GENDER EQUALITY AND SOCIAL INCLUSIVENESS IN THE NATIONAL HEALTH INSURANCE SCHEME (GESI IN NHIS) PROJECT
ABANTU for Development is implementing a project on “Enhancing Gender and Social Responsiveness of the National Health Insurance Scheme (NHIS): The case of female Head Porters and Female Senior Citizens”. The project combines research advocacy on the extent of gender responsiveness of the National Health Insurance Scheme (NHIS). The two-year project is being supported by STAR-Ghana (strengthening Transparency, Accountability and Responsiveness in Ghana), pooled funding mechanism for civil society organisations and Parliament.
What is Ghana’s National Health Insurance Scheme (NHIS)?
Over the past two decades, the focus of major reforms in Ghana’s health sector has been to accelerate access to quality healthcare, especially for the poor and the vulnerable. In order to achieve this objective, the health sector continues to deepen efforts towards enhancing efficiency in the service delivery and ensuring sustainable healthcare through public financing arrangements that protect the poor. The implementation of National Health Insurance Scheme (NHIS) in 2004 has been one major step towards providing accessible and affordable healthcare. The objectives of the National Health Insurance Policy were spelt out in the National Law 2004; (LI 1809). The National Health Insurance Scheme (NHIS) is a system of health care without financial constraints. It was also aimed at addressing the problem of financial barriers to health care access within the context of Ghana Poverty Reduction Strategy (GPRS). The policy objective to institute the NHIS which will ensure that every resident of Ghana belongs to a health insurance scheme was intended to adequately cover women and men, children, the disabled and all other vulnerable groups against the need to pay out their pockets at the point of accessing health services. The NHIS was to exempt the extreme poor from contributing and provides for poor to pay less than the rich, apparently to enhance access of the poor to health care services.
According to Ghana Living Standard Survey (GLSS 4), the incidence of poverty in Ghana is measured at two levels, namely, upper and extreme lower levels. The upper poverty line in Ghana refers to income levels of up to GH 90.00 a year or GH 7.50 per month. The extreme poor are women and men with incomes below GH 70.00 a year or GH 5.80 a month. Additionally, the current national statistics on poverty estimates that about 40% of the national population has incomes below the upper poverty line; whilst about 27% of the population has incomes below the extreme poverty line with the majority of these being women. Analytically, the category of the population which falls within these poverty lines also include vulnerable groups such as female senior citizens with ages above seventy (70) years and female head porters (kayayee). These income disparities appear to pose large gaps and inequalities in accessing social services such as health care between urban and rural, rich and poor, women and men.
Additionally, there is an inadequate social protection and health infrastructure as well as lack of efficiency and equity in the health system among others. Currently, it is not clear the extent to which the NHIS is actually impacting on the lives of vulnerable groups specifically female head porters and senior citizens.
Why focus on Kayayee and senior citizens?
ABANTU is interested in female head porters and senior citizens because of their specific vulnerability and health needs. Kayayee spend much of the day and time working in the markets carrying headloads in the scorching sun while sleeping in makeshift and insecure spaces at night. With no fixed wages and poor sleeping conditions, they are extremely prone to all kinds of illness such as fatigue, headache, malaria and waist pains. Senior citizens suffer from similar illness and others specific to their age. But they are often too weak to move from their place of residence to NHIS service delivery centres. Changes in the value system of the country are also impacting negatively on the extent of empathy and care for the poor and aged. Therefore, the project is interested in examining the extent of responsiveness of the NHIS in addressing the health needs of low income, often excluded and marginalized groups such as kayayee and senior citizens.
Data will be collected from three metropolitan Assemblies namely, Kumasi, Sekondi-Takoradi and Accra. Findings from the research will inform advocacy towards strengthening the capacity of the Ministry of Health and its agencies to meet the specific needs and concerns of socially excluded women.
What are the aims and objectives of the Project?
The project therefore aims at improving the gender responsiveness and social inclusiveness (GESI) of the NHIS through research and policy advocacy. The specific objectives are:
- To examine through evidence-based research, the extent to which the health needs and experiences of female head porters and senior citizens are addressed under the NHIS to promote equity and inclusiveness
- To advocate and strengthen commitment and accountability of the Ministry of Health (MoH) on the gender and inclusive issues of the NHIS through the use of Gender and Social Inclusion (GESI) guidelines and relevant gender responsive information packs
What Result do we expect?
The expected results of the project are:
- To create platforms for the voices and concerns of female head porters and senior citizens to be effectively addressed by the policy makers on issues of the National Health Insurance Scheme (NHIS)
- To increase the availability of evidence based data on the experiences of female head porters and senior citizens on the NHIS for enhanced access and effectiveness
- To strengthen commitment and accountability of the Ministry of Health (MoH) to gender and social inclusive issues in the NHIS
It is our expectation that critical gender and social inclusion issues in the NHIS would be highlighted through the research. This should then inform policy making for greater responsiveness to vulnerable groups such as Kayayee and senior citizens.