Health for all? The realities of Ghana’s National Health Insurance Scheme
Author: Esther Azasi, Global Health Policy Student
In the past 20 years, health financing has occurred in two major stages in Ghana.
I remember when I was a child, there was a practice commonly called by many Ghanaians, the “cash and carry” system for health financing. To receive health care services, you had to provide money out of your pocket. Clearly, this system came with great challenges, leaving the poor even more ill because they couldn’t afford to access the health system.
It was a relief to many when a new government policy was introduced, known as
the National Health Insurance Scheme (NHIS), which aimed at providing universal health care to Ghanaians.
The NHIS operates as a common pool resource where the majority of citizens contribute to it, thus granting more people access to health care. Chronic disease care, often expensive to treat, is not however covered. Communicable diseases remain the primary target and are covered. But does it work? Sadly many challenges still exist. The poor are still very ill and continue to have the highest health cost burden which is not covered under the NHIS.
For my perspective, the health situation is worsening under the NHIS than it started because the scheme is constantly revised to eliminate some drugs and other treatments, further deepening the health problems of poor citizens and causing confusion to health providers.
A recent discussion within the Ghanaian media blames the low performing NHIS on corruption. According to them, the government and other top officials embezzle funds from the system and leave little to provide for the country’s health needs. Such accusations are sadly not too hard to believe. When I worked for a district-level health administration in Ghana, most facilities routinely complained about late arrival of NHIS funds. These delays made health care provision challenging and expensive. In other facilities, they oftentimes did not have drugs for several months due to stock outs. It is not hard to understand why some facilities seek to return back to the “cash and carry system!”
An interesting observation by OXFAM revealed that, although the NHIS is deemed successful, “millions of Ghanaians do not benefit.” Furthermore, although the NHIS officials claim people who are not benefiting are those who haven’t renewed their insurance, OXFAM officials believe these people are genuinely unable to renew their premium because they cannot afford it (Gadugah, 2013).
Ghana is not the only country struggling with health care financing. Evidence suggests that even though Tanzania and Kenya both introduced similar policies as well, 10 and 50 years ago respectively, only 17% of Tanzanians and 18% of Kenyans are presently covered (Gadugah, 2013).
There is a clear need for reform of health insurance policies in Ghana and elsewhere. While we wait and advocate for the restructuring of the NHIS, I appreciate Ghana’s attempt to provide health service to all of its citizens.
Gadugah, N. (2013, October Wednesday). We cannot go begging people to re-register onto NHIS- Ametor slams OXFAM report. Retrieved from Ghana|Myjoyonline.com|: http://www.myjoyonline.com/news/2013/October-9th/we-cannot-go-begging-people-to-re-register-onto-nhis-ametor-slams-oxfam-report.php