Insurance Scheme Research Articles

Willingness to join community-based health insurance and its associated factors among households in Nekemte City, Ethiopia. A community-based cross-sectional study

IntroductionEthiopia has been implementing community-based health insurance programs since 2011 to improve health care financing system. However, the prevalence of household willingness to join the community-based health insurance (CBHI) program and its associated factors are less explored in urban area. Therefore, this study was aimed to assess the prevalence of willingness to join community-based health insurance program and its associated factors among households in Nekemte City, Ethiopia.MethodsA community-based cross-sectional study was conducted on 422 randomly selected households in Nekemte City, Ethiopia. Bivariate and multivariable analyses were performed to see the association between the independent and outcome variables using binary logistic regression model. Association was described using an adjusted odd ratio (AOR) and a 95% confidence interval (CI). Finally, p-value < 0.05 was considered the cut-off point for declaring a significant.ResultsAmong 422 study participants, 320 (75.83%) [95% CI = 71.5-79.8%)] of the households were willing to join community-based health insurance program. The willingness to join for community-based health insurance was 3.11 times more likely among households who were in the richest quintile (AOR = 3.11; 95% CI = 1.08–8.93), 3.4 times more likely among those who were merchants (AOR = 3.40;1.33, 8.69), 2.52 times more likely among those who had history of chronic illness in the household (AOR = 2.52; 95% CI = 1.43–4.45), 4.09 times more likely among those who had the awareness about the scheme (AOR = 4.09; 95% CI = 1.97–8.47) and 3.29 times more likely among those who had the experience of borrow for medical care (AOR = 3.29; 95% CI = 1.48–7.30).ConclusionNearly three fourth of the households were willing to join community-based health insurance program, however, about one fourth of households were not willing, which is a significant public health problem. Being merchant, having awareness about the scheme, being in the richest wealth quintile, having experience of borrowing for medical care, and having history of chronic illness in the household were factors found to be significantly associated with willingness to join community based health insurance in the study area. Therefore, strengthening awareness creation at community level about the benefit package and principle of the program would increase their demand for the community-based health insurance scheme.

Prevalence, perceptions and associated factors of health insurance enrollment among older persons in selected cash grant communities in Ghana: a cross-sectional mixed method

BackgroundUniversal Health Coverage has been openly recognized in the United Nations health-related Sustainable Development Goals by 2030, though missing under the Millennium Development Goals. Ghana implemented the National Health Insurance Scheme programme in 2004 to improve financial access to healthcare for its citizens. This programme targeting low-income individuals and households includes an Exempt policy for older persons and indigents. Despite population ageing, evidence of the participation and perceptions of older persons in the scheme in cash grant communities is unknown. Hence, this paper examined the prevalence, perceptions and factors associated with health insurance enrollment among older persons in cash grant communities in Ghana.MethodsData were from a cross-sectional household survey of 400 older persons(60 + years) and eight FGDs between 2017 and 2018. For the survey, stratified and simple random sampling techniques were utilised in selecting participants. Purposive and stratified sampling techniques were employed in selecting the focus group discussion participants. Data analyses included descriptive, modified Poisson regression approach tested at a p-value of 0.05 and thematic analysis. Stata and Atlas-ti software were used in data management and analyses.ResultsThe mean age was 73.7 years. 59.3% were females, 56.5% resided in rural communities, while 34.5% had no formal education. Two-thirds were into agriculture. Three-fourth had non-communicable diseases. Health insurance coverage was 60%, and mainly achieved as Exempt by age. Being a female [Adjusted Prevalence Ratio (APR) 1.29, 95%CI:1.00–1.67], having self-rated health status as bad [APR = 1.34, 95%CI:1.09–1.64] and hospital healthcare utilisation [APR = 1.49, 95%CI:1.28–1.75] were positively significantly associated with health insurance enrollment respectively. Occupation in Agriculture reduced insurance enrollment by 20.0%. Cited reasons for poor perceptions of the scheme included technological challenges and unsatisfactory services.ConclusionHealth insurance enrollment among older persons in cash grant communities is still not universal. Addressing identified challenges and integrating the views of older persons into the programme have positive implications for securing universal health coverage by 2030.

