Mundane? Demographic characteristics as predictors of enrolment onto the National Health Insurance Scheme in two districts of Ghana

In 2003, Ghana passed a law to establish a National Health Insurance Scheme (NHIS) to serve as the main vehicle for achieving universal health coverage. Over 60% of the population had registered by 2009. Current active membership is however 40%. The stagnation in growth has been recorded across all the membership categories. Clearly, the Scheme is falling short of its core objective. This analysis is a critical thematic contextual examination of the effects of demographic factors on enrolment onto the Scheme.

Seventy-nine percent of the survey respondents have ever enrolled onto the NHIS with three-fifths being females. Of the ever enrolled, 63% had valid cards. Age, gender and educational level were significant predictors of enrolment in the multivariate analysis. Respondents between the ages 41–60 years were twice (p = 0.05) more likely to be enrolled onto a district Scheme compared with respondents between the ages 21–40 years. Females were thrice (p = 0.00) more likely to enroll compared with males. Respondents educated to the tertiary, five times (p = 0.02), and post-graduate, four times (p = 0.05), levels were more likely to enroll compared with non-educated respondents. No significant association was observed between occupation and enrolment.

Uptake of the scheme is declining despite high awareness and knowledge. Leadership, innovation and collaboration are required at the district Scheme level to curtail issues of low self-enrolment and to grow membership. Otherwise, the goal of universal coverage under the NHIS will become merely a slogan and equity in financial access to health care for all Ghanaians will remain elusive.