The thesis empirically examines how microfinance products are designed and implemented, and the implications for clients’ households and sources of livelihood. The study argues that the design of products and implementation that reflect the livelihood needs and poverty context of clients is one of the effective ways to reduce poverty. It investigates the microfinance operations of three financial institutions: Sinapi Aba Trust (SAT), St Joseph’s Cooperative Credit Union (CCU) and Sonzele Rural Bank (SRB) in Jirapa, a municipality in Northern Ghana. The study deployed a mixed-methods approach to collect data from six rural and urban communities. Data was sought from secondary sources, 20 interviews, 10 focus group discussions and 120 questionnaires. The research adopted the Sustainable Livelihoods and the Making Markets Work for the Poor approaches as a guide in the framework of analysis. The study, using qualitative and quantitative analytical tools found that product designs of SAT and SRB did not reflect the needs and poverty context of the majority of their clients. Clients of SAT and SRB were found to be less involved in the product design processes, suggesting a top-down institutional approach that seldom incorporated the needs of the poor. The method of group formation has a substantial implication on members’ poverty outcomes. Groups involving only females had a significant and positive relationship with members’ household and business outcomes, while members of male-only groups had a negative relationship with their household outcomes. The thesis concludes that accessible interest on loans and incentives to encourage savings would make microfinance markets work more sustainably for the rural poor. The findings challenge a reconsideration of the design of microfinance products to integrate financial technology as an efficient approach to deliver financial services, especially in rural areas.

This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit.

This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit. / Ghana Education Trust Fund (GETFund)