Browsing by Author "Akazili, James"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    Open Access
    Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana
    (BioMed Central, 2017-05-22) Akazili, James; Ataguba, John Ele-Ojo; Kanmiki, Edmund Wedam; Gyapong, John; Sankoh, Osman; Oduro, Abraham; McIntyre, Di
    Background: There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana’s national health insurance scheme. Methods: Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen’s parade of “dwarfs and a few giants” is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. Results: There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. Conclusion: It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana’s national health insurance scheme on impoverishment due to OOP healthcare payments.
  • Thumbnail Image
    Item
    Open Access
    Economic costs of seeking malaria care to households in the Kassena-Nankana district of Northern Ghana
    (2000) Akazili, James; Govender, Veloshnee
    Although, malaria is a major problem in Ghana, as III many Sub-Saharan Africa countries, there has been little research on its economlC impact, particularly at the household level. National statistics only show that malaria accounted for more deaths, more cases and more potential days of life lost than other cause, however little was said about the costs to households. The aim of the study was to estimate the economic costs (direct and indirect) of seeking malaria care to households and in doing this, the study used data collected from a randomly sampled 423 households in K-N district. Malaria was ascertained not by parasitological test but through self-reporting based on symptoms described by respondents using a one-month recall period. The estimation of direct cost involved the out-of-pocket expenditure on special foods, drugs, transportation, diagnostic and consultation and all other related costs (e.g. inpatient cost, toiletry cost, etc.). Indirect cost was estimated based on the number of days forgone and waiting time incurred due to malaria episode or caretaking and daily wage rate. The estimated costs were divided between direct and indirect costs, and examined in terms of location and case severity. Total direct cost per case in urban area was ¢6,701 ($1.79) compared to ¢7,822 ($2.09) in rural area. With regards to severity, direct cost per severe malaria was ¢11,182 ($2.98) compared to ¢5,317 ($1.42) of mild malaria. In the case of indirect cost and with regards to days lost, the average duration of severe malaria was 5.3 days, which was significantly higher when compared to 2.3 days of mild malaria. Estimated indirect cost per case in urban area was ¢20,804 ($5.55) compared to ¢15,842 ($4.22) in rural area. In terms of severity, 55% of the days lost were due to severe malaria and women in general lost more days and often incurred higher losses in potential earnings than men.
  • Thumbnail Image
    Item
    Open Access
    Equity in Health Care Financing in Ghana
    (2010) Akazili, James; McIntyre, Di
    Financial risk protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". The study (the first of kind in Ghana) measured the relative progressivity of health care financing mechanisms, the catastrophic and impoverishment effect of direct health care payments, as well as evaluating the factors affecting enrolment in the national health insurance scheme (NHIS), which is the intended means for achieving equitable health financing and universal coverage in Ghana. To achieve the purpose of the study, secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other ministries and departments, and further complemented with primary household data collected in six districts. In addition 44 focus group discussions with different groups of people and communities were conducted. In-depth interviews were also conducted with six managers of District NHI schemes as well as the NHIS headquarters. The study found that generally Ghana's health care financing system is progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes which account for over 50% of health care funding. The national health insurance levy is mildly progressive as indicated by a Kakwani index of 0.045. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are associated with significant catastrophic and impoverishment effects on households. The results also indicate that high premiums, ineffective exemptions, fragmented funding pools and perceived poor quality of care affect the expansion of the NHIS. For Ghana to attain adequate financial protection and ultimately achieve universal coverage, it needs to extend cover to the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the NHI. Furthermore, the funding pool for health care needs to grow and this can be achieved by improving the efficiency of tax collection and increasing the budgetary allocation to the health sector.
  • Thumbnail Image
    Item
    Open Access
    Informal workers’ access to health care services: findings from a qualitative study in the Kassena-Nankana districts of Northern Ghana
    (BioMed Central, 2018-05-16) Akazili, James; Chatio, Samuel; Ataguba, John E; Agorinya, Isaiah; Kanmiki, Edmund W; Sankoh, Osman; Oduro, Abraham
    Background Over the past two decades, employment in the informal sector has grown rapidly in all regions including low and middle-income countries. In the developing countries, between 50 and 75% of workers are employed in the informal sector. In Ghana, more than 80% of the total working population is working in the informal sector. They are largely self-employed persons such as farmers, traders, food processors, artisans, craft-workers among others. The persistent problem in advancing efforts to address health vulnerabilities of informal workers is lack of systematic data. Therefore, this study explored factors affecting informal workers access to health care services in Northern Ghana. Method The study used qualitative methodology where focus group discussions and in-depth interviews were conducted. Purposive sampling technique was used to select participants for the interviews. The interviews were transcribed and coded into emergent themes using Nvivo 10 software before thematic content analysis. Results Study participants held the view that factors such as poverty, time spent at the health facility seeking for health care, unpleasant attitude of health providers towards clients affected their access to health care services. They perceived that poor organization and operations of the current health system and poor health care services provided under the national health insurance scheme affected access to health care services according to study participants. However, sale of assets, family support, borrowed money from friends and occasional employer support were the copying strategies used by informal workers to finance their health care needs. Conclusion Most of the population in Ghana are engaged in informal employment hence their contribution to the economy is very important. Therefore, efforts needed to be made by all stakeholders to address these challenges in order to help improve on access to health care services to all patients particularly the most vulnerable groups in society.
  • Thumbnail Image
    Item
    Open Access
    Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys
    (BioMed Central Ltd, 2011) Ataguba, John; Akazili, James; McIntyre, Di
    BACKGROUND:Inequalities in health have received considerable attention from health scientists and economists. In South Africa, inequalities exist in socio-economic status (SES) and in access to basic social services and are exacerbated by inequalities in health. While health systems, together with the wider social determinants of health, are relevant in seeking to improve health status and health inequalities, those that need good quality health care too seldom get it. Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. However, these studies are based on selected disease conditions and only consider a single point in time. Trend analyses have yet to be produced. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s. METHODS: Several rounds (2002, 2004, 2006, and 2008) of the South African General Household Surveys (GHS) data were used, with standardized and normalized self-reported illness and disability concentration indices to assess the distribution of illness and disability across socio-economic groups. Composite indices of socio-economic status were created using a set of common assets and household characteristics. RESULTS: This study demonstrates the existence of socio-economic gradients in self-reported ill-health in South Africa. The burden of the major categories of ill-health and disability is greater among lower than higher socio-economic groups. Even non-communicable diseases, which are frequently seen as diseases of affluence, are increasingly being reported by lower socio-economic groups. For instance, the concentration index of flu (and diabetes) declined from about 0.17 (0.10) in 2002 to 0.05 (0.01) in 2008. These results have also been confirmed internationally. CONCLUSION: The current burden and distribution of ill-health indicates how critical it is for the South African health system to strive for access to and use of health services that is in line with need for such care. Concerted government efforts, within both the health sector and other social and economic sectors are therefore needed to address the significant health inequalities in South Africa.
  • Thumbnail Image
    Item
    Open Access
    Who pays for health care in Ghana?
    (BioMed Central Ltd, 2011) Akazili, James; Gyapong, John; McIntyre, Diane
    BACKGROUND:Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. METHODS: Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. RESULTS: Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. CONCLUSION: For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced.