Household perceptions and their implications for enrollment in the National Health Insurance Scheme in Ghana.

Contains fulltext : 108141.pdf (publisher's version ) (Closed access)OBJECTIVE: This paper identifies, ranks and compares perceptions of insured and uninsured households in Ghana on health care providers (quality of care, service delivery adequacy, staff attitudes), health insurance schemes (price, benefits and convenience) and community attributes (health 'beliefs and attitudes' and peer pressure). In addition, it explores the association of these perceptions with household decisions to voluntarily enroll and remain in insurance schemes. METHODS: First, data from a household survey of 3301 households and 13,865 individuals were analysed using principal component analysis to evaluate respondents' perceptions. Second, percentages of maximum attainable scores were computed for each cluster of perception factors to rank them according to their relative importance. Third, a multinomial logistic regression was run to determine the association of identified perceptions on enrollment. RESULTS: Our study demonstrates that scheme factors have the strongest association with voluntary enrollment and retention decisions in the National Health Insurance Scheme (NHIS). Specifically these relate to benefits, convenience and price of NHIS. At the same time, while households had positive perceptions with regards to technical quality of care, benefits of NHIS, convenience of NHIS administration and had appropriate community health beliefs and attitudes, they were negative about the price of NHIS, provider attitudes and peer pressure. The uninsured were more negative than the insured about benefits, convenience and price of NHIS. CONCLUSIONS: Perceptions related to providers, schemes and community attributes play an important role, albeit to a varying extent in household decisions to voluntarily enroll and remain enrolled in insurance schemes. Scheme factors are of key importance. Policy makers need to recognize household perceptions as potential barriers or enablers to enrollment and invest in understanding them in their design of interventions to stimulate enrollment.1 mei 201

Sensing, territory, population: Computation, embodied sensors, and hamlet control in the Vietnam War

This article analyses a mid-20th century computerized pacification reporting system, the Hamlet Evaluation System (HES), used by the US military to measure hamlet-level security and development trends in the Vietnam War. The significance of the HES was its capacity to translate US Military Advisor observations of Vietnamese hamlet life into a machine-readable format used by US military systems analysts to disclose ‘patterns of life.’ I show how US Military Advisors operated as ‘embodied sensors’ within the HES, producing a distinctive location-based event ontology – a ‘view of below’ – accompanied by rudimentary digital maps in-formation from incoming hamlet-level observation streams. I argue that acts of translating the rich texture of hamlet and village life into an objectified information format constituted a unique form of ‘epistemic violence,’ rooted not so much in the narrative subjection of the ‘Other,’ but in the pure abstraction of life into a digitally stored data trace