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

Dina Adei,Williams Agyemang-Duah,Anthony Acquah Mensah

doi:10.1186/s13104-019-4782-2

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.

Highlights

After independence, the Government of Ghana introduced free healthcare for its citizens [1], with the rationales of removing all forms of barriers to healthcare accessibility and utilization and, ensuring universal health coverage [2]
Approximately 17% of the participants were enrolled in National Health Insurance Scheme (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)

Summary

Introduction

The Government of Ghana introduced free healthcare for its citizens [1], with the rationales of removing all forms of barriers to healthcare accessibility and utilization and, ensuring universal health coverage [2]. Free healthcare was funded through taxes and donor support [3]. As part of the free healthcare policy, the government provided additional healthcare facilities across the country and strengthened preventive interventions such as immunization and antenatal care. In the 1980s, due to the poor economic growth resulting in limited resources, the government abolished the free healthcare policy [2]. The out-of-pocket payment systems were gradually implemented in Ghana in the mid-1980s [4].

Results

Discussion

Conclusion