Objectives and approach
Indigents are the poorest and vulnerable members of the population. In 2011 the National Health Insurance Authority (NHIA) estimated that less than 2% of Ghana’s population was enrolled in the NHIS as indigent. Given that an estimated 28% of Ghanaians is living under the poverty line according to 2006 Ghana Living Standard Survey figures, then registering 2% of indigents was purported to be very low. The bid to increase the enrolment of indigents therefore has led to sharp increases in enrolment of indigents up to 14.3% in 2014. In the same year the enrolment of people less than 18 years was about 45%. So close to 60% NHIS members do not pay any premium raising concerns for the NHIS sustainability.
The aim of this study is to assess the factors influencing the large enrolment of indigents in different districts. We aim to determine the proportion of indigents enrolled in the NHIS, the socio-economic status of persons classified as indigents enrolled in the NHIS and the actual criteria adopted for enrolling indigents at the NHIS selected schemes. Quantitative and qualitative surveys will be carried out complemented by focus group discussions and in-depth interviews of community members who have been enrolled as indigents and the general community to understand the process of selection and enrolment.
Objectives and approach
The Community Health Fund (CHF) is a health insurance scheme pooled at the district level, aimed at providing coverage to the informal sector amongst Tanzania’s rural areas. In exchange for an low annual premium contribution, the CHF gives members access to a range of health care services and medicines at their local public health facility. In some districts the membership covers an entire household (up to 6 individuals). Although the population targeted makes up approximately 70% of the Tanzanian population, the CHF’s coverage remains relatively low, below 10%. The problem lies in a lack of enrollment into the CHF, as well as insufficient retention of existing members. Although, the CHF would seem like a reasonable investment on paper, it may not be within the interests of the household to enroll. It therefore becomes important to understand the household’s perspective and their decision-making process when exploring the reasons for low enrollment and retention.
The main objective of this study is to investigate the households’ determinants of the CHF renewals. Among the main variables, socio-economic characteristics of the households, as well as household compositions, health status of the individuals and use of service are taken into account. This study adopts a quantitative approach based on a cross-sectional households’ survey conducted in Dodoma region. Approximately 400 households have been assessed along a multitude of dimensions, so as to provide as comprehensive picture of the most prominent influencers of the decision-making process. Logistic regression models including different independent variables are run to assess the extent to which they predict an individual’s decision to renew membership to the CHF.