National Health Insurance Scheme Awareness and Benefit-statement Endorsement among Urban- and Rural-classified Respondents in a Ghanaian Household Survey
Dadia Stephen *
Department of Public Health, Ghana Health Service, Kpandai District Health Directorate, Kpandai, Ghana.
Michael Oppong Yeboah
Department of Public Health, Akramaman Health Centre, Ga West Municipal Health Directorate, Amasaman, Accra, Ghana.
Samira Mastura Sulleman
Department of Population and Reproductive Health, Mana Mission Hospital, Accra, Ghana.
Jerdu Bin-eranaa Nuhu
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
John Kwame Agbenyeavu
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
Rebecca Tricia Morrison
Department of Population and Reproductive Health, University of Port Harcourt, Port Harcourt, Nigeria.
Boaz Ahulu
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria and Department of Public Health, Community Health Nursing Training College, Akim Oda, Ghana.
Oscar Vetsi
Department of Public Health, Disease Control Unit, Ghana Health Service, Ada West District, Sege, Ghana.
Abubakar Alhassan
Department of Public Health, Federal University of Health Sciences, Azare, Bauchi State, Nigeria.
Porbilla Ewura Ofosu-Apea
Department of Public Health, School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
Richard Kwaku Essien
Department of Public Health, Abuakwa South Municipal Health Directorate, Ghana.
Eric Addo Owusu
Department of Population and Reproductive Health, University of Port Harcourt, Port Harcourt, Nigeria.
Benjamin Kwasi Amoako
Department of Public Health, Disease Control Unit, Assin Fosu Municipal Health Directorate, Assin Fosu, Ghana.
Best Ordinioha
School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Aims: To describe self-reported awareness of Ghana's National Health insurance scheme (NHIS), affirmative responses to broad benefit statements and their distribution across recorded urban and rural groups.
Study Design: A descriptive cross-sectional household survey with exploratory comparisons by recorded settlement classification.
Place and Duration of Study: Four districts in the present Northern Region of Ghana constituted the intended sampling frame; interviews took place from March 2025 to February 2026.
Methodology: A four-stage household selection procedure was specified. Fourteen positively phrased benefit statements were administered; one for which 80.0% of responses were missing was excluded, leaving a 13-item endorsement count (0–13). The three descriptive score bands were 11–13, 8–10 and 0–7. Statistical intervals and tests did not account for clusters or sampling weights.
Results: Among 595 analysed records (194 urban; 401 rural), 591 (99.3%) reported NHIS awareness. The endorsement bands contained 49 (8.2%), 290 (48.7%) and 256 (43.0%) respondents, respectively. Affirmative responses were least frequent for physiotherapy (27.9%), specialist consultation (39.8%), general surgery (40.2%) and basic dental care (40.5%). The highest-band proportion was 10.8% in the urban group and 7.0% in the rural group (unadjusted difference 3.8 percentage points; 95% CI −0.8 to 9.4; nominal P = .11); the three-band comparison yielded nominal P = .26. Internal consistency of the 13-item index was low (KR-20 = 0.35). Geographic fields recorded districts outside the intended four for 46 records and other regions for 15 records.
Conclusion: General NHIS awareness was frequently reported, whereas endorsements of individual benefit statements varied considerably. The unvalidated, low-reliability score, conditional benefit entitlements, discrepancies in geographic fields and lack of design-based analysis prevent conclusions about regional prevalence, validated literacy or urban–rural equivalence.
Keywords: National Health Insurance Scheme, benefit statements, self-reported awareness, endorsement score, urban–rural classification, cross-sectional survey