Social Capital and Enrolment in Social Health Insurance: The Experience of Ghana’s National Health Insurance Scheme (NHIS)
Loading...
Date
2018-07
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University Of Ghana
Abstract
In response to calls for studies that highlight the social determinants of Social Health Insurance
enrolment, this study investigated the forms of social capital (SC) in selected communities in
Ghana and how they influence the enrolment decision. It also explored how SC structures in the
selected communities could be leveraged to drive enrolment in Ghana’s National Health Insurance
Scheme (NHIS). Situated in an interpretive paradigm, the study adopted a qualitative research
methodology with semi-structured interviews, focus group discussions and documentary reviews
as the key data collection tools. The data was analyzed thematically in a six staged process.
The study established that SC capital facilitates enrolment decisions in three main ways; bonding,
bridging and linking. Although weakening in recent years, bonding SC expressed through
solidarity, trust and reciprocity within the familial unit is prevalent, providing social support to
people in the communities. Bonding influences the enrolment decision in several ways. Solidarity
creates a sense of responsibility in family members to impress on others to register. Family, friends
and neighbours are trusted sources of information on the NHIS and whether positive or negative,
such information influenced the enrolment decision. On the other hand, bridging SC in the form
of groups and associations was also found to be predominant with religious groups, as the most
important. The groups and associations compensated for the weakening bonds in traditional family
structure. Linking SC in the form of relationships with state institutions seemed weak, with less
engagement between community and state institutions, and mistrust in public officials and
institutions reinforced some negative sentiments among respondents which affected decisions to
enroll. The study revealed that key structures and local community organisations including,
traditional rulers, religious groups, trade unions, business groups NGO’s, CBO’s and their leaders,
are trusted and have a social advantage and their involvement in the NHIS will serve as a badge of
assurance and accountability, and thereby drive people to enrol.
The study makes a number of contributions to enhance understanding of enrolment in social health
insurance (SHI). Situating the enrolment analysis in a SC framework moves the argument beyond
the prevailing dominant explanation that economic factors are the most important determinants of
enrolment. The study demonstrates that in addition to economic factors, other considerations based
on solidarity, reciprocity and trust relations within and among communities shape people’s
decision to enroll in voluntary SHI. By this, SC has proven to be sharper and comprehensive in
explaining enrolment outcomes. Also, the study’s careful examination of the SC structures and
actors that impinge on enrolment (policy outcomes) in a manner which hitherto, had not been so
clearly articulated in this study offers a more nuanced understanding of the subtle relations
between individuals, communities and government institutions, as well as the strategies through
which policies can be embedded and complemented by these structures.
Description
PhD.
Keywords
Social Health Insurance, Ghana’s National Health Insurance Scheme (NHIS)