Gender inequities in global health: Insights from Ghana’s National Health Insurance Scheme

https://doi.org/10.35912/amor.v7i1.3419
Published: Oct 6, 2025

Abstract:

Purpose: This systematic review examines gender inequities in global health and critically analyzes how these inequities manifest within Ghana’s National Health Insurance Scheme (NHIS), drawing on the Gender and Development (GAD) theoretical framework.

Methodology/approach: This study followed PRISMA 2020 guidelines, for systematic reviews to select thirty-seven articles from major databases. Thematic synthesis was applied to identify recurring patterns.

Results/findings: Findings showed that globally, gender inequities in health systems were linked to women’s economic dependency, sociocultural norms, and limited decision-making autonomy. Within Ghana’s NHIS, these inequities manifested through lower enrollment and renewal rates among women, affordability challenges for informal sector workers, and barriers tied to cultural norms that restrict autonomy in healthcare utilization. While maternal health exemptions improved access, they were insufficient to address deeper structural inequalities.

Conclusion: This study concludes that Ghana’s NHIS, though designed to promote universal coverage, often replicate broader gender inequities unless deliberate structural reforms are integrated.

Limitations: The focus on Ghana as a case, while illustrative, also limits the transferability of findings to other national health systems with differing socio-cultural and policy contexts.

Contribution: This review advances scholarship by applying the GAD framework to emphasize the structural and relational barriers that must be addressed for truly gender-responsive health policy.

Keywords:
1. Gender and Development
2. Ghana
3. Global Health
4. National Health Insurance Scheme
5. Systematic Review
Authors:
Anita Bans-Akutey
BlueCrest University College, Ghana
https://orcid.org/0000-0003-0305-9377
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How to Cite
Bans-Akutey, A. (2025). Gender inequities in global health: Insights from Ghana’s National Health Insurance Scheme. Annals of Management and Organization Research, 7(1), 141–153. https://doi.org/10.35912/amor.v7i1.3419
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Vol. 7 No. 1 (2025): August
Articles
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References

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    Agyepong, I. A., & Adjei, S. (2008). Public Social Policy Development And Implementation: A Case Study Of The Ghana National Health Insurance Scheme. Health policy and planning, 23(2), 150-160. doi:https://doi.org/10.1093/heapol/czn002

    Akazili, J., Ataguba, J. E.-O., Kanmiki, E. W., Gyapong, J., Sankoh, O., Oduro, A., & McIntyre, D. (2017). Assessing The Impoverishment Effects Of Out-Of-Pocket Healthcare Payments Prior To The Uptake Of The National Health Insurance Scheme In Ghana. BMC international health and human rights, 17(1), 13. doi:https://doi.org/10.1186/s12914-017-0121-7

    Akotia, C. S., & Anum, A. (2015). Gender, Culture, And Inequality In Ghana: An Examination Of Sociocultural Determinants Of Gender Disparity. Psychology of gender through the Lens of Culture: theories and applications, 375-394. doi:https://doi.org/10.1007/978-3-319-14005-6_18

    Alhassan, R. K., Nketiah-Amponsah, E., & Arhinful, D. K. (2016). A Review Of The National Health Insurance Scheme In Ghana: What Are The Sustainability Threats And Prospects? PloS one, 11(11), e0165151. doi:https://doi.org/10.1371/journal.pone.0165151

    Ameyaw, E. K., Ahinkorah, B. O., Baatiema, L., & Seidu, A.-A. (2021). Is The National Health Insurance Scheme Helping Pregnant Women In Accessing Health Services? Analysis Of The 2014 Ghana Demographic And Health Survey. BMC Pregnancy and Childbirth, 21(1), 201. doi:https://doi.org/10.1186/s12884-021-03651-6

    Amoah, P. A., & Phillips, D. R. (2018). Health Literacy And Health: Rethinking The Strategies For Universal Health Coverage In Ghana. Public health, 159, 40-49. doi:https://doi.org/10.1016/j.puhe.2018.03.002

    Ayanore, M. A., Adjuik, M., Ameko, A., Kugbey, N., Asampong, R., Mensah, D., . . . Manu, E. (2020). Self-Reported Breast And Cervical Cancer Screening Practices Among Women In Ghana: Predictive Factors And Reproductive Health Policy Implications From The Who Study On Global Ageing And Adult Health. BMC women's health, 20(1), 158. doi:https://doi.org/10.1186/s12905-020-01022-5

