Abstract:
Background: Health care financing is one of the major and pressing issues challenging the healthcare delivery
sector in Ghana. Right after attaining independence, the country embraced the socialist philosophy, where the
then government made healthcare services completely free, as was the case with education and other social
intervention programs. However, not too long into the era, Ghanaians were made to pay out-of-pocket when
receiving healthcare services in the famous “Cash-and-Carry” delivery system. Since 2003, the country
introduced the National Health Insurance Scheme as a means to lessen the burden on the healthcare expenditure
of the people. However, over 16 years of its implementation, there is still the problem of enrolment and
retention. This study aimed at determining the factors influencing enrolment into the National Health Insurance
Scheme in the Lower Manya Krobo Municipality of the Eastern Region in Ghana. Methods: The study
employed a cross-sectional study design with a quantitative approach to determine the factoring influencing
NHIS enrolment in the Lower Manya Krobo Municipality. The total sample size was 362, with data obtained
through questionnaire administration. Univariate, bivariate, and multivariate analyses were conducted to
respectively estimate frequencies, measure the level of associations, and predict outcomes on selected variables
outputs. A p-value <0.05 was considered as significant level with 95% CI. Results: Almost all the respondents
(98.1%) have heard about the Ghana Health Insurance Scheme. Major sources of such information were from
Radio and Television, and family or relatives. NHIS enrollment stood at 69.1%, and factors such as age (p =
0.033), sex (p<0.001), educational level (p <0.001), and income status (p <0.05) were significantly associated
with enrolment. Again, 90% had expressed their intentions to renew membership. Indicators such as reported
educational level, marital status, and income were also concomitant with respondents’ intentions to renew
membership. Conclusion: Although NHIS enrolment in the study region was higher than the national average,
there were still over 30% of the respondents who have never enrolled. More efforts are needed to achieve total
enrolment by all given that was the policy directive guiding the scheme.
