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Ten years on and major pitfalls still hindering Ghana’s National Health Insurance Scheme

As the Government of Ghana gears up its plans to celebrate the 10th anniversary of its now internationally famed National Health Insurance Scheme, Ghana’s Universal Access to Healthcare Campaign today launch our own assessment of progress to date. Our new paper explains how 65% of the population is still paying out-of-pocket in the old ‘cash and carry’ system and that at the current rate of progress UHC will not be achieved until at least the year 2076. Our campaign argues that progress will continue to stall as long as the NHIS structure excludes the very people it seeks to protect through overly-burdensome and unworkable insurance premiums.

Next week Ghana’s National Health Insurance Authority (NHIA) will host a three day International conference in Accra with the theme: “Towards Universal Health Coverage: Increasing Enrolment whilst Ensuring Sustainability”.  The conference will attract Universal Health Coverage (UHC) practitioners, academia, policy makers, NGOs and CSOs in their numbers, and seeks to examine the successes and challenges of the NHIS, and elicit feedback and proposals for reform.

While the Universal Access to Healthcare Campaign (UAHCC ) welcomes the anniversary event, we are concerned that inherent pitfalls of the NHIS have been consistently left on the sideline over the past decade and if unadressed will stifle any prospect the NHIS has of achieving UHC in the near future. The UAHCC will convey this position at the anniversary conference, where we have been invited to participate in a panel discussion, but also in our own civil society forum today to which government officials and donor agency staff have been invited.

The paper launched today acknowledges some strengths of the scheme including its generous benefits package, comprehensive level of care and treatment coverage and relatively broad range of exemption categories. However, these strengths are only relevant to NHIS active members. The UAHCC calls on the Government of Ghana to act on the glaring short falls of the scheme including:

  • Lack of coverage and access to service: in 2012, only 35% of the population was recorded as being active NHIS subscribers – a less than 2% increase from 2010.  The NHIS is therefore irrelevant to the 65% of the population who still pay out-of-pocket in the burdensome and inequitable “cash and carry” system.  At the current rate of progress Ghana will not achieve UHC until 2076!
  • Exclusion of poor and low-income earners: a growing body of evidence shows that premium payments are beyond the means of a large portion of informal sector workers and constitute a significant barrier to joining the NHIS.  The rich are twice as likely to join and benefit from the scheme as the poor. The value of the premiums is in serious question – while constituting a massive obstacle to progress on UHC they constitute less than 5% of the total annual inflow to the NHIA.  There must be a shift in focus from extracting premium contributions from people who are evidently too poor to pay, to prioritising spending on health, for example through a reduction of inefficiencies and improvements to general progressive taxation.
  • Unsustainable and inequitable financial model: the NHIS was created with a solid financial base, however by 2011 it was facing a deficit of more than GHC 47.3 million.  This is due in part to large scale inefficiencies and cost escalation in the system and the continued belief that financial sustainability will be solved by increased enrollment of members from the informal sector.  More effort must be focused on identifying alternative sources of financing by tackling service provider fraud and corruption, reducing funding leakages and waste across the health system and by instituting progressive reforms to taxation.

 

 

Sidua Hor is coordinator for the Ghana Universal Access to Healthcare Campaign Coalition

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6 Responses to “Ten years on and major pitfalls still hindering Ghana’s National Health Insurance Scheme”

  1. Macarius says:

    Could you please send me a copy or the correct link to your paper “Our new paper explains how 65% of the population is still paying out-of-pocket…”? Thanks!

  2. Steve bright says:

    Can a citizen of ghana be denied emergency treatment due to no health coverages?
    Due to a vehicle accident
    Please respond as soon as possible
    Thank you

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Global Health Check was created by Anna Marriott and is currently edited by Mohga Kamal-Yanni