Community concepts of poverty: an application to premium exemptions in Ghana’s National Health Insurance Scheme

Globalization and Health

Irene A Agyepong²  Sjaak van der Geest³  Rob Baltussen¹  Daniel K Arhinful⁴  Ernst Spaan¹  Agnes M Kotoh³  Caroline Jehu-Appiah⁴  Genevieve C Aryeetey⁴ 

[1] Radboud University Nijmegen Medical Cente, Nimegen, Netherlands;School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Ghana;University of Amsterdam, Amsterdam, Netherlands;Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana

关键词: Ghana;    Targeting;    Wealth ranking;    Community participation;    Poor households;    Exemptions;    Health insurance;   

Others  :  819348
DOI  :  10.1186/1744-8603-9-12

 received in 2012-10-16, accepted in 2013-03-07,  发布年份 2013

【 摘 要 】

Background

Poverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana’s National Health Insurance Scheme.

Methods

We employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty.

Results

Community defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community.

Conclusion

The in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care.

【 授权许可】

   
2013 Aryeetey et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Coady D, Grosh M, Hoddinott J: The Targeting of Transfers in Developing Countries: Review of Experience and Lessons,. Washington DC: The World Bank; 2003.
• [2]Castaneda T, Lindert K, De La Brier B: Designing and implementing household targeting systems: lessons from Latin America and the United States. Washington DC: The World Bank; 2005.
• [3]Narayan D: Voices of the Poor: Poverty and Social Capital in Tanzania, in Environmentally and socially sustainable development studies and Monographies Series. World Bank: Washington; 1997.
• [4]Hulme D: Why does poverty endure? Maymana and Mofizul’s story, in CPRC Working Paper 22. Manchester: IDPM, University of Manchester; 2003.
• [5]Kothari U, Hulme D: Narratives, stories and tales: understanding poverty dynamics through life histories, in Working paper series 011. Manchester: Global Poverty Research Group, University of Manchester; 2004.
• [6]Gilson L: Building the field of health policy and systems research: social science matters. Plos Medicine 2011, 8.
• [7]World Bank: Attacking poverty: opportunity, empoowerment, and security, in The World Development Report 2000/2001. Washington DC: The World Bank; 2000.
• [8]Matin I, Halder SR: Combining methodologies for better targeting of the extreme poor: lessons from BRAC’s CFPR/TUP programme. Canada: BRAC Research and Evaluation Division & Aga Khan Foundation; 2004.
• [9]Carletto G, Zezza A: Being poor, feeling poorer: combining objective and subjective measures of welfare in Albania. J Dev Studies 2006, 42:739-760.
• [10]Davis P, Baulch B: Parallel realities: exploring poverty dynamics using mixed methods in rural Bangladesh. Manchester: Chronic Poverty Research Center; 2009.
• [11]MOH: Aligning exemption policy and practice with poverty reduction goals A report of the Annual Health Sector review 2002. Ghana: Ministry of Health; 2003.
• [12]MOH: The Health Sector 2008 Programme of Work: Creating Health Through Wealth. Ghana: Ministry of Health; 2008.
• [13]Garshong B: A study on factors affecting the implementation of the exemption policy in Ghana. Bull Health Info 2002, 1:22-31.
• [14]Aikins M, Arhinful D: Review of the exemptions policy: a report on the annual health sector review 2005. Ghana: Ministry of Health Accra; 2006.
• [15]Ghana: National Health Insurance Act (Act 650). Accra: Ghana Publishing Company Limited; 2003.
• [16]Ghana: National Health Insurance Regulation (LI 1809). Accra: Ghana Publishing Company Limited; 2004.
• [17]Aryeetey GC: Identification of poor households for premium exemptions in Ghana’s National Health Insurance Scheme: empirical analysis of three strategies. Trop Med Int Health 2010, 15(12):1544-1552.
• [18]Collins SB: An understanding of poverty from those who are poor. Action Res 2005, 3(1):9-31.
• [19]Hargreaves J: Assessing household wealth in health studies in developing countries: a comparison of participatory wealth ranking and survey techniques from rural South Africa. Emerg Themes Epidemiol 2007., 4(4)
• [20]Kebede B: Community wealth ranking and household surveys: an integrative approach, in Center for International Studies. Toronto: University of Toronto; 2007.
• [21]Souares A: Using community wealth ranking to identify the poor for subsidies: a case study of community based health insurance in Nouna Burkina Faso. Health Soc Care Comm 2010, 18(4):363-368.
• [22]Ridde V: A community based targeting approach to exempt the worst-off from user fees in Burkina Faso. J Epidemiol Com Health 2010, 64:10-15.
• [23]Simanowitz A, Nkuna B, Kasim S: Overcoming the obstacles of identifying the poorest families, in Microcredit Summit Campaign. Sussex: Institute for Development Studies; 2000.
• [24]Ghana: A repository of all districts in the Republic of Ghana. Accra: Ministry of Local Government and Rural Development; 2006.
• [25]National Health Insurance Authority: Annual Report of the NHIS for 2010: Growing Healthier and Stronger. Accra-Ghana: National Health Insurance Authority; 2011.
• [26]Shine Ghana Project: Evaluation of Ghana’s NHIS in Eastern and Central Regions of Ghana: Baseline and Follow-up household surveys. Accra: University of Ghana/Radboud University Nijmegen; 2011.
• [27]Coulombe H: Ghana Census-Based Poverty Maps: District and Sub-District level Results. Ghana Statistical Service & DfID: Accra; 2005.
• [28]Ghana Statistical Services: 2000 Population and Housing Census. Summary report of final results. Accra: Ghana Statistical Services; 2002.
• [29]World Health Organization: Commission on Social Determinants of Health-final report. Geneva: WHO; 2008.
• [30]Bourguignon F, Chakravarty SR: The measurement of multidimensional poverty. J Econ Inequality 2003, 1:25-49.
• [31]Saunders P, Naidoo Y: Poverty, deprivation and consistent poverty. Econ Rec 2009, 85(271):417-432.
• [32]Agyepong IA, Adjei S: Public social policy development and implementation: a case study of the Ghana National Health Insurance Scheme. Health Policy Plann 2008, 23:150-160.
• [33]Van der Geest S: Money and Respect: the changing value of old age in rural Ghana. J Int African Ins 1997, 67(4):534-559.
• [34]Appiah P, Appiah KA, Agyeman-Duah I: Bu Me Be: Proverbs of the Akans. Accra-Ghana: Ayebia Clarke Publications Ltd; 2008.