The hidden ingredient: Healthcare for sustainable cocoa farming

Margaret Amponsah and her family have been growing cocoa for years in Tetekasum, a small village in Ghana's Suhum region. The organic cocoa beans they harvest are used in some of the world's finest chocolates, enjoyed by chocolate enthusiasts around the globe. Yet, behind this premium product lies a hidden worry: until recently, Margaret and her family had no access to health insurance.

This isn’t just Margaret’s story; it’s the reality for countless farming families across Ghana and other cocoa-growing countries. Despite their hard work and the high value of their produce, only about 15 percent of the rural population has access to health insurance, despite the availability of the National Health Insurance Scheme (NHIS), a state-run service.

The reasons for this disparity are complex and multifaceted:

1. Financial barriers present a significant hurdle, as many families find the costs associated with enrolling in and maintaining coverage beyond their reach.
2. Geographical challenges exacerbate the situation, with remote villages like Tetekasum often lacking the infrastructure to access healthcare services easily. Poor roads and inadequately equipped facilities contribute to this problem.
3. A pervasive lack of trust in the healthcare system discourages many from seeking the necessary coverage.

As a result, a vast number of Ghanaians remain vulnerable, without the essential healthcare services they require. This widespread absence of coverage threatens individual health and limits the overall well-being and development of communities nationwide.

When illness strikes, farmers without health insurance are burdened with high out-of-pocket costs for care and medication, including expenses for even basic treatments, such as those for malaria. Routine doctor’s visits, diagnostic tests, and emergency room visits can lead to overwhelming bills. For chronic conditions, the ongoing need for treatments and specialist consultations can quickly become unmanageable. Previously, all too frequently, farmers were forced to ignore symptoms in the hope they would improve, but when conditions worsened, the resulting hospital bills often pushed families into deep poverty.

Savita Essel Mensah, nurse from Kromameng Chips Health Center, Suhum, Eastern Region of Ghana

Smallholder farmer Margaret Amponsah joined an organic cocoa cooperative ten years ago in Tetesakum. “They buy my cocoa, and I benefit from organic fertilizers and spraying machines. Additionally, they pay premiums during the off-season.” However, despite these benefits, until recently, whenever she fell ill, she had no health coverage and had to decide whether she could afford to see a doctor. In 2022, that changed when elea portfolio venture Elucid partnered with the cooperative and introduced a healthcare program to farmers and their families in Tetesakum. “This is my membership card. Now, when we get sick, all treatments are covered. They even enrolled two of my sons and four grandchildren under the policy.”

Through the initiative, more than 1’100 cocoa farming families from Margaret’s cooperative have better access to health services, and together with partners, Elucid has expanded to many other communities across Ghana, Madagascar, Venezuela, and Ecuador. Farmers gradually gain confidence in the medication and treatments they receive by having regular access and being more informed. They feel more empowered to ask questions about the services provided while spending less time getting access to treatment. Furthermore, health insurance increases available household income. Farmers can invest their savings in better nutrition, the education of their children, and the further advancement of their businesses – to name a few.

To encourage farmers like Margaret to take an active role in their healthcare journey and ensure they value these services, they are required to contribute to their healthcare costs.

Nurse Savita Essel Mensah remarks, “Since the partnership with Elucid and the subsequent healthcare coverage, farmers consistently come to the clinic when they’re ill, and they also bring their children when they need care.” This model not only significantly improves the health and well-being of farmers in a sustainable way, but it also benefits healthcare providers, such as community health centers and hospitals. The increased patient volume translates into higher income, as the center receives faster, more reliable reimbursements than out-of-pocket payments. This, in turn, enhances the quality of care by enabling better staffing, access to advanced equipment, and more resilient healthcare systems. Most importantly, it leads to healthier rural farmers, creating a positive ripple effect throughout the community.

When a cocoa farmer falls ill, it jeopardizes their livelihood and the delicate balance of the broader chocolate supply chain. Without health insurance, unexpected treatment costs can reduce productivity or force harmful coping mechanisms, such as resorting to child labor, borrowing money, or selling land to cover expenses. For more information on some health insurance benefits, you can read this document by Elucid.

The broader implications for chocolate manufacturers who rely on these farmers are significant. Poor health among farmers reduces productivity, affecting the quality and consistency of the cocoa supply and, consequently, impacting the consumer price. By integrating healthcare access into the supply chain, chocolate manufacturers can help safeguard the well-being of the farmers who are vital to their industry.

Adopting this proactive approach not only ensures a more stable and productive supply chain but also addresses underlying issues of poverty and inequity. Creating a more sustainable and fair system benefits everyone involved – from the farmer to the final consumer – resulting in a healthier and more resilient industry.

Cocoa supply chain actors play a crucial role from the outset, beginning with identifying farmers within their supply chains. Elucid then maps nearby healthcare providers. Community workers who engage directly with both farmers and healthcare providers facilitate enrolment. Healthcare providers are onboarded and trained on using Elucid's digital platform while farming households are involved in awareness campaigns and training sessions. Once the program is operational within a community, farming households can benefit from improved healthcare access, including national insurance enrolment, essential and emergency care, and mobile clinics.

Throughout the program, Elucid ensures smooth execution by verifying farmer eligibility, reviewing reimbursement claims to prevent fraud, and ensuring that healthcare providers receive payments within 72 hours of rendering services. As farmers make their healthcare visits, Elucid collects and analyzes health and socio-economic data, allowing them to monitor impact, inform stakeholders, and provide valuable insights for data-driven decision-making. This streamlined approach ensures the program functions efficiently and delivers tangible benefits to all parties involved.

Elucid enhances healthcare access for small-scale producers by closely collaborating with national health services, such as the NHIS in Ghana, focusing on strengthening and improving existing systems. By bolstering current healthcare frameworks — particularly in critical areas like maternal health and emergency care — Elucid expands coverage and enhances the sustainability of these systems. This collaboration increases membership and extends the reach of national and local insurance providers. In doing so, Elucid aligns with and supports the broader goals of national health programs.

Co-founder Samuel Knauss resumes: “Access to healthcare is a fundamental human right and a catalyst for resilience. By improving access to care and protection from impoverishing health expenses, we support the well-being and livelihoods of farmers, ultimately strengthening the sustainability and resilience of the supply chain."

Author: Romy Sauer, Communications Specialist at elea