Factors Contributing To The Low Registration Of National Health Insurance Scheme (Nhis) In Kassena-Nankana District (Knd) In Upper East Region, Ghana

ABSTRACT

Health insurance is a method of financing health care in which payment for health care is

made at a time that one is sick. It is a policy of the Government of Ghana to replace the

previous cash and carry system with the Mutual Health Insurance Scheme since the

previous method makes health care financially inaccessible to the citizenry especially the

poor and the vulnerable.

Even though much education on the scheme has been carried out in the district since its

inception through durbars, use of the local FM station, organized talks at the churches

and the health facilities; registration in the scheme in the KND is still low, only 8.34% of

the inhabitants have registered as compared to the national target of 50% registration by

the end o f 2006. Therefore the purpose of this study was to determine the factors

contributing to the low participation in the scheme.

Some o f the factors studied include age group, gender, level of education and occupation

of the household heads who have not registered and registered with the scheme.

Geographical accessibility of health facilities within the district, the method of payment

of the premium that the inhabitants prefer and the community’s participation in the

establishment o f the scheme were also studied.

The assumption posed in the study was that there was no difference in the characteristics

of household heads who have not registered and those who have registered with the

scheme. Hypothesis tested was that there is difference between characteristics of

household heads who have registered and not registered.

The study was a case control study across the whole Kassena-Nankana District (KND).

This method was chosen because it provides the means of comparing the characteristics

of those who have not registered (cases) with those who have registered (controls). The

cases were all household heads between the ages of 18 years and 69 years who have not

register with the National Health Insurance Scheme (NHIS) and reside permanently in

KND whilst the controls were all household heads with the same characteristics but who

have registered with the scheme. The method used was random sampling using Epi Info.

The sample size was 320 consisting of 160 each of cases and controls. The nearest

neighbour who is of the same sex as the case was selected as the control.

The result from the study shows that there are differences in characteristics of the

household heads who have not registered and those who have registered. It was observed

that within KND, females were 75% times more likely to register in the scheme as

compared to males (OR= 0.25, p-value= 0.02). Also household heads with 3 or more

dependents were 85% more likely to register with the scheme as compared to those with

2 or less. On the other hand household heads within the age groups 40-49 and 60-69

years were 5.21 times more likely not to register as compared to those within 20-29

years. Again as compared to civil servants, farmers (5.73 times) and unemployed (1.97

times) are less likely to register.

With reference to community factors, it was revealed that those who have access to

health facilities are rather 3.34 times more likely not to register as compared those who

do not have access.

Community members who believe that they a role to play in establishing the scheme were

73% more likely to register than those who believe they do not have any role to play.

Lastly the respondents who obtained all their drugs at the health facilities during the last

six months are 3.55 times more likely not to register.

It is therefore recommended the scheme manager and his staff should intensify their

education to convince the males especially to register. The education campaign should

emphasize that the community members have a role to play to make the scheme

successful. Lastly, the scheme manager should employ the necessary mechanisms to be

able to identify all the core poor within the district so as to enjoy the exemption policy

instituted by the government.