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Background: Several lowand middle-income countries implementing health insurance programmes are challenged with increasing coverage of the poor and the informal sector workers, resulting in low population coverage and weak risk-pool. In this evaluation study of the National Health Insurance Scheme (NHIS) in Ghana, we examined effects of combined information, education and communication (IEC) and community outreach registration intervention on enrolment, health insurance knowledge, and healthcare utilisation. Methods: We employed a quasi-experimental design to assign study participants into treatment and control groups in two districts (Kadjebi and North Tongu) of the Volta region of Ghana after a baseline study in 2015. Participants in the treatment group received the IEC and on-site registration intervention for a period of nine months (April–December 2018). A follow-up survey using interviewer-administered questionnaire was conducted in January 2019 to collect data in the intervention and control districts. A total of 1,199 individuals participated in the preand post-intervention survey. We examined the data using descriptive statistics and difference-in-differences analysis. Results: The IEC-Community outreach registration intervention significantly increased enrolment in the intervention group by 15.8 percentage points, compared to the control group. It also increased healthcare utilisation in the intervention group by 18.5 percentage points, relative to the control group. The intervention, however, had no significant effect on participants' knowledge of the NHIS. Conclusion: The study demonstrates that integrated IEC and community outreach registration improves enrolment of people in remote areas, as well as utilisation of health services. Policy makers need to consider these findings in their decisions to accelerate progress towards realization of universal health coverage.

journal of global health science

The impact of community outreach intervention on national health insurance enrolment, knowledge and health services utilisation: evidence from two districts in Ghana