A potential pathway for identifying hypertension among urban residents aged 60+ years in China: the role of health insurance.

Identification is the first step for treatment of hypertension. However, the awareness rate of hypertension was not high globally. This study aimed to examine the potential role of health insurance for early-identifying hypertension among urban older residents in China. In this cross-sectional study, urban residents aged 60+ years were chosen from Nanjing municipality of China in 2018. The outcome measure was hypertension status ("no hypertension," "diagnosed hypertension" or "un-diagnosed hypertension"). Independent variable was health insurance ("Urban Employee Basic Medical Insurance scheme, UEBMI" or "Urban Resident Basic Medical Insurance scheme, URBMI"). Logistic regression models were introduced to estimate odds ratio (OR) and 95% confidence interval (CI) to examine the association between health insurance and hypertension. Totally, 19,742 participants completed the study. Among overall, URBMI and UEBMI participants, 47.2% (95%CI = 46.5, 47.9%), 38.4% (95%CI = 37.3, 39.6%) and 52.1% (95%CI = 51.2, 53.0%), separately, were diagnosed with hypertension, while the prevalence of un-diagnosed hypertension was 12.7% (95%CI = 12.2, 13.2%), 18.5% (95%CI = 17.6, 19.4%) and 9.6% (95%CI = 9.1, 10.1%), respectively. For overall participants, those with UEBMI were more likely to have hypertension identified (OR = 1.20; 95%CI = 1.11, 1.29) and at lower odds to experience un-diagnosed hypertension (OR = 0.68; 95%CI = 0.61, 0.76) compared to their counterparts with URBMI after control for potential confounders. Moreover, such associations of health insurance with diagnosed and un-diagnosed hypertension were also observed among participants stratified by age and gender. Favorable health insurance may be a pathway for identifying hypertension among urban older residents in China. This study has important public health implications that hypertension may be identified early through favorable health insurance policies for older residents in China.

Impact of Government Funded Health Insurance Scheme on OOP and Quality of Health Care: A Study of Maternal Health Care in Rajasthan

There has been a gradual shift of India’s health policies in favour of government-funded health insurance schemes rather than investment in public health facilities. The impact of this shift on quality of health care, especially for the poor and vulnerable population, is yet to be fully understood. The current study has been undertaken to study the effectiveness of one such state government-funded health insurance scheme, known as Bhamashah Swasthya Bima Yojana (BSBY), on out-of-pocket (OOP) expenditure and quality of health care services for the child delivery cases in a low-income community in the capital city of Jaipur in Rajasthan, India. While this study contributes to knowledge on the impact of access to health insurance on OOP expenditure, it covers a critical gap in the literature regarding its effect on quality of health care. The empirical analysis, conducted using log-linear and logit models, indicates that BSBY has a positive impact on reduction of OOP and improvement in quality of treatment in the study area.

Random Forest Spatial Interpolation Techniques for Crop Yield Estimation at District Level

