Out-of-Pocket Healthcare Payments and Impoverishment Among Migrant Adolescent Female Head Porters in Ghana: A Cross Sectional Study

Abstract

Direct out-of-pocket (OOP) payments for healthcare can have devastating effects on vulnerable populations leading to impoverishments. Ghana’s National Health Insurance Scheme (NHIS) aims to remove financial hardships associated with seeking healthcare. However, there are concerns that vulnerable sections of the population still face healthcare-related financial hardships. This paper examines the impoverishing effects of OOP healthcare payments and the determinants of impoverishment due to OOP healthcare payments among migrant adolescent female head porters aged 10-19 years in Ghana. A quantitative cross-sectional survey was administered to a sample of 336 respondents who reported ill and sought healthcare within the last 12 months, January-December 2015, prior to the survey in 2016. Impoverishment due to OOP payment was assessed by computing the net income after payment for health care using the World Bank’s poverty line of income of $1.90 a day converted to 2015 purchasing power parity (PPP) equivalence for Ghana. The results illustrate that poverty incidence increased from 23 percent before OOP payment to 76 percent post OOP payment for healthcare. In a multivariate analysis, primary education [AOR=0.32, 95%CI=0.15-0.68]; Mamprusi (AOR=0.41, 95%CI=0.19-0.87) and other ethnic groups [AOR=0.33, 95%CI=0.14-0.75] compared to Dagomba; >1year in head portage (AOR=0.46; 0.23 - 0.95); drug store (AOR=0.43, 95%CI=0.19 - 0.96) and home treatment [AOR=0.20, 95%CI=0.05-0.85] were significantly associated with lower odds, whilst never registering for (AOR=4.05; 95%=1.82 - 9.03) or no valid NHIS card (2.29; 95%CI=1.08 - 4.83), Kumasi city [AOR=5.14; 95% CI:2.45-10.77] and severity of illness[AOR=2.86, CI 1.49-5.45] were associated with higher odds, of impoverishment due to OOP payment.. We recommend that the Ministries of Gender, Children and Social Protection and Health should collaborate to enrol adolescent female head porters onto the NHIS in order to increase their financial risk protection. Government should also put in place policy interventions including skills training and livelihood programmes to increase income levels, and improve the poverty situation of adolescent girl head porters. 
 
 Key Words: Impoverishment, out-of-pocket healthcare payments, adolescent girls, migrants, Ghana

Premium exemptions and active health insurance membership among teenage migrant head porters in Ghana: a cross-sectional study

“…Majority (60.31%) of the teenage migrant head porters did not benefit from NHIS premium exemptions. This suggests that the majority of the teenage girls would have to self-finance their healthcare expenditure out-of-pocket, when in fact, the NHIS law exempts all persons below the age of 18 years (Alatinga et al, 2022). The low access to NHIS premium exemptions for the teenage migrant head porters reported here could be attributed to poor awareness of the exemption policy (Dake & van der Wielen, 2020;Derbile & Van Der Geest, 2013).…”

“…The findings are revealing as they question the effectiveness of the NHIS exemption policy, particularly for the teenagers who are legally entitled to free healthcare. In the absence of exemptions, the teenage head porters do have to self-finance their healthcare needs out-ofpocket (Alatinga et al, 2022). This finding questions the robustness of social arrangements and processes (Rawls, 1999;Sen, 2002) put in place by the National Health Insurance Authority to ensure that vulnerable people such as migrant teenage head porters fully benefit from a pro-poor policy such as the NHIS.…”

“…The study questionnaire collected data on respondents' demographics and income, healthcare utilization, enrolment onto the NHIS, access to premium exemptions, and reproductive health behaviour among others. A total of 503 female head porters were interviewed (Alatinga et al, 2022). However, this paper makes use of data from 257 participants, representing those below the age of 18years who are eligible to benefit from premium exemptions under the national health insurance policy.…”

Female adolescent sexual reproductive health service utilization concerns: A qualitative enquiry in the Tema metropolis of Ghana

“…In spite of this, the essential package of health care in many countries excludes critical sexual reproductive health services such as safe abortion of which Ghana is no exception. In a similar vein, [27] reported the impact of out of pocket payment for health services among female adolescents, leading to impoverishment and consequently a higher likelihood of not utilizing health services. Inadequate international and domestic public funding of sexual reproductive health services contributes to a continual burden of self paying expenditure and inequities in access to sexual reproductive health services [28].…”