Abstract:
Objectives The study aimed to understand the impact of
integrating a fee waiver for the National Health Insurance
Scheme (NHIS) with Ghana’s Livelihood Empowerment
Against Poverty (LEAP) 1000 cash transfer programme on
health insurance enrolment.
Setting The study was conducted in five districts
implementing Ghana’s LEAP 1000 programme in Northern
and Upper East Regions.
Participants Women, from LEAP households, who were
pregnant or had a child under 1 year and who participated
in baseline and 24-month
surveys (2497) participated in
the study.
Intervention LEAP provides bimonthly cash payments
combined with a premium waiver for enrolment in NHIS to
extremely poor households with orphans and vulnerable
children, elderly with no productive capacity and persons
with severe disability. LEAP 1000, the focus of the
current evaluation, expanded eligibility in 2015 to those
households with a pregnant woman or child under the age
of 12 months. Over the course of the study, households
received 13 payments.
Primary and secondary outcome measures Primary
outcomes included current and ever enrolment in NHIS.
Secondary outcomes include reasons for not enrolling in
NHIS. We conducted a mixed-methods
impact evaluation
using a quasi-experimental
design and estimated intent-to-
treat
impacts on health insurance enrolment among
children and adults. Longitudinal qualitative interviews
were conducted with an embedded cohort of 20 women
and analysed using systematic thematic coding.
Results Current enrolment increased among the
treatment group from 37.4% to 46.6% (n=5523) and
decreased among the comparison group from 37.3%
to 33.3% (n=4804), resulting in programme impacts
of 14 (95% CI 7.8 to 20.5) to 15 (95% CI 10.6 to 18.5)
percentage points for current NHIS enrolment. Common
reasons for not enrolling were fees and travel.
Conclusion While impacts on NHIS enrolment were
significant, gaps remain to maximise the potential of
integrated programming. NHIS and LEAP could be better
streamlined to ensure poor households fully benefit from
both services, in a further step towards integrated social
protection.
