Understanding Qualitative and Community Indicators of Poverty for National Health Insurance Scheme Exemptions in Ghana

Abstract

The exemptions of the National Health Insurance Scheme (NHIS) for poor people in Ghana have not been sufficiently explored. Using a qualitative approach that involved gathering and analyzing viewpoints from the community, this article investigates the factors that are used to determine NHIS exemptions. Focus group discussions and interviews of key informants were conducted during the period (August 2015–August 2016) within the Ashanti and Greater Accra regions in Ghana. Nine focus group discussions were conducted in nine different communities with 72 respondents. Nine key informants including local and national policy makers, civil servants, and local community members were also interviewed. A sampling method was adopted to capture a range of understandings of community indicators of poverty for NHIS exemptions. Community perceptions of the indicators of poverty included interconnected themes of income, employment, education, assets, and social marginalization. The findings highlight contextual and community descriptions associated with exemptions, of which poverty is a predictor, and discovered that to identify the indigent for exemptions based only on income and quantitative measures is not enough. The results are significant for a number of reasons including poor fit with official measures and the neglect of lay perspectives. For practice implications, our findings show that communities should be principal stakeholders for describing the disadvantaged groups that require exemptions.