General Crop Estimation Surveys (GCES) based on Crop Cutting Experiments (CCEs) are conducted for estimation of crop yield following random sampling approach for almost all major crops. About 13 lakh CCEs are conducted every year which has now increased rapidly due to the Pradhan Mantri Fasal Bima Yojana (PMFBY) which is yield based insurance scheme. As suggested by Ministry of Agriculture and Farmers’ Welfare (MoA&amp;FW), this number needs to be reduced drastically by developing sampling procedures based on the use of advanced technologies and advanced survey techniques for crop yield estimation. In this study, an attempt has been made to develop crop yield estimation procedures using Random Forest Spatial Interpolation (RFSI) technique including the spatial variables like spatial distance and nearest neighbours as covariates. RFSI is one of the most adaptable and user-friendly interpolation techniques, as well as one of the fastest in large training datasets. Estimates of yield of wheat were obtained for all the six tehsils of Barabanki district using the estimator under stratified two stage sampling technique. The district level estimates were also obtained by pooling area under wheat crop in each tehsil along with the district level estimate of crop yield, estimate of variance, estimate of standard error (SE) and percentage SE (%SE) of these estimates were also computed in order to make comparison. The results of this study suggest that the estimates derived using RFSI are comparable to kriging and superior to inverse distance weighting (IDW) for the prediction of yield at unknown locations using distance and nearest neighbours.

Older Carers and Social Division of Welfare in China

This study used the social division of welfare approach to analyze how Chinese older carers have access unequally to pensions, medical insurance, and public assistance schemes. Face-to-face interviews were conducted with 40 older carers aged 60 years or above who were taking care of their family members with disabilities or chronic illnesses. The amount of pension and coverage of medical insurance of these respondents and their care recipients was affected by their employment, types of employers, and living locations. Moreover, the older carers’ capacity to address financial and medical burdens was associated with the available support from their family members, especially their adult children. This paper concludes that the social division of welfare amongst older carers was driven by China’s market-oriented pension and medical insurance reforms, decentralization of welfare provisions, and the welfare capacity of families. Future studies can examine the social division of welfare among young and minority ethnic carers and adopt a comparative approach to analyze factors shaping unequal access to welfare benefits among older carers in different countries.

An Observational Study on Perception of Efficacy of Crop Insurance among the Farmers of a Community Development Block in the State of West Bengal

Crop insurance is a formal mechanism of risk management to farmers exposed to a similar type of risk in agricultural production. It is a means to protect the cultivators against financial loss on account of anticipated crop loss which might arise out of uncontrollable natural calamities such as natural fire, weather, floods, pests, diseases etc. In West Bengal, various crop insurance schemes have been implemented so far. The common aim of the schemes is to provide financial support to farmers in the event of crop failure and stabilize farm production and income of the farming community. This is the motivation behind the study. The study has been conducted among farmers of Hooghly district in West Bengal to understand their perception of efficacy of crop insurance schemes. Respondents include both insured and non-insured farmers. The mean age of the farmers with crop insurance was 43.18±16.13 years and the mean age of the ones without crop insurance was 44.22±18.07 years respectively (p=0.62). All respondents were males with full ownership of farms. The mean size of the farms was 5.95±3.28 bigha. A total number of 60 farmers were selected randomly out of which 30 farmers were with crop insurance and rest 30 were without crop insurance. Among the risk management strategies adopted for the destruction of crops, sale/ mortgage of land, sale of livestock and government relief were higher among non-insured farmers as compared to insured farmers (p&gt;0.05).

Does income matter for the policy effect of public long-term care insurance on informal care use in China? A quasi-experimental study.

Since 2016, the Chinese government has been piloting a public long-term care insurance (LTCI) scheme. This study examined whether the LTCI scheme reduced the use of informal care and how this has varied across income groups. We used data from the 2011, 2014, and 2018 waves of Chinese Longitudinal Healthy Longevity Survey, focusing on community-dwelling older adults aged 65 years and older. We used staggered difference-in-differences analyses with propensity score matching to examine the effects of the policy. The LTCI scheme reduced the probability and intensity of informal care use by 5.7% (p < .05) and 17.4% (p < .05), respectively. The policy impact was limited to older people in the middle-income group, reducing the probability and intensity of informal care use by 15.6% (p < .001) and 43.1% (p < .05), respectively. We did not find a statistically significant policy effect for older adults with high or low incomes. The LTCI scheme had different effects on reducing the informal care burden for family caregivers by income level. We suggest that the scheme should entitle people with low incomes to a preferential co-payment rate, thereby enhancing their access to formal care.

