Despite the fact that national health insurance has been available in Ghana since 2003, the coverage is far from universal, especially in rural areas. This study evaluates a consumer education intervention for microfinance clients by Freedom from Hunger and Sinapi Aba Trust designed to increase awareness, knowledge and eventually take-up rates of the National Health Insurance Scheme (NHIS). Designed as a randomized control trial, the study looked at two methods of providing health education to clients of microfinance institutions (MFIs) as well as a “reminder” session provided one year later. Findings indicated no significant differences in health insurance enrollment rates between the treatment groups and control group, by type of education or for those who got reminder sessions. The education may not have had a large impact because baseline enrollment and knowledge of insurance was already high, suggesting that knowledge was not a barrier to enrollment. Rather, it appears that convenience of registration and clients following through on stated intent to enroll, and the timing of making the premium payments are more common challenges for enrollment. In environments where knowledge and enrollment are low, educational programs may have more impact. Enrollment increased for the studied groups at a higher rate than the general population. It is possible that the repeated surveys, along with the treatment activities, might have served as “touch points” that prompted clients to take action to register or enroll in insurance. There are several important opportunities for greater engagement of MFIs and similar organizations to increase uptake of health insurance enrollment among the poor that emerge from this study and its findings. Governments seek sustained methods to enroll and retain informal-sector families in health insurance schemes. MFIs that have field agents who meet regularly with clients are well positioned to partner with public schemes to promote insurance, deliver education about client- value and provide needed prompts and reminders regarding enrollment and re-enrollment. MFIs also have the capacity to provide financing products (small loans) to mitigate enrollment barriers related to having cash on hand at the time of enrollment.
Despite the fact that national health insurance has been available in Ghana since 2003, the coverage is far from universal, especially in rural areas. This study evaluates a consumer education intervention for microfinance clients by Freedom from Hunger and Sinapi Aba Trust designed to increase awareness, knowledge and eventually take-up rates of the National Health Insurance Scheme (NHIS).
Incentive pay is a key component of management strategy, and yet field evidence on the impacts of both individual and team incentives is limited to studies carried out in high-income countries. The mechanisms that lie behind individual responses to incentives go far beyond rational considerations of wage maximization, and encompass concerns for social visibility, preferences for collective work and other behavioral norms. These norms tend to vary by culture, potentially creating considerable heterogeneity in responses to incentives across countries. We present evidence from a field experiment designed to evaluate the impact of individual and group monetary incentives and individual and group rank incentives in Accra, Ghana. We precisely estimate that, contrary to earlier findings in other settings, these incentives have no impact on productivity, work quality and firm profitability. The findings indicate that more research is needed to shed light on the cultural characteristics of the setting that determines whether performance pay is effective.
Many basic economic theories with perfectly functioning markets do not predict the existence of the vast number of microenterprises readily observed across the world. We put forward a model that illuminates why financial and managerial capital constraints may impede experimentation, and thus limit learning about the profitability of alternative firm sizes. The model shows how lack of information about one’s own type, but willingness to experiment to learn one’s type, may lead to short-run negative expected returns to investments on average, with some outliers succeeding. To test the model we put forward first a motivating experiment from Ghana, and second a small meta-analysis of other experiments. In the Ghana experiment, we provide inputs to microenterprises, specifically financial capital (a cash grant) and managerial capital (consulting services), to catalyze adoption of investments and practices aimed towards enterprise growth. We find that entrepreneurs invest the cash, and take the advice, but both lead to lower profits on average. In the long run, they revert back to their prior scale of operations. The small meta analysis includes results from 18 other experiments in which either capital or managerial capital were relaxed, and find mixed support for this theory.
This study provides experimental evidence about the barriers to adoption of formal savings in Africa. In collaboration with a large commercial bank, I conduct an experiment designed to measure the relative importance of convenience and information on the adoption of formal savings. When individuals can open an account at their place of business they are much more likely to open an account. Novel information about the benefits of savings has a slight but insignificant negative effect on account opening. While over half (55%) of individuals report an interest in opening an account when initially approached, only 2% of individuals are using the accounts 2 months later. I explore several potential explanations between individuals’ selfreports of interest in the accounts and their later behavior. I argue that individuals’ behavior in the experiment is consistent with social pressure to conform to the encouragement to open an account and some projection bias in predicting their future behavior. The results illustrate that for individuals struggling to save, encouraging enrollment in formal finance may be less effective than tools which help individuals follow-through with self-reported savings intentions.