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Community concepts of poverty: an application to premium exemptions in Ghana’s National Health Insurance Scheme

Genevieve C Aryeetey14*, Caroline Jehu-Appiah24, Agnes M Kotoh15, Ernst Spaan3, Daniel K Arhinful4, Rob Baltussen3, Sjaak van der Geest5 and Irene A Agyepong1

Author Affiliations

1 School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Ghana

2 African Development Bank, Tunis, Tunisia

3 Radboud University Nijmegen Medical Cente, Nimegen, Netherlands

4 Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana

5 University of Amsterdam, Amsterdam, Netherlands

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Globalization and Health 2013, 9:12  doi:10.1186/1744-8603-9-12

Published: 14 March 2013



Poverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana’s National Health Insurance Scheme.


We employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty.


Community defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community.


The in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care.

Health insurance; Exemptions; Poor households; Community participation; Wealth ranking; Targeting; Ghana