Enrolment of Indigents into the National Health Insurance Scheme in Ghana through the Livelihood Empowerment Against Poverty Programme: What are the perceptions of the community?
Abstract Background: TheLivelihood Empowerment Against Poverty (LEAP) programme in Ghana as part of its beneficiary programme identifies the poor/indigents for exemptions from premium payments into the National Health Insurance Scheme (NHIS). The criteria for identifying the poor by the LEAP into NHIS is yet to be explored.This paper sought to understand community perceptions of enrolling the poor in the NHIS through LEAPin order to inform policy. Methods: The study adopted a descriptive cross-sectional study design using a qualitative approach. The study was conducted in three geographical regions: Greater Accra, Brong-Ahafo and Northern region representing the three ecological zones of Ghana between October 2017 and February 2018. The study population included community members, health workers, NHIS staff and social welfare officers/social development officers.Eighty-one In-Depth Interviews (IDIs) and 23 Focus Group Discussions (FGDs) across the three regions. Data were analysed thematically and verbatim quotes from participants are used to support the views of participants. Results: The study shows that participants are aware of the existence of LEAP and its benefits. There is however a general belief that the process of LEAP has been politicized and therefore favours only people who are sympathizers of the ruling government.Participants are also of the view that the process of selecting beneficiaries lacks transparency. As a result, the participants are not satisfied with the entire selection process. However, the study shows the ability of the community in identifying the poor. Furthermore, the study shows varying concepts of poverty and its identification across the three ecological zones or regions. The study also identifies poverty and cost of treatment as reasons in the decision to enrol into the NHIS. However, poor quality of care, out-of-pocket payment, far travel distance to NHIS registration / renewal centre and delays of the process are suggested barriers to low NHIS enrolment by participants. Conclusion: There is a general perception of politicization and lack of transparency of the selection of the poor into the NHIS through the LEAP in Ghana. Community-based approaches in the selection of the indigent is recommended to safeguard the NHIS-LEAP beneficiary process.