Health-related inequalities in out-of-pocket expenditure under universal health coverage in Taiwan: A cross-sectional decomposition analysis.

Studies have investigated income-related inequality in out-of-pocket expenditure (OOPE) on health care but less is known about health-related inequality of OOPE distribution. This study analysed the relationship between health-related inequality and OOPE and the factors contributing to OOPE inequality in Taiwan. We developed a household OOPE questionnaire and conducted a nationally representative cross-sectional survey of households in Taiwan between January and August 2022, using two-stage probability proportional-to-size sampling based on a national address registry in Taiwan. We calculated a concentration index to determine OOPE inequality in health. We then identified factors contributing to OOPE inequality in health distribution by performing a decomposition analysis. A total of 657 people responded to the survey (81.4% response rate). The two largest categories of OOPE were spending on curative care and on medical goods and pharmaceuticals, with concentration indices of -0.265 (p < .001), -0.272 (p = .006) and -0.227 (p = .003), respectively, indicating that the OOPE burden fell disproportionately on people with poor health. Socioeconomic status explained significant proportions of inequality in total, curative and medical goods and pharmaceuticals OOPE. Utilisation of health care increased the OOPE burden among people with poor health while having private health insurance worked in the opposite direction. In Taiwan, people in poor health faced a disproportionately high OOPE burden, indicating that the National Health Insurance scheme may not meet their needs for health care. There is a need for policies to take account of the different factors affecting health inequalities in OOPE in order to enhance equity in Taiwan's universal health system.

Incremental Healthcare Costs of Diabetes Mellitus in a Middle-Income Country Using Administrative Healthcare Data

ObjectivesTo estimate the incremental medical cost of diabetes mellitus using information from administrative databases in Colombia. MethodsWe carried out a retrospective cohort study with administrative health databases from Colombian population affiliated in the contributory health insurance scheme. We used an operative definition to select the cohort with diabetes. Incremental cost and cost ratio of diabetes were estimated using an inverse probability weighting of treatment approach to find the causal effect of having the disease. Weights were calculated by a propensity score method using a Random Forest model. The flexibility of this machine learning algorithm allows to have a better specification and bias reduction. Additionally, we reported incremental costs and cost ratios with confidence intervals using bootstrapping and analyzed costs by age groups and complications associated with diabetes. ResultsThe estimated prevalence of diabetes was 2834 per 100 000 cases, in 2018. The group with diabetes was comprised 634 015 people and the control group 1 524 808. The calculated annual direct medical cost was $860, for which the incremental cost was $493 and the cost ratio 2.34. The incremental annual cost for some type of complication ranges from $1239 to $2043, renal complication being the most expensive. Incremental cost by age groups ranges from $347 to $878, being higher in younger people. ConclusionsAlthough the cost of diabetes in Colombia ranges among the global averages and is similar to other Latin-American countries, a greater incremental cost was found in patients with renal, circulatory, and neurologic complications.

Barriers to Enrollment of National Health Insurance Scheme in Uttargaya Rural Municipality, Rasuwa

The Social Health Security Program (SHSP) is a social protection program of the Government of Nepal that aims to enable all citizens to access quality and effective healthcare services without any financial burden. A cross-sectional household-based and quantitative in-nature study was conducted in Rasuwa district. This study's population was residents of Uttargaya rural municipality wards no 4 and 5. How different factors are related to SHI enrolment. Ethnicity (p=&lt;0.001), religion (p=&lt;0.001), IWI grade (p=0.010), know about health insurance (p=&lt;0.001), the behavior of service providers (p=&lt;0.001), neighbors enrollment (p=&lt;0.001), discussed SHI with neighbors (p=0.001), and family members agreed to enroll (p=0.002) were significantly associated with enrollment in SHI whereas others factors did not show any significant association with enrollment in social health insurance. This study found that enrollment was significantly associated with different independent variables. Poor knowledge of SHI, unfriendly behaviors of service providers, lack of trust, and unaffordability of premium costs were identified as barriers. Furthermore, Inappropriate timing of premium collection, limited services point, feeling that enrollment was not necessary, long queue, inadequate number of enrollment assistant and mandatory refer card were also reasons for not enrolling in SHI.

