Factors Influencing Enrolment in the National Health Insurance Scheme among Slum Dwellers in Agbogbloshie

ABSTRACT 

It is estimated that about 43% of urban dwellers in Ghana live in slums, with 1.3million slum dwellers living in Accra. Slum dwellers live in overcrowded and substandard housing, lacking safe water and sanitation systems and access to quality health care services. With increasing slum populations, equitable access to quality health care services remains a challenge. Social health protection systems such as the National Health Insurance Scheme are mechanisms that countries use to address the challenges related to providing access to health care services to their citizens, especially the poorer segments of the population such as slum dwellers. 

It has been shown that active membership in the National Health Insurance Scheme stood at 36.8% in 2013. The proportion of slum dwellers enrolled in the National Health Insurance Scheme and accessing care is little known. This study aims at assessing factors influencing enrolment in the National Health Insurance Scheme among slum dwellers in Agbogbloshie. This study was a descriptive cross-sectional survey involving 371 household heads in Agbogbloshie. Multi-stage sampling was used to select household heads for the study from May-June 2015. Results showed that 24% (373) of slum dwellers were enrolled in the National Health Insurance Scheme and this is 13% lower than the national average of 36.8% in 2013, implying that slum dwellers are not enrolling. More than half (52.5%) of households who recorded an illness had no health insurance and close to forty-percent (143) of them sought care at Chemical shops/Pharmacies.  The factors affecting enrolment among slum dwellers at the individual level were sex, type of employment, perceived health status of the household head and their inability to afford the premium. At the household level, socioeconomic status of the household, and facility used for seeking care were factors affecting enrolment in the National Health Insurance Scheme. As Ghana aims at achieving Universal Coverage, policy makers should consider expanding the exemption policy under the National Health Insurance Scheme to include social groups such as slum dwellers with financial difficulties to enable them access health care.