IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0209126.html
   My bibliography  Save this article

Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study

Author

Listed:
  • Cherri Zhang
  • Md Shafiur Rahman
  • Md Mizanur Rahman
  • Alfred E Yawson
  • Kenji Shibuya

Abstract

Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9–3.5) and 0.4% (95%CrI: 0.2–0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1–1.3) and 0.2% (0.0–0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps.

Suggested Citation

  • Cherri Zhang & Md Shafiur Rahman & Md Mizanur Rahman & Alfred E Yawson & Kenji Shibuya, 2019. "Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-19, May.
    • Handle: RePEc:plo:pone00:0209126
    DOI: 10.1371/journal.pone.0209126
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209126
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0209126&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0209126?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Philip Ayizem Dalinjong & Alex Y Wang & Caroline S E Homer, 2018. "Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-19, February.
    2. Ties Boerma & Patrick Eozenou & David Evans & Tim Evans & Marie-Paule Kieny & Adam Wagstaff, 2014. "Monitoring Progress towards Universal Health Coverage at Country and Global Levels," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-8, September.
    3. Chunling Lu & Brian Chin & Jiwon Lee Lewandowski & Paulin Basinga & Lisa R Hirschhorn & Kenneth Hill & Megan Murray & Agnes Binagwaho, 2012. "Towards Universal Health Coverage: An Evaluation of Rwanda Mutuelles in Its First Eight Years," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-16, June.
    4. Angus Deaton & Salman Zaidi, 2002. "Guidelines for Constructing Consumption Aggregates for Welfare Analysis," World Bank Publications, The World Bank, number 14101, April.
    5. Igna Bonfrer & Lyn Breebaart & Ellen Van de Poel, 2016. "The Effects of Ghana’s National Health Insurance Scheme on Maternal and Infant Health Care Utilization," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-13, November.
    6. World Bank, 2016. "UHC in Africa," World Bank Publications - Books, The World Bank Group, number 26072.
    7. Somkotra, Tewarit & Lagrada, Leizel P., 2008. "Payments for health care and its effect on catastrophe and impoverishment: Experience from the transition to Universal Coverage in Thailand," Social Science & Medicine, Elsevier, vol. 67(12), pages 2027-2035, December.
    8. Gajate-Garrido, Gissele & Owusua, Rebecca, 2013. "The national health insurance scheme in Ghana: Implementation challenges and proposed solutions:," IFPRI discussion papers 1309, International Food Policy Research Institute (IFPRI).
    9. Robert Kaba Alhassan & Edward Nketiah-Amponsah & Daniel Kojo Arhinful, 2016. "A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-16, November.
    10. Aluísio J D Barros & Cesar G Victora, 2013. "Measuring Coverage in MNCH: Determining and Interpreting Inequalities in Coverage of Maternal, Newborn, and Child Health Interventions," PLOS Medicine, Public Library of Science, vol. 10(5), pages 1-9, May.
    11. Yeetey Akpe Kwesi Enuameh & Sumiyo Okawa & Kwaku Poku Asante & Kimiyo Kikuchi & Emmanuel Mahama & Evelyn Ansah & Charlotte Tawiah & Kwame Adjei & Akira Shibanuma & Keiko Nanishi & Francis Yeji & Enoch, 2016. "Factors Influencing Health Facility Delivery in Predominantly Rural Communities across the Three Ecological Zones in Ghana: A Cross-Sectional Study," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-16, March.
    12. Obinna Onwujekwe & Kara Hanson & Benjamin Uzochukwu, 2012. "Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Healthcare Services and Health Facilities in Nigeria," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-6, July.
    13. Carapinha, João L. & Ross-Degnan, Dennis & Desta, Abayneh Tamer & Wagner, Anita K., 2011. "Health insurance systems in five Sub-Saharan African countries: Medicine benefits and data for decision making," Health Policy, Elsevier, vol. 99(3), pages 193-202, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    2. Patrick Opoku Asuming & Hyuncheol Bryant Kim & Armand Sim, 2021. "Selection and Behavioral Responses of Health Insurance Subsidies in the Long Run: Evidence from a Field Experiment in Ghana," Papers 2105.00617, arXiv.org.