Long-run consequences of informal elderly care and implications of public long-term care insurance

We estimate a dynamic structural model of labor supply, retirement, and informal caregiving to study short and long-term costs of informal caregiving in Germany. Incorporating labor market frictions and the German tax and benefit system, we find that in the absence of Germany’s public long-term insurance scheme, informal elderly care has adverse and persistent effects on labor market outcomes and, thus, negatively affects lifetime earnings and future pension benefits. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that while public long-term care insurance policies are fiscally costly and induce negative labor market effects, they can largely offset the personal costs of caregiving and increase welfare, especially for low-income individuals.

Knowledge and Uptake of Community-Based Healthcare Financing in Management of Non-Communicable Diseases among Community Members in Anambra State, Nigeria

Background: Catastrophic health expenditure is one of the challenges people living with non-communicable disease face, especially in Nigeria. This has led to the emergence of community-based health insurance as a means to achieve universal health coverage and reduce out-of-pocket payments. However, lack of knowledge about the insurance scheme and how it helps to manage non-communicable diseases seems to affect utilization. Aim: The study assessed the knowledge and uptake of community based healthcare financing in the management of non-communicable diseases among community members in Anambra State. Materials and Methods: A descriptive cross-sectional survey design was adopted for the study, sample size was 444 and a multistage sampling technique was used. The instrument for data collection was a self structured questionnaire and data obtained were analyzed using Microsoft excel, descriptive statistics, inferential statistics for hypothesis testing and IBM statistical package for social Sciences (SPSS) version 29. Results: 64.1% had a good knowledge of community based healthcare financing; 51.4% managed their health condition through hospital visits under CBHI. There was a significant relationship between the level of education of respondents and their level of knowledge of community based health insurance (p-value 0.001 &lt; 0.05). Conclusion: Majority had a good knowledge; those suffering pregnancy related non-communicable diseases used the insurance more although half of the respondents still pay through their pocket. The following recommendations were made: increase access to community-based healthcare financing information, encourage those in the informal sector to enroll and plan benefit packages to have wide illness coverage.

