Community perceptions of enrolment of indigents into the National Health Insurance Scheme in Ghana: a case study of the Livelihood Empowerment against Poverty Programme

Abstract

Background: The Livelihood Empowerment against Poverty (LEAP) programme in Ghana as part of its benefciary programme, identifes the poor/indigents for exemptions from premium payments in the National Health Insurance Scheme (NHIS). This paper sought to understand community perceptions of enrolling the poor in the NHIS through LEAP in order to inform policy. Methods: The study adopted a descriptive cross-sectional study design by using a qualitative approach. The study was conducted in three geographical regions of Ghana: Greater Accra, Brong-Ahafo and Northern region represent ing the three ecological zones of Ghana between October 2017 and February 2018. The study population included community members, health workers, NHIS staf and social welfare ofcers/social development ofcers. Eighty-one in-depth interviews and 23 Focus Group Discussions were conducted across the three regions. Data were analysed thematically and verbatim quotes from participants were used to support the views of participants. Results: The study shows that participants were aware of the existence of LEAP and its benefts. There was, however, a general belief that the process of LEAP had been politicized and therefore favours only people who were sympa thizers of the ruling government as they got enrolled into the NHIS. Participants held the view that the process of selecting benefciaries lacked transparency, thus, they were not satisfed with the selection process. However, the study shows the ability of the community to identify the poor. The study reports varying concepts of poverty and its identifcation across the three ecological zones of Ghana. Conclusion: There is a general perception of politicization and lack of transparency of the selection of the poor into the NHIS through the LEAP programme in Ghana. Community-based approaches in the selection of the indigent are recommended to safeguard the NHIS-LEAP benefciary process.