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Received: 2020-09-10 Received in revised form: 2021-01-04 Accepted: 2021-03-20 Given concerns about the spiralling cost of health services in low and middle-income countries (LMICs), this study draws on a framework for assessing poverty and access to health services to ascertain progress towards achieving vertical equity in the National Health Insurance Scheme (NHIS) in a rural setting in northern Ghana. Rural-urban disparities in financial access to NHIS services are seldom explored in equity-related studies although there is a knowledge gap of progress and challenges of implementing the scheme’s vertical equity objectives to inform social health protection planning and implementation. A qualitative approach was used to collect and analyse the data. Specifically, in-depth interviews and observation were deployed to explore participants’ lived experiences, the relationship between location, livelihoods and ability to pay for health insurance services. The article found that flat rate contributions for populations in the informal sector of the economy and lack of flexibility and adaptability of timing premium collections to the needs of rural residents make the cost of membership disproportionately higher for them, and this situation contradicts the vertical equity objectives of the NHIS. The study concludes that the current payment regimes serve as important deterrence to poor rural residents enrolling in the scheme. Based on this, we advocate strict adherence and implementation of the scheme’s vertical equity measures through the adoption of the Ghana National Household Register (GNHR) as a tool for ensuring that contributions are based on income, and collection is well-timed.

Vertical equity in access to health insurance services: An exploration of perceptions and enrolment in the Jirapa Municipality, north-western Ghana