title: Community concepts of poverty: an application to premium exemptions in Ghana's National Health Insurance Scheme.
abstract: BACKGROUND
  Poverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana's National Health Insurance Scheme.
  
  
  METHODS
  We employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty.
  
  
  RESULTS
  Community defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community.
  
  
  CONCLUSIONS
  The in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care.
authors.affiliation: School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Ghana. okailey.aryeetey@gmail.com
authors.forename: Genevieve C
authors.initials: GC
authors.lastname: Aryeetey
authors.forename: Caroline
authors.initials: C
authors.lastname: Jehu-Appiah
authors.forename: Agnes M
authors.initials: AM
authors.lastname: Kotoh
authors.forename: Ernst
authors.initials: E
authors.lastname: Spaan
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Arhinful
authors.forename: Rob
authors.initials: R
authors.lastname: Baltussen
authors.forename: Sjaak
authors.initials: S
authors.lastname: van der Geest
authors.forename: Irene A
authors.initials: IA
authors.lastname: Agyepong
mesh_terms: D005869:Ghana; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D020380:Needs Assessment; D011203:Poverty; D012111:Residence Characteristics; D012959:Socioeconomic Factors