    Boniol, M., Kunjumen, T., Nair, T. S., Siyam, A., Campbell, J., & Diallo, K. (2022). The Global Health Workforce Stock And Distribution In 2020 And 2030: A Threat To Equity And ‘Universal’health Coverage? BMJ global health, 7(6), e009316. doi:https://doi.org/10.1136/bmjgh-2022-009316

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    Ebi, K. L., & Hess, J. J. (2020). Health risks due to climate change: inequity in causes and consequences: study examines health risks due to climate change. Health Affairs, 39(12), 2056-2062. doi:https://doi.org/10.1377/hlthaff.2020.01125

    Fadda, J. (2020). Climate Change: An Overview of Potential Health Impacts Associated with Climate Change Environmental Driving Forces. Renewable Energy and Sustainable Buildings: Selected Papers from the World Renewable Energy Congress WREC 2018, 77-119. doi:https://doi.org/10.1007/978-3-030-18488-9_8

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    Habib, S., Khan, M. A., & Hamadneh, N. N. (2022). Gender Sensitivity In Accessing Healthcare Services: Evidence From Saudi Arabia. Sustainability, 14(22), 14690. doi:https://doi.org/10.3390/su142214690

    Jehu-Appiah, C., Aryeetey, G., Agyepong, I., Spaan, E., & Baltussen, R. (2012). Household Perceptions And Their Implications For Enrolment In The National Health Insurance Scheme In Ghana. Health policy and planning, 27(3), 222-233. doi:https://doi.org/10.1093/heapol/czr032

    Jehu-Appiah, C., Aryeetey, G., Spaan, E., De Hoop, T., Agyepong, I., & Baltussen, R. (2011). Equity Aspects Of The National Health Insurance Scheme In Ghana: Who Is Enrolling, Who Is Not And Why? Social Science & Medicine, 72(2), 157-165. doi:https://doi.org/10.1016/j.socscimed.2010.10.025

    Keville, T. D. (1993). The Invisible Woman: Gender Bias In Medical Research. Women's Rts. L. Rep., 15, 123.

    Kumbhar, U., Ashok, W., Nashte, A., Limkar, S., Patil, V., & Chaudhari, K. (2023). Globalization And Public Health: An Examination Of Cross-Border Health Issues. South East Eur J Public Health, 21, 171-180. doi:https://doi.org/10.70135/seejph.vi.450

    Lambin, R., & Nyyssölä, M. (2022). Two Decades Of Tanzanian Health Policy: Examining Policy Developments And Opportunities Through A Gender Lens. doi:https://doi.org/10.35188/unu-wider/2022/161-7

    Langer, A., Meleis, A., Knaul, F. M., Atun, R., Aran, M., Arreola-Ornelas, H., . . . Caglia, J. M. (2015). Women And Health: The Key For Sustainable Development. The Lancet, 386(9999), 1165-1210. doi:https://doi.org/10.1016/s0140-6736(15)60497-4

    Long, H. A., French, D. P., & Brooks, J. M. (2020). Optimising The Value Of The Critical Appraisal Skills Programme (CASP) Tool For Quality Appraisal In Qualitative Evidence Synthesis. Research Methods in Medicine & Health Sciences, 1(1), 31-42. doi:https://doi.org/10.1177/2632084320947559

    Matin, B. K., Williamson, H. J., Karyani, A. K., Rezaei, S., Soofi, M., & Soltani, S. (2021). Barriers In Access To Healthcare For Women With Disabilities: A Systematic Review In Qualitative Studies. BMC women's health, 21(1), 44. doi:https://doi.org/10.1186/s12905-021-01189-5

    Moser, C. (1993). Gender Planning and Development: Theory, Practice and Training (1st ed.): Routledge.

    Osei-Assibey, E. (2014). Nature And Dynamics Of Inequalities In Ghana. Development, 57(3), 521-530. doi:https://doi.org/10.1057/dev.2015.25

    Owusu, P. K. (2021). The Impact of the National Health Insurance Scheme on Maternal Health Care in Ghana. University of Saskatchewan.

    Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., . . . Brennan, S. E. (2021). The PRISMA 2020 Statement: An Updated Guideline For Reporting Systematic Reviews. bmj, 372. doi:https://doi.org/10.31222/osf.io/jb4dx

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    Salam, M. A., Al-Amin, M. Y., Salam, M. T., Pawar, J. S., Akhter, N., Rabaan, A. A., & Alqumber, M. A. (2023). Antimicrobial Resistance: A Growing Serious Threat For Global Public Health. Healthcare, 11(13), 1946. doi:https://doi.org/10.20944/preprints202305.0555.v1

    Santos, W. M. d., Secoli, S. R., & Püschel, V. A. d. A. (2018). The Joanna Briggs Institute Approach For Systematic Reviews. Revista latino-americana de enfermagem, 26, e3074. doi:https://doi.org/10.1590/1518-8345.2885.3074

    Sen, G., George, A., Ostlin, P., & Ramos, S. (2007). Unequal, Unfair, Ineffective And Inefficient Gender Inequity In Health: Why It Exists And How We Can Change It.

