Ghana Health Policy Dialogue

Impact: Marginalized Workers Gain Healthcare Access

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kayayei

A Health Policy Dialogue held in Accra, Ghana on July 26, 2012 resulted in over 1,000 head porters, known as kayayei in Ghana, gain access to health care services through the Ghanaian National Health Insurance Scheme (NHIS). 

Kayayeis are notably young women (including adolescents) who migrate from the Northern regions to the major cities, often in an attempt to escape abject poverty. There are also a number of trafficked young women from the North who end up working as kayayei.
In markets, they transport material for vendors, or assist buyers to carry their shopping to board vehicles. Many also work for shop owners at the markets in re-stocking, packing and tidying up.

The aim of the policy dialogue, facilitated by WIEGO, was to identify ways in which to help kayayei better access health services, and to help integrate these workers into the Ghanaian National Health Insurance Scheme (NHIS).

Background

The event was organized as a follow up to the WIEGO/HomeNet Thailand Health Policy Dialogue in Bangkok in January 2012, where WIEGO’s Laura Alfers presented a case study of the Ghana NHIS. Her findings showed that kayayeiwere unable to easily use the health services in Accra:

  • A large number of kayayei were not registered with the NHIS. Most could not afford the premium. Although the scheme’s minimum annual premium is set at $5, in reality $15-$20 is charged as a minimum in urban areas. Many kayayei earn $2-3 or less a day, making this unaffordable for them.
  • Those few who could afford to join complained that they were mistreated or ignored when they went to use the health services.
  • Reliable, good information on health programmes – such as free care for pregnant women – was not reaching the kayayei. They were often paying for health services, though legally, these services should be free to them.

health policy dialogue - kayayei 2012

In view of these findings and the progress made during the Bangkok Health Policy Dialogue, the Health Policy Dialogue in Ghana was organized with a specific focus on the kayayei. Representatives from the National Health Insurance Authority and the Ghanaian Ministry of Health; organizations of kayayei; and civil society organizations and activists who have an interest in health were invited to participate.

This Health Policy Dialogue was attended by about 100 kayayei. They shared their experiences and asked direct questions of 12 key policymakers from the Ministry of Health and NHIS. According to Dorcas Ansah, Accra Focal City Coordinator, the kayayei “amazed the officials present” with their confidence and their ability to pose critical questions. “Their anger at being unable to access health services even when they had saved to buy the NHIS card was very strongly expressed,” said Dorcas.

NHIS registration of kayayei

Two important commitments emerged from the discussions. First, NHIS officials asked for WIEGO’s assistance in registering associations ofkayayei with the scheme. Dorcas Ansah assisted the kayayei organizations in negotiating a significantly reduced annual premium of $2.50. The NHIS then held a special registration for the kayayei on 9 September 2012. Over 1,500 people registered with the scheme on that day – 1,000 of whom were kayayei. The others were community members who demanded they be allowed to register under the same conditions, and the NHIS agreed, once the kayayei were done, to register 500 additional people.

The second important commitment was from the Ministry of Health, which has indicated a willingness to enter into discussions with the kayayei associations and WIEGO on the poor quality of care received by these workers when accessing health services. Suggestions which were put forward by the MoH officials were that clinics and hospitals in areas where kayayei live and work would have doctors and nurses specially mandated to look after their needs.

WIEGO has also produced a pamphlet specifically for kayayei on the free maternal healthcare available to them in Ghana.

The kayayei still have a long fight ahead in their struggle to get decent healthcare, but things are certainly looking more positive. Dorcas Ansah, assisted by Kweku Kyere, is working towards setting up a low cost monitoring system for those kayayei now registered with the scheme. Evidence collected from this will be used in advocacy campaigns to push the Ghanaian health system to better serve poor workers.

The Ghana News Agency (GNA) posted this article after the Policy Dialogue.

Read a case study from Ghana of good practice in developing OHS for informal workers, by WIEGO's Laura Alfers.

What is a Policy Dialogue?

A Policy Dialogue brings people from different interest groups to the same table to focus on an issue in which they have a mutual – but not necessarily common – interest. It assumes that people in different positions will have different perspectives on the same problem. For example:

  • a person providing a service may have a more complete level of information about the services available than an informal worker seeking out the service
  • a person from the health insurance industry may have a different judgment about the quality of a service than either a person working in the health service or a service consumer 
  • a female informal worker may have different health needs than a male informal worker

A Policy Dialogue is a vehicle through which people can come to see problems from each others’ perspectives, thus bringing improvements to a policy or programme. It fully acknowledges power differences between different stakeholders, and tries to identify areas where it is in the interest of all to make improvements and reforms.

This is one in a series of WIEGO Network impact stories.