Enrolment of Urban Poor in National Health Insurance Scheme in the Ga East Municipality, Ghana

Abstract

Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. This study sought to determine the rate and factors influencing enrolment in the National Health Insurance Scheme (NHIS) among the urban poor in the Ga East municipality, Ghana. A cross sectional study was conducted in the Grushi community of Ga East Municipality of the Greater Accra Region using data from a household survey of 250 household participants. Data were collected from household level using structured questionnaires. Logistic regression models were used to assess the socio-demographic and facility related predictors of enrolment in the NHIS. All statistical tests were two-tailed and considered significant at p-value <0.05. 76.5% of the participants were enrolled in the NHIS whereas 23.5% were not. Most, 76.3% of card bearers face problems of drug unavailability when they visit the facility. Having secondary and primary education was associated with 4.28 (adjusted odds ratio, [AOR], 95% confidence interval, [CI]; 4.28, 1.51-12.43) and 5.15 (AOR, 95% CI; 5.15, 1.85-14.16) times higher odds of enrolling in the NHIS scheme. Living very far from the NHIS service center was also associated with reduced odds of enrolling in the scheme (AOR, 95% CI; 0.19, 0.04-0.93). There is a generally high enrolment into the NHIS scheme among the urban poor people in Accra, Ghana. Enrolment in the NHIS was influenced by the educational level, use of healthcare services and distance from an NHIS accredited facility. Extending geographical access and improving service quality could be an important strategy for expanding NHIS membership among this population.

Keywords: National Health Insurance Scheme, Enrolment, Urban, Poor, Ghana