Voices from the field - Experiences of WOTRO researchers in their Ph.D. or post-doc projects

22 July 2010

Ghanaian economist Genevieve Aryeetey studies the impact and costs of alternative approaches to identify the poor for premium exemptions under National Health Insurance in Ghana. Her PhD project is part of the WOTRO Integrated Programme ‘Reaching the poor in Ghana's National Health Insurance Scheme’ coordinated by Rob Baltussen (Radboud University) and Irene Agyepong (Ghana Health Service). WOTRO asked Genevieve six questions about her research project.

What is your research about?
Ghana’s National Health Insurance Scheme is being implemented since 2004. For the poor, premium exemptions are available. However, who is entitled to premium exemptions is not clearly formulated. They are simply defined as the poor population, while there is little knowledge on how the poor can best be identified. This study provides a guide to possible alternative strategies (and related costs) to identify the poor for premium exemptions.

Describe one day in the field
My study involved conducting a household survey as well as undertaking a community participatory wealth ranking exercise. The former involves obtaining information on household expenditures (means testing) and assets (proxy means testing) which was analysed in order to categorise communities into wealth quintiles. The latter involves participating with community members (participatory wealth ranking) who serve as informants to identify the poor.

A typical day in the field would be a meeting with selected community representatives. We discuss indicators of poverty and indicators of wealth. Subsequently, the representatives rank the households into five categories from very rich to very poor.

Which fieldwork experience will you never forget and why?
During a community discussion poverty was associated with laziness. There was a huge debate on the classification of a widow. Some informants viewed widows as persons who have inherited some kind of property from their dead husbands and are involved in rigorous trading activities to support their families. Therefore, widows could not be classified as poor. The informants’ perceptions about who is poor were based on having the freedom to live at peace with community members.

What motivates you to do this research?
To serve as a channel between the people and policy makers, so the voices of the poor can be heard. Moreover, to serve as a channel between policy makers and the poor, to carry the knowledge about premium exemptions to the people – especially those in remote communities. What are do’s and don’ts for your fellow researchers when starting a research of this kind in Africa? Do not assume that all rural dwellers are poor based on expenditure, as poverty is multidimensional; and be open minded and consider every contribution as important.

What is the main result of your research so far?
While results from means testing and proxy means testing can be generalised for all communities, we cannot generalise results of participatory wealth ranking, because they are community specific.