For women, accessing health care depends largely on the ability to have access to resources and the control of these resources. It also depends on the ability of these women to make personal health decisions.

However, studies have found female head porters also known as 'kayayei' experience challenges when accessing health care due to marginalisation.

The gender and migrant status of these migrant 'kayayei' make them very vulnerable.

Salamatu is a 26-year-old migrant from Mamprugu Moagduri District, one of the six districts in North East Region, Ghana. She migrated to Kumasi about 3 months ago.  

“I migrated because there is a high rate of poverty in our district and there is no one to help you come out of it. One has to therefore devise strategies in order to survive. I therefore decided to come here to earn some money to help my family back home” she said.

She is married with 5 children, the eldest is 13 years and the youngest, 4. Her husband is a peasant farmer. She earns about 40 to 50 Ghana cedis a day.

She sleeps in a kiosk with about 12 other kayaye friends. She said, “The one difficulty I and my friends are having now is with accommodation. We have been asked to move out of our current habitat and we are still struggling to get a new home”

Salamatu has a national health insurance card which has expired but she has not renewed it due to financial constraints. She hasn’t been ill since she arrived here.

But she says she will prefer to buy drugs from the pharmacy shop rather than go to the hospital due to the huge money involved in paying hospital bills.

For the vulnerable?

The National Health Insurance Scheme was brought to birth in 2004. Its primary aim was to ensure that all persons resident in Ghana can access basic health care services.

To be able to achieve this aim, the vulnerable in the society were exempted from making annual premium payments so as to enable them access healthcare easily without any financial restrictions or barriers.

Amongst the vulnerable groups enlisted to benefit from the scheme are the ‘‘indigent members’’ of the society. This, with no iota of doubt will include migrant Kayayes who earn about 20-30 Ghana cedis a day

Despite all these measures put in place, how friendly is the NHIS to these Kayayes?

Some of these Kayayes leave their health insurance cards when migrating. Others also have expired health insurance cards and do not have enough money to renew them.

‘‘I do have a health insurance but it has expired. I haven’t made enough money to renew it. If I renew it, I will take my child to the hospital to have his leg repaired,’’ Salamatu’s friend, Aisha said.

Without valid health insurance cards, even those insured, end up facing similar financial barriers to healthcare as the uninsured migrants.

Migrant Kayayes mostly exclude themselves from accessing formal healthcare from hospitals. This is because, they are usually torn between using the money earned for survival – buying food, clothes among others-or for healthcare.

According to a 2018 report in the Sage journals, many migrants only seek health care when it is critically necessary.

They prefer to prioritize self-care for illnesses. This is because seeking formal medical care will cause them to lose their hard-earned income and even potential income.

“When you take your ill child to the hospital, you will have to pay even for a prescription form and then the drugs. In the case that you cannot afford these, you can’t take your child there,’’ another Kayaye at Adum, Adisa lamented.

Migrant Kayayes work all day to pay their daily survival costs and also accumulate enough money to learn a trade or fend for their families back home.

They therefore buy drugs from drug store as temporary fixes to address health problems.

“I am here to gather some money to take home. I’ll use the money to learn a trade. I want to be a hairdresser,” another Kayaye, Asibi said.

The NHIS addresses equity access to healthcare: enrolling particular groups including the vulnerable and also achieving Universal Health Coverage for all citizens and persons with legal residence.

According to the WHO, sufficient financial resources are needed by the government to finance the exempted services. This is crucial for Free Health Care policies in order to contribute towards Universal Health Coverage.

Some NGOs such as the Kayaye Youth Association have been instituted to help these vulnerable individuals.

Banks, like other corporate institutions, have Corporate Social Responsbility like MTN which can target vulnerable in society. In many instances, these institutions support such causes which fall within their budget.

Therefore, some NGOs who seek to help kayayei acquire extra skill to help them generate more income, can make such requests and may get some help to support these kayayeis.

Financial barriers and a lack of health insurance prevents migrant workers from utilizing health care in many settings.

Therefore, culturally appropriate care or specific migrant-friendly health services can be put in place to help improve health service uptake and health awareness among migrant Kayayes and collectively realize our goal of Universal Health Coverage.