The solidarity of self-interest: Social and cultural feasibility of rural health insurance in Ghana

Abstract

To Angie and our childrenThe Ghanaian adinkra symbol NKONSONKONSON (chain links) is used to signify solidarity.It is used to remind citizens that in unity lies strength and entreats them to contribute to the community.It was the rallying symbol of the 1997 abortive NHIS pilot scheme in the Eastern Region.vii A certain naivety sometimes surrounds health planners' enthusiastic pleas for community health insurance.Community health insurance is being reduced to a particular financial arrangement but, at the same time, its complex social and cultural dimensions are being underestimated.One could say, rather provocatively, that community health insurance has become too much the exclusive study domain of health economists, whereas there is need to study and unravel, in a systematic way and in a variety of settings, people's expectations and fears in these innovative but complex forms of health care financing.There is, therefore, a need for more qualitative research by sociologists and anthropologists.It is precisely here that the merits of Daniel Kojo Arhinful's study lie.He critically analyses the gap between the official rhetoric concerning community health insurance and the reality of people's views and expectations.He further investigates the links to be made, if any, between community health insurance and existing traditional solidarity systems in rural Ghana.His study findings point to the crucial importance of trust in the institutions in charge of the management of the scheme, and the need for an acceptable level of quality of care -and certainly relational quality -to be provided by health care workers.And last but not least, Arhinful shows that the Ghanaian community insurance schemes he studied do not constitute an option for the destitute in society.This study will definitely lead to a better understanding of the complexities of developing community health insurance in Ghana.Daniel Arhinful's work constitutes, in my view, an important contribution to more evidence-based policies with regard to the promotion and organisation of community health insurance in Sub-Saharan Africa.