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Background:
Social Health Insurance (SHI) is widely used by countries attempting to move toward Universal Health Coverage (UHC). While evidence suggests that SHI is a promising strategy for achieving UHC, low-income countries often struggle to implement and sustain SHI systems. It is therefore important to understand how SHI enrollees use health i...
Contexts in source publication
Context 1
... were cross-sectional surveys of social franchise clients at three networks supported by AHME. See Table 2 for an overview of the sampling pattern used to conduct the client exit surveys. The target sample size for each network, based on historic client flow data, was a minimum of 214 clients, across a randomized sample of 40 franchise sites per network for the first round of data collection, while one AHME partner (MSIG) conducted a census of all 107 of their facilities in the second round of data collection. ...Context 2
... were cross-sectional surveys of social franchise clients at three networks supported by AHME. See Table 2 for an overview of the sampling pattern used to conduct the client exit surveys. The target sample size for each network, based on historic client flow data, was a minimum of 214 clients, across a randomized sample of 40 franchise sites per network for the first round of data collection, while one AHME partner (MSIG) conducted a census of all 107 of their facilities in the second round of data collection. ...Similar publications
This paper examines factors that affect public policy implementation in developing world context, with some evidence from Ghana. It looks at how public policy design; organisational and individual factors affect implementation. Public policy implementation debate is along with top-down, bottom-up or mixed approaches. The health insurance scheme in...
Citations
... Evidence suggests that insurance coverage contributes to enhanced affordability of healthcare, with clients reporting an increased frequency of seeking care and improved access to a diverse range of healthcare providers. (16). Women's enrollment in HI has been linked to increased use of maternal healthcare (17). ...
Background: Universal Health Coverage aims to alleviate poverty caused by out-of-pocket health expenses, affecting 150 million annually, particularly in low- and middle-income countries. Health Insurance plays a crucial role, yet faces challenges like low coverage rates and equity issues. This study aimed to assess the extent of coverage and identify factors influencing the utilization of health insurance among reproductive women in Tanzania, utilizing data from the 2022 Demographic Health Survey.
Methods: The study quantitatively examined data from the 2022 Tanzania Demographic and Health Survey, involving 15,254 women of reproductive age. The analysis included univariate, bivariable, and multivariable techniques utilizing chisquare and multilevel logistic regression. Findings reported as adjusted odds ratios (AOR), determined statistical significance at p<0.05.
Results: The overall coverage of Health Insurance (HI) stood at a mere 5.7%. Individuals aged 35-49 years were 1.6 times more inclined to utilize insurance compared to those aged 15-24 years (AOR=1.633, 95%CI: 1.326-2.010). Residents in rural areas exhibited a 1.3 times higher likelihood of using HI compared to their urban counterparts (AOR=1.300, 95%CI: 1.086-1.556). Moreover, individuals with a higher level of education were 8 times more inclined to use HI compared to those with no education (AOR=8.113, 95%CI: 5.009-13.141), indicating a correlation between increased educational attainment and HI utilization. Additionally, participants owning a television were 1.4 times more likely to use HI than those without (AOR=1.419, 95%CI: 1.135-1.774). Those who held an account in a bank or financial institution were 3.9 times more likely to utilize insurance compared to those without an account (AOR=3.999, 95%CI=3.302-4.843).
Conclusions: The extent of Health Insurance (HI) coverage in Tanzania continues to fall short, impeding advancements toward universal health coverage.
Recommendation: The study recommends bolstering public awareness initiatives to underscore the benefits of HI services and striving to enhance their affordability.
... Many studies have attributed non-renewal of subscription under the NHIS to high insurance premium (Boateng and Awunyor-Vitor, 2013;Jehu-Appiah et al., 2012), distance to the closest health facility (Savitha, 2017), displeasure of certain components of the scheme (Ranabhat et al., 2020;Amu and Dickson, 2016), inadequate knowledge of the scheme (Mpuuga et al., 2020;Suchman et al., 2020;Alhassan et al., 2016), preference for private health insurance (Bamfo and Dogbe, 2017), and poor service delivery by service providers (Fenny et al., 2016;Boateng and Awunyor-Vitor, 2013). Studies that focus on socioeconomic inequalities only focused on coverage (Dake, 2018) and exemption policies (Novignon et al., 2021). ...
