Paper short abstract:

By investigating the impact of social protection on children’s healthcare access we highlight their needs and vulnerabilities as distinct from, but related to the household’s. Focusing on children is also important in proactively addressing life cycle and intergenerational poverty and vulnerability.

Paper long abstract:

In 2003 Ghana abolished its cash-and-carry health care financing policy and replaced it with a National Health Insurance Scheme (NHIS) which aspires to universal coverage. To enhance enrolment in the scheme, the NHIS law has embedded a social assistance component which exempts some categories of people including indigents, the elderly over 70+ years, social security contributors and children from paying premiums. Membership of the country’s flagship cash transfer programme, the Livelihood Empowerment Against Poverty (LEAP) also exempts beneficiaries from paying premiums for NHIS services. Despite recent improvements in health care access in Ghana through the NHIS, about 60% of Ghanaian residents are uninsured, 40% of children are being left behind in health care access and there is uneven geographical coverage. This study investigates the impact and different outcomes of LEAP on children’s health care access along three main dimensions, namely enrolment on NHIS, skilled birth attendance (ante-natal, delivery and post-natal) and immunization. We draw primary data from in-depth qualitative interviews and focus group discussions with caregivers, non-subscribers, service providers, NHIS and Ghana Health Service officials in two implementation districts with differing poverty levels and access to social services. We complement this with an analysis of statistical data from the Multiple Indicators Cluster and Ghana Living Standards Surveys and extensive reviews of programme documents, NGO and media reports. We find that linking cash transfers to health insurance may enhance health care access for children although other factors including distance, quality of service and state infrastructural power lead to uneven outcomes.