    Sharman, A., & Holmes, J. (2010). Evidence?Based Policy Or Policy?Based Evidence Gathering? Biofuels, The EU And The 10% Target. Environmental Policy and Governance, 20(5), 309-321. doi:https://doi.org/10.1002/eet.543

    Sheikh, K., & Abimbola, S. (2021). Learning Health Systems: Pathways To Progress. Flagship report of the Alliance for Health Policy and Systems Research. Geneva: World Health Organization.

    Silver, J. K., Slocum, C. S., Bank, A. M., Bhatnagar, S., Blauwet, C. A., Poorman, J. A., . . . Parangi, S. (2017). Where Are The Women? The Underrepresentation Of Women Physicians Among Recognition Award Recipients From Medical Specialty Societies. Pm&r, 9(8), 804-815. doi:https://doi.org/10.1016/j.pmrj.2017.06.001

    Yamson, P., Tetteh, J., DeGraft-Amoah, D., Quansah, H., Mensah, G., Biritwum, R., & Yawson, A. E. (2021). Unmet Needs Of Healthcare Services And Associated Factors Among A Cohort Of Ghanaian Adults: A Nationally Stratified Cross-Sectional Study Design. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 00469580211028172. doi:https://doi.org/10.1177/00469580211028172

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  2. Acheampong, A. K., Ohene, L. A., Asante, I. N. A., Kyei, J., Dzansi, G., Adjei, C. A., . . . Nyante, F. (2021). Nurses’ And Midwives’ Perspectives On Participation In National Policy Development, Review And Reforms In Ghana: A Qualitative Study. BMC nursing, 20(1), 26. doi:https://doi.org/10.21203/rs.3.rs-50227/v3
  3. Agyepong, I. A., & Adjei, S. (2008). Public Social Policy Development And Implementation: A Case Study Of The Ghana National Health Insurance Scheme. Health policy and planning, 23(2), 150-160. doi:https://doi.org/10.1093/heapol/czn002
  4. Akazili, J., Ataguba, J. E.-O., Kanmiki, E. W., Gyapong, J., Sankoh, O., Oduro, A., & McIntyre, D. (2017). Assessing The Impoverishment Effects Of Out-Of-Pocket Healthcare Payments Prior To The Uptake Of The National Health Insurance Scheme In Ghana. BMC international health and human rights, 17(1), 13. doi:https://doi.org/10.1186/s12914-017-0121-7
  5. Akotia, C. S., & Anum, A. (2015). Gender, Culture, And Inequality In Ghana: An Examination Of Sociocultural Determinants Of Gender Disparity. Psychology of gender through the Lens of Culture: theories and applications, 375-394. doi:https://doi.org/10.1007/978-3-319-14005-6_18
  6. Alhassan, R. K., Nketiah-Amponsah, E., & Arhinful, D. K. (2016). A Review Of The National Health Insurance Scheme In Ghana: What Are The Sustainability Threats And Prospects? PloS one, 11(11), e0165151. doi:https://doi.org/10.1371/journal.pone.0165151
  7. Ameyaw, E. K., Ahinkorah, B. O., Baatiema, L., & Seidu, A.-A. (2021). Is The National Health Insurance Scheme Helping Pregnant Women In Accessing Health Services? Analysis Of The 2014 Ghana Demographic And Health Survey. BMC Pregnancy and Childbirth, 21(1), 201. doi:https://doi.org/10.1186/s12884-021-03651-6
  8. Amoah, P. A., & Phillips, D. R. (2018). Health Literacy And Health: Rethinking The Strategies For Universal Health Coverage In Ghana. Public health, 159, 40-49. doi:https://doi.org/10.1016/j.puhe.2018.03.002
  9. Ayanore, M. A., Adjuik, M., Ameko, A., Kugbey, N., Asampong, R., Mensah, D., . . . Manu, E. (2020). Self-Reported Breast And Cervical Cancer Screening Practices Among Women In Ghana: Predictive Factors And Reproductive Health Policy Implications From The Who Study On Global Ageing And Adult Health. BMC women's health, 20(1), 158. doi:https://doi.org/10.1186/s12905-020-01022-5
  10. Boniol, M., Kunjumen, T., Nair, T. S., Siyam, A., Campbell, J., & Diallo, K. (2022). The Global Health Workforce Stock And Distribution In 2020 And 2030: A Threat To Equity And ‘Universal’health Coverage? BMJ global health, 7(6), e009316. doi:https://doi.org/10.1136/bmjgh-2022-009316
