Household resilience among fish value chain actors during the COVID-19 pandemic in Malawi.

We analyse household resilience capacities during the COVID-19 pandemic in the fishing communities along Lake Malawi by using FAO's resilience index measurement assessment (RIMA) methodology. The study is based on a sample of 400 households, and we employ the multiple indicators multiple causes (MIMIC) model to estimate resilience capacities. The model uses household food security indicators as development outcomes. Our findings show that the COVID-19 pandemic significantly reduces household food security and resilience capacity. COVID-19 shocks that significantly reduce household resilience capacities are death and illness of a household member. Important pillars for resilience building are assets, access to basic services and adaptive capacity. These findings point to the need to build assets of the households, build their adaptive capacity, and identify innovative ways of improving access to basic services to build household resilience capacities in the fishing communities. We recommend providing external support to households that have been directly affected by the pandemic through the death or illness of a member because their capacities to bounce back on their own significantly declines.

Exemption for the poor or the rich? An assessment of socioeconomic inequalities in Ghana's national health insurance exemption policies.

Out-of-pocket payments for health are considered a major limitation to universal health coverage (UHC). Policymakers across the globe are committed to achieving UHC through the removal of financial barriers to health care. In Ghana, a national health insurance scheme was established for this purpose. A unique feature of the scheme is its premium exemption policies for vulnerable groups. In this article, we access the nature of socioeconomic inequality in these exemption policies. We used data from the Ghana Living Standards Survey rounds six and seven. Socioeconomic inequality was assessed using concentration curves and indices. Real household annual total consumption expenditure adjusted by adult equivalence scale was used as a wealth indicator. Four categories of exemption were used as outcome variables. These were exemptions for indigents, individuals <18 years, the aged and free maternal service. The analysis was also disaggregated by rural and urban locations of individuals. We found that while overall national health insurance scheme (NHIS) coverage was concentrated among the wealthy, all categories of premium exemption were concentrated among the poor. There was also evidence of a general decline in the magnitude of inequality over the survey years. With the specific exemptions, inequalities in exemption for indigents and maternal services were most relevant in rural locations, while inequalities in exemption for individuals <18 years and the aged were significant in urban areas. The findings suggest that the exemption policies under the NHIS are generally progressive and achieve the objective of inclusion for the underprivileged. However, it also provides lessons for better targeting and effective implementation. There may be a need for separate efforts to better target individuals in rural and urban locations to improve enrolment.