    3. Hubert Amu & Kwamena Sekyi Dickson & Akwasi Kumi-Kyereme & Eugene Kofuor Maafo Darteh, 2018. "Understanding variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania: Evidence from demographic and health surveys," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-14, August.
    4. Hsu, Justine & Majdzadeh, Reza & Mills, Anne & Hanson, Kara, 2021. "A dominance approach to analyze the incidence of catastrophic health expenditures in Iran," Social Science & Medicine, Elsevier, vol. 285(C).
    5. Elham Ahmadnezhad & Adrianna Murphy & Rezvaneh Alvandi & Zhaleh Abdi, 2019. "The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1833-1845, October.
    6. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    7. Hubert Amu & Abdul-Aziz Seidu & Ebenezer Agbaglo & Robert Kokou Dowou & Edward Kwabena Ameyaw & Bright Opoku Ahinkorah & Kwaku Kissah-Korsah, 2021. "Mixed effects analysis of factors associated with health insurance coverage among women in sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-15, March.
    8. Raymond Elikplim Kofinti & Josephine Baako-Amponsah & Prince Danso, 2023. "Household National Health Insurance Subscription and Learning Outcomes of Poor Children in Ghana," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 16(1), pages 357-394, February.
    9. Patrick Asuming & Hyuncheol Bryant Kim & Armand Sim, 2018. "Long-run Consequences of Health Insurance Promotion When Mandates are Not Enforceable: Evidence from a Field Experiment in Ghana," Papers 1811.09004, arXiv.org, revised Jun 2019.
    10. Eric Gaisie, 2017. "Living standards in pre-independent Ghana: evidence from household budgets," HHB Working Papers Series 7, The Historical Household Budgets Project.
    11. John A. Maluccio, 2009. "Household targeting in practice: The Nicaraguan Red de Protección Social," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(1), pages 1-23.
    12. Mahmud, Mahreen & Riley, Emma, 2021. "Household response to an extreme shock: Evidence on the immediate impact of the Covid-19 lockdown on economic outcomes and well-being in rural Uganda," World Development, Elsevier, vol. 140(C).
    13. Oihana Aristondo & Casilda Lasso De La Vega & Ana Urrutia, 2010. "A New Multiplicative Decomposition For The Foster–Greer–Thorbecke Poverty Indices," Bulletin of Economic Research, Wiley Blackwell, vol. 62(3), pages 259-267, July.
    14. Çakır, Mustafa Yavuz & Kabundi, Alain, 2013. "Trade shocks from BRIC to South Africa: A global VAR analysis," Economic Modelling, Elsevier, vol. 32(C), pages 190-202.
    15. Ijeoma Nkem Okedo‐Alex & Ifeyinwa Chizoba Akamike & Obumneme Benaiah Ezeanosike & Chigozie Jesse Uneke, 2019. "A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1387-1404, October.
    16. Pape, Utz & Verme, Paolo, 2023. "Measuring Poverty in Forced Displacement Contexts," GLO Discussion Paper Series 1245, Global Labor Organization (GLO).
    17. Akanksha Srivastava & Sanjay Mohanty, 2012. "Poverty Among Elderly in India," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 109(3), pages 493-514, December.
    18. Tesfaye Alemayehu Gebremedhin & Stephen Whelan, 2008. "Prices and Poverty in Urban Ethiopia 1," Journal of African Economies, Centre for the Study of African Economies, vol. 17(1), pages 1-33, January.
    19. Janz, Teresa & Augsburg, Britta & Gassmann, Franziska & Nimeh, Zina, 2023. "Leaving no one behind: Urban poverty traps in Sub-Saharan Africa," World Development, Elsevier, vol. 172(C).
    20. repec:dgr:rugggd:gd-114 is not listed on IDEAS
    21. Kwame Adjei-Mantey & Charles Yuji Horioka, 2023. "Determinants of health insurance enrollment and health expenditure in Ghana: an empirical analysis," Review of Economics of the Household, Springer, vol. 21(4), pages 1269-1288, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0209126. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.