Social Capital as a catalyst for increasing enrolment in Ghana's National Health Insurance Scheme: the case of selected districts

Ghana introduced its National Health Insurance Scheme (NHIS) in 2003 with the aim of achieving universal access for the entire population. And yet after almost twelve years current enrolment figures stand at less than 50% of... [ view full abstract ]

Ghana introduced its National Health Insurance Scheme (NHIS) in 2003 with the aim of achieving universal access for the entire population. And yet after almost twelve years current enrolment figures stand at less than 50% of the population. With the low enrolment and retention challenge acknowledged by the NHIA as a major albatross, the critical question is how a health insurance policy designed to cater for the inclusion of the poor and yet subject to payment of a prescribed premium can ensure voluntary enrolment and its goal of universal coverage.
This study investigates the low enrolment challenge of the NHIS from the social perspective by exploring how the networks and social relations (horizontal social capital) among Ghanaians can be leveraged to drive continuous membership and guarantee willingness to enrol, pay and remain in a state centred health insurance. It also explores the issue of whether or not satisfaction in service providers engenders confidence (vertical social capital) in the NHIS and how that translates into voluntary enrolment and participation. The novelty of this study is that it is underpinned by social capital concepts and theories and therefore departs from earlier studies that employ the economic systems frameworks to analyse the challenges of the NHIS and other public policies. Anchored on the interpretive paradigm, the study explores how the different types of social capital and the social support that characterize social networks among Ghanaians influence their perceptions, choice and decision making as far as healthcare and insurance are concerned.
Data for the study is collected qualitatively mainly from NHIS insured and non-insured clients, managers and NHIS officials in four communities and of primary healthcare facilities, through interviews and focus group discussions across Ashanti and Eastern regions of Ghana. The study contributes to the literature and a better understanding of the social drivers of public policy implementation in Ghana and other developing countries by highlighting the significant virtue that the concept and discourse of social capital holds in whipping up participation and support for public policies.