Social capital and active membership in the Ghana National Health Insurance Scheme - a mixed method study

BACKGROUND: People’s decision to enroll in a health insurance scheme is determined by socio-cultural and socio-economic factors. On request of the National health Insurance Authority (NHIA) in Ghana, our study explores the influence of social relationships on people’s perceptions, behavior and decision making to enroll in the National Health Insurance Scheme. This social scheme, initiated in 2003, aims to realize accessible quality healthcare services for the entire population of Ghana. We look at relationships of trust and reciprocity between individuals in the communities (so called horizontal social capital) and between individuals and formal health institutions (called vertical social capital) in order to determine whether these two forms of social capital inhibit or facilitate enrolment of clients in the scheme. Results can support the NHIA in exploiting social capital to reach their objective and strengthen their policy and practice. METHOD: We conducted 20 individual- and seven key-informant interviews, 22 focus group discussions, two stakeholder meetings and a household survey, using a random sample of 1903 households from the catchment area of 64 primary healthcare facilities. The study took place in Greater Accra Region and Western Regions in Ghana between June 2011 and March 2012. RESULTS: While social developments and increased heterogeneity seem to reduce community solidarity in Ghana, social networks remain common in Ghana and are valued for their multiple benefits (i.e. reciprocal trust and support, information sharing, motivation, risk sharing). Trusting relations with healthcare and insurance providers are, according healthcare clients, based on providers’ clear communication, attitude, devotion, encouragement and reliability of services. Active membership of the NHIS is positive associated with community trust, trust in healthcare providers and trust in the NHIS (p-values are .009, .000 and .000 respectively). CONCLUSION: Social capital can motivate clients to enroll in health insurance. Fostering social capital through improving information provision to communities and engaging community groups in health care and NHIS services can facilitate peoples’ trust in these institutions and their active participation in the scheme

Spatial organization of small-scale industries in the Kassena-Nankana District of Ghana

No Abstract

Traditional birth attendants and health service delivery in northwest Ghana-operational dynamics and new frontiers

No Abstract.Ghana Journal of Development Studies Vol.4 (1) 2007: pp. 73-8

Local Knowledge and Livelihood Sustainability: The Role of Indigenous Institutions in Sustaining Rural Agriculture in North-eastern Ghana

This paper drew on new anthropological and social perspectives on institutions for exploring the nexus between local knowledge and the sustainability of rural agriculture in north-eastern Ghana. In particular, it analysed the role that tacit local knowledge, explicit in indigenous and non-indigenous institutions play in the sustainability of rural agriculture in a dynamic environment. The paper used qualitative data from fourteen in-depth interviews and observation on two different types of farm systems in two purposively sampled communities in the Atankwidi basin, north-eastern Ghana. These include Sammani farming and small-scale groundwater irrigation agriculture. The results show that farmers have resorted to the Sammani farming system, an indigenous farming practice for agriculture intensification, and application of indigenous forms of manure and checking soil erosion for soil conservation. Farmers are also depending on indigenous forms of social solidarity in labour pooling and combined application of indigenous forms of organic manure with least application of chemical fertilizer, for sustaining ground water irrigation. The paper highlights the flexibility in indigenous land tenure systems for accommodating both ‘individual’ and ‘collective’ interests in small-scale ground water irrigation in the dry season. Drawing on these findings, the paper asserts that local knowledge, as explicit in the utilization of indigenous farming practices and in combination with least application of conventional knowledge systems, enhances the resilience and sustainability of rural agriculture under wider environmental conditions, including climate variability, land degradation and poverty in north-eastern Ghana. Key Words: Local Knowledge; Indigenous Institutions; Agriculture; livelihood Sustainability; Ghan