The Effect of Community Engagement on Healthcare Utilization and Health Insurance Enrolment in Ghana Results from a Randomized Experiment

Abstract

Background: Health insurance enrolment in many Sub-Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. This paper evaluates the impact of a community engagement intervention implemented in Ghana with the aim of improving clients' perceptions on service quality and subsequently improving healthcare utilization and health insurance enrolment. Method: We used a panel data of 6,937 individuals from a cluster randomized controlled trial conducted in 64 communities in two regions in Ghana. A random half of communities received the intervention after a baseline survey in April 2012; the remaining communities served as controls. A follow-up survey was conducted in March 2014 to evaluate the intervention. Ordinary Least Squares regression estimations were used to measure the intervention's impact on quality perceptions, and on healthcare utilization and health insurance enrolment for the full and balanced samples of all household members as well as the uninsured at baseline. Results: In the short term (12 months) the intervention did not produce any significant impact on perceptions of service quality, healthcare utilization or health insurance enrolment in the targeted population. It however reduced the frequency of illness by 13.8 percentage points, suggesting an overall improvement in health status. It also resulted in a 7.2 percentage points increase in insurance enrolment for the uninsured. Conclusion: Community engagement has the potential to motivate service providers to improve quality of care. However, this may not lead to improved perception of service quality, and increased healthcare utilization in the short term. Still, engaging clients in community discussions on quality improvements can effectively enhance health insurance uptake among those who were previously uninsured. Further long-term intervention is necessary to investigate its longterm effects.

Health insurance subscription among women in reproductive age in Ghana: do socio-demographics matter?

“…Women in rural areas being more likely to subscribe to health insurance than women in urban areas is an indication of the higher need for health care services documented to exist in rural areas than in urban areas [ 40 – 42 ]. Thus, women in the rural areas were more likely to subscribe to the health insurance so as to be able to afford health care in times of need, as they may not be able to afford health care out-of-pocket if they fall sick [ 43 ].…”

Citizen engagement in public services in low‐ and middle‐income countries: A mixed‐methods systematic review of participation, inclusion, transparency and accountability (PITA) initiatives

“…Several service access and use outcomes were assessed as having increased on average but not statistically significantly, including service quality (SMD=0.19, 95%CI=−0.01, 0.39; 7 studies) and user satisfaction (SMD=0.13, 95%CI=−0.04, 0.30; six studies). Finally, a few single studies reported positive wellbeing outcomes for reducing illness (Duku et al, ) and crime (Palladium, ), and improving empowerment and assets (Fiala & Premand, ) (Figure ). Only one study (Fiala & Premand, ) measured state‐society relations outcomes and was not able to detect significant changes due to citizen feedback mechanisms.…”

Incentives for climate mitigation in the land use sector – the effects of payment for environmental services (PES) on environmental and socio-economic outcomes in low- and middle-income countries: a mixed-method systematic review

“…User satisfaction was measured through satisfaction surveys in health (Duku et al, 2018;Gine et al, 2018), policing (Banerjee et al, 2014), general satisfaction with local amenities provided by government including infrastructure (Beuermann et al, 2014;Molina, 2014) and employment services (Ravallion et al, 2013), and complaints reported (Banerjee et al, 2018). User satisfaction with service delivery staff was also assessed in policing (Banerjee et al, 2014), health (Bradley et al, 2005;Gine et al, 2018) and family planning (Gullo et al, 2017) and in local leadership (Molina, 2014;Fiala et al, 2017).…”

“…A variety of wellbeing outcomes among study participants were measured. Health outcomes included mortality (Touchton & Wampler, 2015;Bjorkman et al, 2017;Gine et al, 2018), illness (Duku et al 2018;Gine et al, 2018), fertility (Bjorkman et al, 2017;Donato & Mosqueira, 2016) and anthropometry (Bjorkman et al, 2017;Gine et al, 2018). Several studies reported agriculture yields (Bandyopadhyay et al, 2010;Huang et al, 2014) and livestock (Fiala et al, 2017).…”

“…Several service access and use outcomes were assessed as having increased on average but not statistically significantly, including service quality (SMD=0.19, 95%CI=-0.01, 0.39; 7 studies) and user satisfaction (SMD=0.13, 95%CI=-0.04, 0.30; six studies). Finally, a few single studies reported positive wellbeing outcomes for reducing illness (Duku et al, 2018) and crime (Palladium, 2015), and improving empowerment and assets (Fiala et al, 2017) (Figure 22). Only one study (Fiala et al, 2017) measured state-society relations outcomes and was not able to detect significant changes due to citizen feedback mechanisms.…”