Ensuring universal health coverage (UHC) is a priority under Sustainable Development Goal 3 (SDG3). To address the intersection between poverty and health and remove cost barriers, the government of Ghana established the national health insurance scheme (NHIS). To ensure that no one is left behind due to unaffordable premiums, the NHIS was linked with the livelihood empowerment against poverty (LEAP) 1000 cash transfer program by waiving premium fees for LEAP 1000 eligible households. This program led to increased NHIS enrolment, however, large gaps still remained. In this study, the authors examine whether LEAP 1000 impacts on NHIS enrolment were moderated by health facilities’ service availability and readiness. The results show that adults in areas with the highest service availability and readiness are 18 percentage points more likely to enrol in NHIS because of LEAP 1000, compared to program effects of only 9 percentage points in low service availability and readiness areas. Based on the findings, the authors recommend that in the quest for expanding financial protection towards accelerating the achievement of UHC, policymakers in Ghana prioritize the integration of efforts to simultaneously address demand- and supply-side factors.
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