Abstract PO4-20-01: A PROSPECTIVE PILOT STUDY OF MAMMOGRAPHIC PREDICTION OF WOMEN’S RISK (M-POWER) IN NIGERIA

Abstract Background There have been no sustained efforts at stemming the rising incidence and mortality from breast cancer in sub-Saharan African countries like Nigeria. Mammography is the gold standard for breast cancer screening and is associated with improved survival particularly among women 50 to 69. Reports from various parts of Nigeria show very low mammography screening uptake. Causes include lack of geographical access, financial issues (less than 5% of the population is covered by the National Health Insurance Scheme), lack of awareness and the increasing expertise gap from the continued brain drain, despite the already low number of radiologists in the country. Given these obstacles, our long-term goal is to devise a rational basis for identifying mammographic risk categories so that this resource can be deployed cost-effectively. We propose to carry out a 5-year prospective mammographic study in Nigerian women and to use machine learning to develop a risk prediction algorithm, so that following a single screening mammogram, the appropriate frequency of subsequent mammograms can be determined. Our immediate goal is to examine the feasibility of performing such a study. To this end, we have initiated a cross-sectional pilot study that will recruit up to 2000 women in multiple urban centers in Nigeria. Objective: To explore feasibility of creating a digital mammography image database representative of the radiological features of the breast of Nigerian women. Objective: To explore feasibility of creating a database that can be used to inform a predictive mammographic risk model for breast cancer and identify the appropriate population that will benefit from breast cancer screening in Nigeria. Design This is a prospective, open-label, cross-sectional pilot study in 2000 eligible women in Nigeria and will include a single screening mammography examination. The mammography images will be read by the study radiologist. The Pilot phase will determine the feasibility and aid in the design of the of the Extension phase in which up to 20,000 participants will undergo yearly mammography examination for 5 years. Incident cases of breast cancer during the study period will permit the development of deep learning algorithms for predicting the risk of breast cancer in this population. Main Eligibility Criteria: Inclusion Criteria All consecutive women aged ≥40 years and &amp;lt; 65 years presenting for screening mammography at the participating institutions will be eligible. Signed study-specific written informed consent. Exclusion Criteria Complaint of a focal dominant lump or a bloody or clear nipple discharge. History of breast implants. Any woman who is pregnant or has reason to believe that she might be pregnant. Statistical Methods Analyses of continuous data will be summarized using descriptive statistics where the following parameters will be reported: Number of observations, Number of missing observations, Mean, Median, Standard deviation (SD), Minimum (Min), Maximum (Max) Categorical data will be presented with absolute and relative frequency (n and %). Present Accrual and Target accrual Two hundred ninety-six women have been enrolled and screening digital mammographic images using GE Digital mammography equipment have been obtained on all participants at 2 study sites in 2 cities in Southern Nigeria. The target accrual is 2000 participants over 12 months. Conclusion Our preliminary experience to date suggests the feasibility of proceeding with a larger prospective study to define mammographic risk groups in Nigerian women which will permit the rational allocation of resources for breast cancer prevention activities in this underserved population. Contact Information: Dr Toyin Shonukan at tshonukan@yemanjacancercare.org Citation Format: Oluwatoyin Shonukan, Hyelakumi Ibrahim, Esther Udoh, Wahab Egbeolu, Kanyinsola Oyeyinka, Jonas Haggstrom. A PROSPECTIVE PILOT STUDY OF MAMMOGRAPHIC PREDICTION OF WOMEN’S RISK (M-POWER) IN NIGERIA [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-20-01.

Health Insurance Utilization and Financial Behaviour: A Study of Rashtriya Swasthya Bima Yojana (RSBY) in Kerala

This paper examines the health behaviour and health insurance landscape in Kerala, India, with a focus on the impact of the Rashtriya Swasthya Bima Yojana (RSBY) on healthcare utilization and financial behaviour. Using primary data collected from Mukkam municipality in Kozhikode district, Kerala, the study analyses the demographic profile of respondents, their health insurance status, and satisfaction levels with the RSBY scheme. The findings indicate a fairly balanced preference between government and private insurance schemes among households, with a significant majority possessing an insurance card. The RSBY scheme has been successful in enrolling a large proportion of households and providing satisfactory coverage at both government and private hospitals. However, there are variations in insurance coverage and satisfaction levels among different demographic subgroups, highlighting the need for targeted interventions and policy measures to improve access to healthcare and financial security among vulnerable populations.

Rapid cost-effectiveness analysis: hemodialysis versus peritoneal dialysis for patients with acute kidney injury in Rwanda

