The Ghana National Health Insurance Scheme: Barriers to Access for Informal Workers

Ghana’s National Health Insurance Scheme (NHIS) is an innovative attempt to extend social protection to informal workers, and, as such, it may hold important policy lessons for other countries where the informal economy is large and growing and where informal workers are excluded from existing social protection mechanisms.

The paper concentrates on the interactions between three groups of women informal workers (traders, headload porters, and indigenous caterers) and the scheme, focusing particularly on the barriers to accessing the scheme and to participating in its development and management.

The major factor for poorer workers was the cost of the premiums, which often sit well above the mandated minimum in urban areas. For better off workers, the major barrier was the chaotic administration of the district schemes, which meant that a significant amount of time had to be spent trying to register with the NHIS. It was also discovered that there has been very little direct involvement of informal workers in either the design or the ongoing management of the scheme, with the result that it does not take into account the particular needs of informal workers.

The paper concludes that, as the NHIS reflects the wider inequalities of Ghanaian society, systemic changes in social and economic policy are necessary for it to truly promote the ideal of universal access to healthcare. It then offers shorter term recommendations for changes that would allow the scheme as it exists at present to become more responsive to the needs of informal workers.

Summary adapted from source.