Impacts of a Social Protection Program Paired With Fee Waivers on Enrollment in Ghana’s National Health Insurance Scheme

Tia Palermo , United Nations Children's Fund (UNICEF)
Elsa Valli, United Nations Children's Fund (UNICEF)
Gustavo Angeles, National Institute of Public Health (INSP), Mexico and University of North Carolina at Chapel Hill
Marlous de Milliano, University of North Carolina at Chapel Hill
Clement Adamba, Institute of Statistical Social and Economic Research, University of Ghana
Tayllor Spadafora, United Nations Children's Fund (UNICEF), Ghana
Clare Barrington, University of North Carolina at Chapel Hill

Cash transfer programs, which aim to reduce poverty and improve human capital investment have been found to have limited impacts on health outcomes, suggesting that complementary programming and linkages to health services may be necessary. We implemented a quasi-experimental, mixed method impact evaluation of Ghana’s Livelihood Empowerment Against Poverty (LEAP) 1000 program, an integrated social protection program pairing cash transfers for poverty reduction with fee waivers for enrolment into Ghana’s National Health Insurance Scheme (NHIS) and intent-to-treat impacts on NHIS enrolment among children and adults. Results indicate that LEAP 1000 increased current NHIS enrolment by 14 and 15 percentage points for children and adults, respectively. Common reasons for not enrolling are cost related, including fees and travel. Gaps in enrolment still remain, particularly for adults. These gaps and implementation challenges suggest that NHIS and LEAP could be better streamlined to ensure that all poor households fully benefit from both services.

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 Presented in Session 8. Economy, Labor Force, Education, & Inequality