BackgroundTo ensure the long-term sustainability of its Community-Based Health Insurance scheme, the Government of Rwanda is working on using Health Technology Assessment (HTA) to prioritize its resources for health. The objectives of the study were to rapidly assess (1) the cost-effectiveness and (2) the budget impact of providing PD versus HD for patients with acute kidney injury (AKI) in the tertiary care setting in Rwanda.MethodsA rapid cost-effectiveness analysis for patients with AKI was conducted to support prioritization. An ‘adaptive’ HTA approach was undertaken by adjusting the international Decision Support Initiative reference case for time and data constraints. Available local and international data were used to analyze the cost-effectiveness and budget impact of peritoneal dialysis (PD) compared with hemodialysis (HD) in the tertiary hospital setting.ResultsThe analysis found that HD was slightly more effective and slightly more expensive in the payer perspective for most patients with AKI (aged 15–49). HD appeared to be cost-effective when only comparing these two dialysis strategies with an incremental cost-effectiveness ratio of 378,174 Rwandan francs (RWF) or 367 United States dollars (US$), at a threshold of 0.5 × gross domestic product per capita (RWF 444,074 or US$431). Sensitivity analysis found that reducing the cost of HD kits would make HD even more cost-effective. Uncertainty regarding PD costs remains.Budget impact analysis demonstrated that reducing the cost of the biggest cost driver, HD kits, could produce significantly more savings in five years than switching to PD. Thus, price negotiations could significantly improve the efficiency of HD provision.ConclusionDialysis is costly and covered by insurance in many countries for the financial protection of patients. This analysis enabled policymakers to make evidence-based decisions to improve the efficiency of dialysis provision.

Antenatal care services in Yobe state Nigeria: The determinants and interventions to increase utilization

Introduction: Maternal and perinatal mortality are global public health issues and Nigeria in particular carries a high burden as 33,000 women dies every year though significant decline in maternal mortality ratio has been observed; neonatal mortality rate is 37 per 100,000 livebirths against the 2015 MDGs target of 12 per 100, 000 and stillbirth is unbearably high. Yobe State remains one of the regions with high maternal and perinatal death in Nigeria most of which are preventable with quality Antenatal care (ANC) services yet the ANC coverage is only 49% against the Nigerian national figure of 68.9% (which is moderate) and more than 67% of the pregnant women did not receive atleast 4 ANC visits in Yobe as recommended by World Health Organization. The aimed of this study was to analyse and recommend interventions in ANC services in order to increase utilization to improve maternal and perinatal health in Yobe State, Nigeria. Methods: This is an in-depth study on ANC service utilization from local and international literatures; databases used are PubMed, Medline and Global health. The conceptual framework is based on socio ecological model. The analytical tools used to analyse the proposed intervention strategies are based on the criteria of technical effectiveness, organisational feasibility, sociocultural feasibility, financial feasibility and equity consideration. Results: Multilevel determinants are responsible for low Utilization of ANC services in Yobe State which include intrapersonal (women education and literacy), interpersonal (families, peers, relatives influence), community (culture and beliefs), health system (health services, human resources, and health policy) and structural determinants (conflicts and poverty). Effective and feasible strategies to increase ANC services Utilization identified and appraised include outreach and health and education; men involvement in ANC; community based health insurance scheme; improving the skills and supportive supervision of ANC providers; employment of CHW and task shifting to lower cadres. Conclusion: ANC services requires multi-dimensional approach to increase Utilization, each intervention augment one another for the desired effects and better outcome of improving maternal and perinatal health. Further research is recommended on interventions of determinants like conflicts, poverty and women education which are beyond the scope of this dissertation and men involvement in ANC, community based health insurance scheme, improving the skills and supportive supervision of health ANC providers; task shifting to lower cadres and further research.

Effect of social capital on enrolment of informal sector occupational groups in the national health insurance scheme in Ghana: a cross-sectional survey

BackgroundEnrolment of informal sector workers in Ghana’s National Health Insurance Scheme (NHIS) is critical to achieving increased risk-pooling and attainment of Universal Health Coverage. However, the NHIS has struggled over the years to improve enrolment of this subpopulation. This study analysed effect of social capital on enrolment of informal sector workers in the NHIS.MethodsA cross-sectional survey was conducted among 528 members of hairdressers and beauticians, farmers, and commercial road transport drivers’ groups. Descriptive statistics, principal component analysis, and multinomial logit regression model were used to analyse the data.ResultsSocial capital including membership in occupational group, trust, and collective action were significantly associated with enrolment in the NHIS, overall. Other factors such as household size, education, ethnicity, and usual source of health care were, however, correlated with both enrolment and dropout. Notwithstanding these factors, the chance of enrolling in the NHIS and staying active was 44.6% higher for the hairdressers and beauticians; the probability of dropping out of the scheme was 62.9% higher for the farmers; and the chance of never enrolling in the scheme was 22.3% higher for the commercial road transport drivers.ConclusionsSocial capital particularly collective action and predominantly female occupational groups are key determinants of informal sector workers’ participation in the NHIS. Policy interventions to improve enrolment of this subpopulation should consider group enrolment, targeting female dominated informal sector occupational groups. Further studies should consider inclusion of mediating and moderating variables to provide a clearer picture of the relationship between occupational group social capital and enrolment in health insurance schemes.