... Such efforts have been successful in Kenya and Ghana. 63 Through the creation of social impact bonds, for example, these partnerships can help increase funding, investments, and workable payment plans in regions with limited resources. It is also possible to complement local money by applying for international funding through the WHO, the United Nations International Children's Emergency Fund (UNICEF), and the United Nations Fund for Population Activities (UNFPA), which would increase the total amount of resources available. ...
Neurological disorders during pregnancy are a substantial threat to women’s health, particularly in low- and middle-income countries. Furthermore, a critical shortage of mental health workers and neurologists exacerbates the already pressing issue, where a lack of coordination of respective healthcare among multidisciplinary teams involved in managing these conditions perpetuates the current state of affairs. Financial restrictions and societal stigmas associated with neurological disorders in pregnancy amplify the situation. Addressing these difficulties would necessitate a multifaceted approach comprising investments in healthcare infrastructure, healthcare professional education and training, increased government support for research, and the implementation of innovative care models. Improving access to specialized treatment and coordinated management of antenatal neurological diseases will precipitate improved health outcomes for women and their families in low- and middle-income countries.
... The HLE of a country is positively influenced by prepaid private health spending in adjacent countries in this study. Ghana introduced national health insurance in 2004, but out-of-pocket health spending still accounted for the largest proportion of Ghana's total health spending until 2017 [26]. Compared with government health financing mechanisms, prepaid private health spending (such as social health insurance) may require higher costs in the long-term, while government sources of health financing may require lower costs in the short-term [5]. ...
Background
Health financing produce a broad range of healthy life expectancy (HLE) disparities. In West Africa, limited research exists on the association between health financing and HLE at ecological level during a consecutive period of time from the spatial perspectives. This study aimed to determine the existence, quantify the magnitude, and interpret the association between health financing and HLE.
Methods
A Dynamic Spatial Durbin model was used to explain the association between HLE and health financing level and structure during 1995-2019 in West Africa. Spatial spillover effects were introduced to interpret the direct and indirect effects caused by health financing level and structure on HLE during the long and short terms.
Results
Spatial dependence and clustering on HLE were observed in West Africa. Although the overall level of total health spending, government health spending, out-of-pocket health spending, and development assistance for health (DAH) increased from 1995 to 2019, government health spending per person experienced a declining trend. Out-of-pocket health spending per total health spending was the highest among other sources of health financing, decreasing from 57% during 1995-1999 to 42% during 2015-2019. Total health spending and out-of-pocket health spending affected HLE positively and negatively in the long term, respectively. Government health spending and prepaid private health spending per person had positive effects on local and adjacent country HLE in the short-term, while DAH had negative effects on the same. The short-term spatial spillover effects of government health spending, DAH, and prepaid private health spending per person were more pronounced than the long-term effects.
Conclusions
Spatial variations of HLE existed at country-level in West Africa. Health financing regarding government, non-government, as well as external assistance not only affected HLE disparities at local scale but also among nearby countries. Policymakers should optimise supportive health financing transition policies and narrow the national gap to reduce health disparities and increase HLE. Externalities of policy of those health financing proxies should be took into consideration to promote health equity to improve global health governance.
... The NHIS in Ghana was launched in 2003 as part of the government's efforts to achieve UHC (Morgan et al., 2022;Quartey et al., 2023). The NHIS is an SHI program (Fenny et al., 2021;Osei Afriyie et al., 2022) that provides access to affordable and quality healthcare services to Ghanaians (Nsiah-Boateng & Aikins, 2018;Suchman et al., 2020). The scheme operates on the principle of risk pooling, where members make contributions to a common fund which is used to finance healthcare services for all members. ...
