Browsing by Author "Parmar, D."
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Item Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries(Health Policy and Planning, 2024) Parmar, D.; Mathauer, I.; Abuosi, A.A.; et al.The COVID-19 pandemic has triggered several changes in countries’ health purchasing arrangements to accompany the adjustments in service delivery in order to meet the urgent and additional demands for COVID-19-related services. However, evidence on how these adjustments have played out in low- and middle-income countries is scarce. This paper provides a synthesis of a multi-country study of the adjustments in purchasing arrangements for the COVID-19 health sector response in eight middle-income countries (Armenia, Cameroon, Ghana, Kenya, Nigeria, Philippines, Romania and Ukraine). We use secondary data assembled by country teams, as well as applied thematic analysis to examine the adjustments made to funding arrangements, benefits packages, provider payments, contracting, information management systems and governance arrangements as well as related implementation challenges. Our findings show that all countries in the study adjusted their health purchasing arrangements to varying degrees. While the majority of countries expanded their benefit packages and several adjusted payment methods to provide selected COVID-19 services, only half could provide these services free of charge. Many countries also streamlined their processes for contracting and accrediting health providers, thereby reducing administrative hurdles. In conclusion, it was important for the countries to adjust their health purchasing arrangements so that they could adequately respond to the COVID-19 pandemic, but in some countries financing challenges resulted in issues with equity and access. However, it is uncertain whether these adjustments can and will be sustained over time, even where they have potential to contribute to making purchasing more strategic to improve efficiency, quality and equitable access in the long run.Item Determinants of enrolment in the NHIS for women in Ghana – a cross sectional study(International Journal of Social Economics, 2018-04) Kusi, A.; Fenny, A.; Arhinful, D.K.; Asante, F.A.; Parmar, D.Purpose The National Health Insurance Scheme (NHIS) was introduced in 2005 to provide equitable access to healthcare. Furthermore, concessions were made for pregnant women, yet inequities in access continue to exist. The purpose of this paper is to explore whether dimensions of social exclusion explain why some groups of women are not benefitting from the scheme. Design/methodology/approach Data were collected from 4,050 representative households in five districts. Logistic regression is used to examine the factors that determine enrolment of women under the NHIS. Findings The study sample consists of a sub-sample of 3,173 women out of whom 58 per cent were insured. The majority (64.9 per cent) of the women were in the reproductive age (15–45 years). The results show that wealth status, age, health status, locality, perception about the quality of care at health facilities and perception of the NHIS, are the key factors that determine enrolment into the scheme. Practical implications By conceptualising social exclusion as the multi-dimensional processes driven by unequal power relationships which lead to differential inclusion and exclusion in social systems, the study provides evidence to show that certain groups of women are systemically excluded from participating in the NHIS. Social implications With women dominating the informal sector of Ghana’s economy which is often characterised by relatively low incomes, these inequities in access need to be addressed. Originality/value Although gender equality incorporates discussions on issues affecting men and women this paper focusses on women in Ghana due to disadvantaged position in which many of them find themselves in terms of access to resources. Almost all of the identified barriers in previous studies have been worsened by gender with women generally facing greater difficulties in accessing adequate care. Few of these papers have taken account the specific health needs and gender-specific constraints of women in the NHIS. The authors aim to fill this gap by using a social exclusion lens to explore whether Ghanaian women (i.e. 15 years and above) are participating in the NHIS and examine the processes by which exclusion occurs and what explains the patterns observed.Item Equitable access to health insurance for socially excluded children. The case of the National Health Insurance Scheme (NHIS) in Ghana(Elsevier, 2017) Asante, F.; Gemma, A.; Parmar, D.; Dkhimi, F.; Arhinful, D.; Mladovsky, P.To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership. In this paper we therefore look beyond economic explanations of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In particular, we investigate whether social exclusion, as measured through a sociocultural, political and economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional survey of 4050 representative households conducted in Ghana in 2012. Household indices were created to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally, economically and politically excluded children are less likely to enrol in the NHIS. Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partiallyenrolled (i.e. not all children enrolled within the household) than fully-enrolled. These results suggest that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to improve coverage by removing the remaining small, annually renewable registration fee, implementing and publicising the new clause that de-links premium waivers from parental membership, establishing additional scheme administrative offices in remote areas, holding regular registration sessions in schools and conducting outreach sessions and providing registration support to female guardians of children. Ensuring equitable access to NHIS will contribute substantially to improving child health and reducing child mortality in Ghana.Item Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana(Social Science and Medicine, 2017) Williams, G.A.; Parmar, D.; Dkhimi, F.; Asante, F.; Arhinful, D.; Mladovsky, P.To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership. In this paper we therefore look beyond economic explanations of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In particular, we investigate whether social exclusion, as measured through a sociocultural, political and economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional survey of 4050 representative households conducted in Ghana in 2012. Household indices were created to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally, economically and politically excluded children are less likely to enrol in the NHIS. Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partially-enrolled (i.e. not all children enrolled within the household) than fully-enrolled. These results suggest that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to improve coverage by removing the remaining small, annually renewable registration fee, implementing and publicising the new clause that de-links premium waivers from parental membership, establishing additional scheme administrative offices in remote areas, holding regular registration sessions in schools and conducting outreach sessions and providing registration support to female guardians of children. Ensuring equitable access to NHIS will contribute substantially to improving child health and reducing child mortality in Ghana. © 2017 Elsevier LtdItem Who uses outpatient healthcare services under Ghana's health protection scheme and why?(BioMed Central Ltd., 2016) Fenny, A.P.; Asante, F.A.; Arhinful, D.K.; Kusi, A.; Parmar, D.Background: The National Health Insurance Scheme (NHIS) was launched in Ghana in 2003 with the main objective of increasing utilisation to healthcare by making healthcare more affordable. Previous studies on the NHIS have repeatedly highlighted that cost of premiums is one of the major barriers for enrollment. However, despite introducing premium exemptions for pregnant women, older people, children and indigents, many Ghanaians are still not active members of the NHIS. In this paper we investigate why there is limited success of the NHIS in improving access to healthcare in Ghana and whether social exclusion could be one of the limiting barriers. The study explores this by looking at the Social, Political, Economic and Cultural (SPEC) dimensions of social exclusion. Methods: Using logistic regression, the study investigates the determinants of health service utilisation using SPEC variables including other variables. Data was collected from 4050 representative households in five districts in Ghana covering the 3 ecological zones (coastal, forest and savannah) in Ghana. Results: Among 16,200 individuals who responded to the survey, 54 % were insured. Out of the 1349 who sought health care, 64 % were insured and 65 % of them had basic education and 60 % were women. The results from the logistic regressions show health insurance status, education and gender to be the three main determinants of health care utilisation. Overall, a large proportion of the insured who reported ill, sought care from formal health care providers compared to those who had never insured in the scheme. Conclusion: The paper demonstrates that the NHIS presents a workable policy tool for increasing access to healthcare through an emphasis on social health protection. However, affordability is not the only barrier for access to health services. Geographical, social, cultural, informational, political, and other barriers also come into play.