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Enrolment of older people in social health protection programs in West Africa – Does social exclusion play a part?

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  • Parmar, Divya
  • Williams, Gemma
  • Dkhimi, Fahdi
  • Ndiaye, Alfred
  • Asante, Felix Ankomah
  • Arhinful, Daniel Kojo
  • Mladovsky, Philipa

Abstract

Although the population of older people in Africa is increasing, and older people are becoming increasingly vulnerable due to urbanisation, breakdown of family structures and rising healthcare costs, most African countries have no social health protection for older people. Two exceptions include Senegal's Plan Sesame, a user fees exemption for older people and Ghana's National Health Insurance Scheme (NHIS) where older people are exempt from paying premiums. Evidence on whether older people are aware of and enrolling in these schemes is however lacking. We aim to fill this gap. Besides exploring economic indicators, we also investigate whether social exclusion determines enrolment of older people. This is the first study that tries to explore the social, political, economic and cultural (SPEC) dimensions of social exclusion in the context of social health protection programs for older people. Data were collected by two cross-sectional household surveys conducted in Ghana and Senegal in 2012. We develop SPEC indices and conduct logistic regressions to study the determinants of enrolment. Our results indicate that older people vulnerable to social exclusion in all SPEC dimensions are less likely to enrol in Plan Sesame and those that are vulnerable in the political dimension are less likely to enrol in NHIS. Efforts should be taken to specifically enrol older people in rural areas, ethnic minorities, women and those isolated due to a lack of social support. Consideration should also be paid to modify scheme features such as eliminating the registration fee for older people in NHIS and creating administration offices for ID cards in remote communities in Senegal.

Suggested Citation

  • Parmar, Divya & Williams, Gemma & Dkhimi, Fahdi & Ndiaye, Alfred & Asante, Felix Ankomah & Arhinful, Daniel Kojo & Mladovsky, Philipa, 2014. "Enrolment of older people in social health protection programs in West Africa – Does social exclusion play a part?," Social Science & Medicine, Elsevier, vol. 119(C), pages 36-44.
    • Handle: RePEc:eee:socmed:v:119:y:2014:i:c:p:36-44
    DOI: 10.1016/j.socscimed.2014.08.011
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    References listed on IDEAS

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    1. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    2. Peter Lloyd‐Sherlock & Nadia Minicuci & John Beard & Somnath Chatterji, 2012. "Social protection and preventing illness in developing countries: Establishing the health effects of pensions and health insurance," International Social Security Review, John Wiley & Sons, vol. 65(4), pages 51-68, October.
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    4. Parmar, Divya & Souares, Aurélia & de Allegri, Manuela & Savadogo, Germain & Sauerborn, Rainer, 2012. "Adverse selection in a community-based health insurance scheme in rural Africa: implications for introducing targeted subsidies," LSE Research Online Documents on Economics 46664, London School of Economics and Political Science, LSE Library.
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    Cited by:

    1. Dovie, Delali A., 2020. "Articulation of the shallow inclusion and deep exclusion of older adults from the Ghanaian policy terrain," Studia z Polityki Publicznej / Public Policy Studies, Warsaw School of Economics, vol. 7(2), pages 1-27, July.
    2. Vincent Z. Kuuire & Eric Y. Tenkorang & Andrea Rishworth & Isaac Luginaah & Alfred E. Yawson, 2017. "Is the Pro-Poor Premium Exemption Policy of Ghana’s NHIS Reducing Disparities Among the Elderly?," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 36(2), pages 231-249, April.
    3. Lloyd-Sherlock, Peter & Amoakoh-Coleman, Mary, 2020. "A critical review of intervention and policy effects on the health of older people in sub-Saharan Africa," Social Science & Medicine, Elsevier, vol. 250(C).
    4. Madeline E. Duhon & Edward Miguel & Amos Njuguna & Daniela Pinto Veizaga & Michael W. Walker, 2023. "Preparing for an Aging Africa: Data-Driven Priorities for Economic Research and Policy," NBER Working Papers 31750, National Bureau of Economic Research, Inc.
    5. Akerkar, Supriya & Joshi, P.C. & Fordham, Maureen, 2016. "Cultures of Entitlement and Social Protection: Evidence from Flood Prone Bahraich, Uttar Pradesh, India," World Development, Elsevier, vol. 86(C), pages 46-58.
    6. Mladovsky, Philipa, 2020. "Fragmentation by design: Universal health coverage policies as governmentality in Senegal," Social Science & Medicine, Elsevier, vol. 260(C).
    7. Mladovsky, Philipa & Ba, Maymouna, 2017. "Removing user fees for health services: A multi-epistemological perspective on access inequities in Senegal," Social Science & Medicine, Elsevier, vol. 188(C), pages 91-99.

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