Achieving universal health coverage (UHC) through the National Health Insurance Scheme (NHIS) has been a priority for Ghanaian governments. Despite the plethora of studies conducted to explore the various factors that influence enrolment in the scheme, there remains a dearth of literature with regards to a systematic review of the health- and system-level determinants of NHIS enrollment among older adults in Ghana. This study aimed to synthesise evidence on macro- and meso-level determinants of NHIS enrollment among older adults in Ghana. With literature from data repositories including Wiley Web of Science, PubMed, PsycINFO, Scopus, Ovid, Science Direct, and Sage, we performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Out of the 124 studies screened, the systematic review included 11 articles. The study identified 4 macro- and 3 meso-determinants of national health insurance enrollment among older adults in Ghana.Macro-determinants identified were perceived scheme benefits, affordability, proximity to NHIS offices, and quality of administrative service delivery. Physical accessibility, quality of care, and staff attitude were identified as meso-determinants. The study recommends improving physical accessibility, quality of care, and staff attitude. Additionally, it suggests addressing perceived scheme benefits and improving the quality of administrative service delivery.
... However, many enrollees had to make co-payments because they were unaware of the accreditation status of the provider's full benefits of SHI. The coverage should expand access to primary healthcare, both to public and private providers, as there seemed to be more confidence in the private sector (39). Another study in Ghana demonstrated that the NHIS resulted in increased health-seeking behavior from informal to formal providers. ...
Social health insurance (SHI) is a form of health finance mechanism that had been implemented in many countries to achieve universal health care (UHC). To emulate the successes of SHI in many developed countries, many developing and middle-income countries (MICs) have attempted to follow suit. However, the SHI implementation has problems and obstacles. Many more obstacles were observed despite some successes. This scoping review aimed to study the various developments of SHI globally in its uses, implementation, successes, and obstacles within the last 5 years from 2017 to 2021. Using three databases (i.e., PubMed, EBSCO, and Google Scholar), we reviewed all forms of articles on SHI, including gray literature. The PRISMA-ScR protocol was adapted as the guideline. We used the following search terms: social health insurance, national health insurance, and community health insurance. A total of 57,686 articles were screened, and subsequently, 46 articles were included in the final review. Results showed that the majority of SHI studies were in China and African countries, both of which were actively pursuing SHI programs to achieve UHC. China was still regarded as a developing country. There were also recent experiences from other Asian countries, but only a few from South America. Implementing SHI to achieve UHC was desirable but will need to consider several factors and issues. This was especially the case in developing and MICs. Eventually, full UHC would only be possible with a combination of general taxation and SHI.
... Low income and low education were frequently linked to low enrolment rates, (Asundep et al., 2013). Despite the fact that evidence demonstrates that SHI is a promising option for achieving UHC, low-income nations frequently struggle to build and sustain SHI systems, (Suchman et al., 2020). ...
The Research sought to determine the knowledge level of the reproductive women about the Nhis services.
... Household members [25,28,31,33,48]; people with access to a private subsidized health insurance program [34]; community members [46]; HIV+ pregnant women [36]; pregnant women [37]; poor women who had given birth [38]; community residents [39]; males and females aged 23 to 59 years [45]; patients exiting healthcare facilities [40]. ...
... This scoping review reports the different strategies (derived from the included studies) to strengthen the health system for attaining UHC in Africa. These strategies include those that fall under capacity building in health facilities, as well as developing and improving health infrastructure (e.g., training, supervising, and retaining healthcare workers, developing healthcare facilities) [19,24,27,30,35,42,49]; health information systems (health technology assessment) [29,41]; access to essential medicines (access to medicines and introducing African traditional medicine and traditional health practitioners into health systems) [23,26]; and health financing [17,18,[20][21][22]25,28,[31][32][33][34][36][37][38][39][40][43][44][45][46][47][48]50]. ...
... Of the 34 studies included, 23 focused on assessing the role of health financing, as a health system strengthening strategy in Botswana, Egypt, Ethiopia, Democratic Republic of Congo, Gabon, Ghana, Kenya, Malawi Nigeria Rwanda, South Africa, Tanzania, Zambia, and Zimbabwe [17,18,[20][21][22]25,28,[31][32][33][34][36][37][38][39][40][43][44][45][46][47][48]50]. These studies investigated and reported various ways in which finances could be enhanced, i.e., through household outof-pocket payments, health insurance, and attracting donors and taxes. ...
Universal health coverage (UHC) is defined as people having access to quality healthcare services (e.g., treatment, rehabilitation, and palliative care) they need, irrespective of their financial status. Access to quality healthcare services continues to be a challenge for many people in low- and middle-income countries (LMICs). The aim of this study was to conduct a scoping review to map out the health system strengthening strategies that can be used to attain universal health coverage in Africa. We conducted a scoping review and qualitatively synthesized existing evidence from studies carried out in Africa. We included studies that reported interventions to strengthen the health system, e.g., financial support, increasing work force, improving leadership capacity in health facilities, and developing and upgrading infrastructure of primary healthcare facilities. Outcome measures included health facility infrastructures, access to medicines, and sources of financial support. A total of 34 studies conducted met our inclusion criteria. Health financing and developing health infrastructure were the most reported interventions toward achieving UHC. Our results suggest that strengthening the health system, namely, through health financing, developing, and improving the health infrastructure, can play an important role in reaching UHC in the African context.
... For women, one common reason was due to lack of access to the enrollment card or card number, as the husband was the principal cardholder. Furthermore, coverage of healthcare centers by NHIF is not uniform and women limited in travel may not have convenient access to providers who ac-cept NHIF, 33 which may highlight why women in our cohort were more likely to present in a delayed fashion and directly to MTRH. The act of enrolling in NHIF is also a challenge for women. ...
Introduction
Gender is an important factor in determining access to healthcare resources. Women face additional barriers, especially in low- and middle-income countries. Surgical costs can be devastating, which can exacerbate engendered disparities. Kenya's National Hospital Insurance Fund (NHIF) aims to achieve universal coverage and protect beneficiaries from catastrophic health expenditures. We examine gender differences in NHIF coverage, health-seeking behavior, and surgical outcomes at a tertiary care hospital in Eldoret, Kenya.
Materials and Methods
All patients ≥13 years admitted to the general surgery service at Moi Teaching and Referral Hospital from January 2018-July 2018 were enrolled. Health records were retrospectively reviewed for demographic data, clinical parameters, NHIF enrollment, and cost information. Descriptive analyses utilized Wilcoxon Rank Sum, Pearson's Chi-square, and Fisher's Exact tests.
Results
366 patients were included for analysis. 48.6% were enrolled in NHIF with significant female predominance (64.8% versus 37.9%, P < 0.0001). Despite differing coverage rates, male and female patients underwent surgery and suffered in-hospital mortality at similar rates. However, women only comprised 39.6% of admissions and were significantly more likely to delay care (median 60 versus 7 days, P < 0.0001), be diagnosed with cancer (26.6% versus 13.2%, P = 0.0024), and require a palliative procedure for cancer (44.1% versus 13.0%, P = 0.013).
Conclusion
Many financial and cultural barriers exist in Kenya that prevent women from accessing healthcare as readily as men, persisting despite higher rates of NHIF coverage amongst female patients. Investigation into extra-hospital costs and social disempowerment for women may elucidate key needs for achieving health equity.
... Globally, social health insurance is widely accepted as a key instrument for improving universal access to health care and financial protection because it involves funds and risk pooling [1,2]. Evidence from low-and-middle-income countries (LMICs) show that health insurance scheme improves access to healthcare services [3][4][5][6] due to health insurance's perceived cost-effectiveness [7,8], and financialrisk protection [9]. More so, a previous study reported that insured people tend to adopt appropriate health-seeking behaviour (HSB) by using formal healthcare facilities than those who are uninsured [6,10]. ...
... Evidence from low-and-middle-income countries (LMICs) show that health insurance scheme improves access to healthcare services [3][4][5][6] due to health insurance's perceived cost-effectiveness [7,8], and financialrisk protection [9]. More so, a previous study reported that insured people tend to adopt appropriate health-seeking behaviour (HSB) by using formal healthcare facilities than those who are uninsured [6,10]. ...
... The implication is that the insurance scheme is achieving its objective of universal access to health care and financial protection and could be a vehicle for achieving UHC in Anambra State. This assertion is in line with previous reports that health insurance significantly increases access to healthcare services [3][4][5][6]. Our finding is in line with other studies that found improved access to health care services among health insurance enrollees [6,10,35]. ...