A Study on the Status of Present Financial Inclusion Policy in the Districts of the State of West Bengal, India

Introduction: The convergence of financially excluded population towards mainstream formal financial institutions through proper accessibility, affordability and usage of services is crucial, to eradicate the dependence on informal money lenders, and to help the vulnerable and poor people to come out of the vicious debt cycle. As India aims to achieve inclusive growth, it has worked upon removing barriers from the path of gaining complete ‘Financial Inclusion (FI)’ through the policy called, Pradhan Mantri Jan Dhan Yojana (PMJDY). This has helped in translating Jan Dhan (wealth of people) to Jan Suraksha (security of people) through insurance and pension schemes, with the objective of building a global social security mechanism for every citizen. Objective: To analyse the status of the FI scheme (PMJDY) in the 23 districts of the state of West Bengal. Research Methodology: This research work will evaluate the effects of the current FI schemes, on the lives of the citizens of the state of West Bengal, which has 23 districts in total. To investigate about the inclusiveness in the financial system of those 23 districts, District FI Index (FII) has been developed, by considering some indicators for sub-indices as well as for composite index, that are clubbed under three dimensions, namely, accessibility, availability and usage of bank offerings. Earlier literature focused on savings and deposit accounts as a variable to compute FI whereas this study bridges the gap and considers only PMJDY scheme-based accounts to evaluate the present status of the scheme in the state. Findings and Conclusion: It is observed that Kolkata has secured the highest place in FII whereas other districts have shown relatively low FI. The state still has a long distance to travel in terms of achieving a complete FI but it has the capability of travelling at a faster rate due to well-developed banking infrastructure. Thus, to make the FI scheme effective, a developed and accessible banking structure is a pre-requisite. The success of this scheme in bringing the deprived and vulnerable section into the fold will not only increase savings and investment but also contribute to strengthening the human capital of the country.

Studying the accessibility of healthcare services for cancer patients in Khartoum state amid the COVID-19 pandemic

ObjectivesThis study aims to assess cancer patients' accessibility to healthcare services and perceived barriers during the COVID-19 pandemic in Khartoum state, aiming to explore the consequent impact on cancer patients. It also aims to determine the coping strategies used by patients to overcome these barriers. Study designThis is a retrospective analytical cross-sectional study. MethodsData were collected from August 2020 to March 2021, with a sample size of 316 cancer patients. Systemic random sampling and SPSS version 25 were utilized for data collection and analysis. ResultsThe study found that 55.7 % of the surveyed cancer patients had experienced disruptions in accessing essential cancer healthcare services during the lockdown. The study identified the most common cancers as breast (19.7 %), gastrointestinal (19 %), and ovarian (11 %). Notable barriers included governmental travel restrictions (51.6 %), outpatient service closures (41.8 %), and high costs (27.8 %). Additionally, delayed treatment was directly associated with a 33.3 % fatality rate among the participants. ConclusionsThis study highlights the considerable negative impact of the COVID-19 lockdown on cancer care in Sudan. Recommendations include a focus on telemedicine as an alternative form of patient consultation, the expansion of health insurance schemes to encompass cancer treatments, and strengthening healthcare infrastructure to facilitate cancer care during crises.