protection scheme among informal sector workers in Kumasi Metropolis of Ghana

Abstract

ObjectiveInformal sector workers are exposed to occupational hazards which could escalate their healthcare expenditures. Thus, enrollment in a health protection scheme among informal sector workers is useful for reducing their catastrophic healthcare expenditures. However, there is scant information on factors predicting their enrollment in the National Health Insurance Scheme (NHIS) in Ghana, a gap this quantitative study aims to fill. A sample of 350 informal sector workers was involved in a cross-sectional survey.ResultsApproximately 17% of the participants were enrolled in NHIS. Respondents who had worked between 5 and 7 years were significantly more likely to enroll in NHIS compared with those who had worked below 2 years (AOR = 13.159, CI 1.135–152.596, p = 0.039). The study further found that apprentices (AOR = 0.72, CI 0.353–1.056, p = 0.005) were less likely to enroll in NHIS compared with their masters. Participants who were exposed to electrical hazards (AOR = 2.93, CI 1.56–5.10, p = 0.013) and suffered from occupational diseases (AOR = 2.75, CI 1.743–5.17, p = 0.001) were significantly more likely to enroll in NHIS. Also, respondents who were non-Christians were significantly less likely to enroll in NHIS compared with their respective counterparts (AOR = 0.726, CI 0.067–2.503, p = 0.011). The findings are useful for increasing the NHIS enrollment rate among informal sector workers in Ghana.

Exploring heterogeneity of national health insurance scheme enrolment among persons in the informal sector

“…In 2010, 2015, and 2017, the nationwide enrolment rates for NHIS were 33% (8.2 million), 41% (11.3 million), and 35% (10.3 million), respectively. 7 The law that established Ghana's NHIS makes it mandatory for the Social Security and National Insurance Trust (SSNIT) contributors to pay 2.5% of their contribution to fund the scheme. Also, the law required SSNIT contributors to enrol without paying a premium.…”

“…Because of their frequent exposure to workplace dangers such as physical, chemical, biological, and other occupational injuries, those working in the informal sector are more likely to seek medical attention and incur catastrophic healthcare costs. 7,14 Expectations are that increasing NHIS enrolment among them would reduce their healthcare spending. For the Government to achieve universal health coverage of providing health services for all persons without risk of a financial catastrophe or impoverishment related to seeking care, promoting households' enrolment in the informal sector must be given attention.…”

“…The Government of Ghana, in August 2003, legislated the National Health Insurance Act (Act 650), establishing National Health Insurance Scheme (NHIS), but the scheme became fully operational in 2005. In 2010, 2015, and 2017, the nationwide enrolment rates for NHIS were 33% (8.2 million), 41% (11.3 million), and 35% (10.3 million), respectively 7 . The law that established Ghana's NHIS makes it mandatory for the Social Security and National Insurance Trust (SSNIT) contributors to pay 2.5% of their contribution to fund the scheme.…”

“…The informal sector also includes persons who do not have health insurance coverage via formal employment arrangements. Because of their frequent exposure to workplace dangers such as physical, chemical, biological, and other occupational injuries, those working in the informal sector are more likely to seek medical attention and incur catastrophic healthcare costs 7,14 . Expectations are that increasing NHIS enrolment among them would reduce their healthcare spending.…”

Barriers to enrollment in National Health Insurance Scheme among informal sector workers in Nigeria

“…Few empirical studies have been conducted on factors associated with the uptake of health insurance among informal sector workers in developing countries which shows that income, education, age, gender, marital status, household size, place of residence, number of dependents, reading the newspaper, socioeconomic status (SES), awareness of health insurance, and television viewing were significant predictors of enrollment in health insurance among informal sector workers (Adei et al, 2019; Barasa et al, 2017; Dartanto et al, 2020; Mathauer et al, 2008; Muiya, 2017; Muketha, 2016; Sarker et al, 2017; Wanjiku, 2011). However, there is limited evidence available on the barriers to enrollment in NHIS among informal sector workers at the national level in Nigeria.…”