“trust as insurance”: The use of traditional risk management schemes to address financial barriers to the utilization of emergency referral services in rural communities of northern Ghana

Community-based financing schemes have been traditionally practiced across much of Africa for decades, including among various cultural groups in Ghana . This practice of risk sharing between community members involves mechanisms for covering both unexpected and anticipated expenditures of community members, including funerals, market and farming ventures, construction, and healthcare.

A community-based emergency referral programme is being introduced in 3 northern districts, as part of the Ghana Essential Health Intervention Programme (GEHIP). Presently, Ghana's National Health Insurance Scheme (NHIS) does not cover the transport costs of emergency referral. With many people unable to afford these expenses, GEHIP seeks to explore the use of traditional community financing schemes to support the sustainability and utilization of the referral system. An exploratory assessment was conducted with community members and health workers examining community financing operations, perceptions of its efficacy, and attitudes on both the feasibility and likelihood for community participation with a new emergency-specific community fund. This paper reports on the results of qualitative formative research indicating that such concepts are readily understood, feasible to introduce and plausibly sustainable with minimal start-up external revenue. In response, a project is being launched where a revolving account is established for each community, public gatherings known as durbars are used to build consensus for the scheme, and emergency transport providers are guaranteed immediate compensation due to the mobilization of the revolving fund.