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  13. Ebi, K. L., & Hess, J. J. (2020). Health risks due to climate change: inequity in causes and consequences: study examines health risks due to climate change. Health Affairs, 39(12), 2056-2062. doi:https://doi.org/10.1377/hlthaff.2020.01125
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  16. Habib, S., Khan, M. A., & Hamadneh, N. N. (2022). Gender Sensitivity In Accessing Healthcare Services: Evidence From Saudi Arabia. Sustainability, 14(22), 14690. doi:https://doi.org/10.3390/su142214690
  17. Jehu-Appiah, C., Aryeetey, G., Agyepong, I., Spaan, E., & Baltussen, R. (2012). Household Perceptions And Their Implications For Enrolment In The National Health Insurance Scheme In Ghana. Health policy and planning, 27(3), 222-233. doi:https://doi.org/10.1093/heapol/czr032
  18. Jehu-Appiah, C., Aryeetey, G., Spaan, E., De Hoop, T., Agyepong, I., & Baltussen, R. (2011). Equity Aspects Of The National Health Insurance Scheme In Ghana: Who Is Enrolling, Who Is Not And Why? Social Science & Medicine, 72(2), 157-165. doi:https://doi.org/10.1016/j.socscimed.2010.10.025
  19. Keville, T. D. (1993). The Invisible Woman: Gender Bias In Medical Research. Women's Rts. L. Rep., 15, 123.
  20. Kumbhar, U., Ashok, W., Nashte, A., Limkar, S., Patil, V., & Chaudhari, K. (2023). Globalization And Public Health: An Examination Of Cross-Border Health Issues. South East Eur J Public Health, 21, 171-180. doi:https://doi.org/10.70135/seejph.vi.450
  21. Lambin, R., & Nyyssölä, M. (2022). Two Decades Of Tanzanian Health Policy: Examining Policy Developments And Opportunities Through A Gender Lens. doi:https://doi.org/10.35188/unu-wider/2022/161-7
  22. Langer, A., Meleis, A., Knaul, F. M., Atun, R., Aran, M., Arreola-Ornelas, H., . . . Caglia, J. M. (2015). Women And Health: The Key For Sustainable Development. The Lancet, 386(9999), 1165-1210. doi:https://doi.org/10.1016/s0140-6736(15)60497-4
  23. Long, H. A., French, D. P., & Brooks, J. M. (2020). Optimising The Value Of The Critical Appraisal Skills Programme (CASP) Tool For Quality Appraisal In Qualitative Evidence Synthesis. Research Methods in Medicine & Health Sciences, 1(1), 31-42. doi:https://doi.org/10.1177/2632084320947559
  24. Matin, B. K., Williamson, H. J., Karyani, A. K., Rezaei, S., Soofi, M., & Soltani, S. (2021). Barriers In Access To Healthcare For Women With Disabilities: A Systematic Review In Qualitative Studies. BMC women's health, 21(1), 44. doi:https://doi.org/10.1186/s12905-021-01189-5
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  30. Salam, M. A., Al-Amin, M. Y., Salam, M. T., Pawar, J. S., Akhter, N., Rabaan, A. A., & Alqumber, M. A. (2023). Antimicrobial Resistance: A Growing Serious Threat For Global Public Health. Healthcare, 11(13), 1946. doi:https://doi.org/10.20944/preprints202305.0555.v1
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  33. Sharman, A., & Holmes, J. (2010). Evidence?Based Policy Or Policy?Based Evidence Gathering? Biofuels, The EU And The 10% Target. Environmental Policy and Governance, 20(5), 309-321. doi:https://doi.org/10.1002/eet.543
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  36. Yamson, P., Tetteh, J., DeGraft-Amoah, D., Quansah, H., Mensah, G., Biritwum, R., & Yawson, A. E. (2021). Unmet Needs Of Healthcare Services And Associated Factors Among A Cohort Of Ghanaian Adults: A Nationally Stratified Cross-Sectional Study Design. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 00469580211028172. doi:https://doi.org/10.1177/00469580211028172