Genevieve Aryeetey and Caroline Jehu-Appiah receive their PhD degree in August 2012


In August, researchers Genevieve Cecilia Aryeetey (Ghana) and Caroline Jehu Appiah (Ghana) received their PhD degree for their work within the WOTRO Integrated "Programme Reaching the poor in Ghana's National Health Insurance Scheme". Jehu-Appiah investigated equity aspects and strategies to improve enrolment of the poor into national health insurance, while Aryeetey looked at strategies to identify the poor and to evaluate the benefits of health insurance for this group.

In recent years, many low and middle income countries have set up health insurance schemes to improve access to health care and to provide protection from the impoverishing effects of direct high health care expenditures. PhD researchers Genevieve Aryeetey and Caroline Jehu-Appiah show that in the case of Ghana, which was one of the first countries to implement a nationwide National Health Insurance Scheme (NHIS), enrolment of the poor into this scheme remains relatively low. They propose measures that can help to increase the effectiveness of the system.

Both research projects are part of the Integrated Programme Reaching the poor in Ghana's National Health Insurance Scheme. In her study, Genevieve Aryeetey looks at ways to identify the poor and investigates the beneficial effects of enrolling into the NHIS. In her thesis, Caroline Jehu-Appiah describes the design, implementation and evaluation of an intervention to increase enrolment with a focus on the poor living in Ghana.

Together, the researchers show that rich households in Ghana are much more likely to enrol in NHIS than poorer families. They also conclude that perceptions vis-à-vis service providers, insurance schemes and community attributes play an important role in household’s decisions to voluntarily enrol and that these perceptions differ between rich and poor: richer families are more sensitive to perceptions about the quality of care, while poorer households are led much more by perceptions about benefits and the price of the insurance. Therefore, the researchers state, ‘policy makers need to recognize community perceptions to stimulate enrolment and retention’.

The researchers also conclude that once enrolled in the NHIS, ‘poor and non-poor households have a similar, equitable, utilization of health services’ and that the system provides protection against catastrophic expenditures and poverty, making equitable enrolment all the more important.

Therefore, the research team designed, tested and evaluated a ‘Multi-Stakeholder Problem-solving programme’ (MSPS). This model posits that to extend enrolment, the programme must first engage and activate multiple stakeholders in a problem-solving group to identify and address barriers to enrolment through improved knowledge, attitudes, joint planning, trust and better relationships between multiple stakeholders. To test this, the researchers set up 15 intervention communities that regularly engaged in constructive dialogue to identify and analyze root causes of barriers to enrolment and implement solutions. As a result, enrolment increased significantly.

Therefore, the researchers recommend that MSPS should be made an integral part of Ghana’s health insurance scheme. This method can also be applied to other low and middle income countries that are implementing health insurance schemes and are struggling with trying to increase equitable access and reaching universal coverage.

Genevieve Aryeetey, Targeting the poor in Ghana’s National Health Insurance Scheme and benefits of enrolment
Caroline Jehuy-Appiah, Reaching the poor in Ghana’s National Health Insurance Scheme: Equity aspects and strategies to improve enrolment

[from WOTRO NewsFlash September 10, 2012] 

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