Last week, following President John Dramani Mahama's announcement that his next government in 2021 will introduce a "Free Primary Healthcare" for all Ghanaians, a lot of confusion has set in at the presidency, including President Akufo-Addo himself who went crying in the Ashanti Regional Chairman Wontumi's Television studios that he did not understand why President Mahama wants to take his job from him.
Seeing that President Akufo-Addo loves the presidency of Ghana so much judging by how he had been globetrotting inexpensive luxurious US$17,000/hour jet plane before coronavirus cut his "ororo" short, I can understand and sympathise with his frustration at Mahama's efforts to cut his pleasures short.
But what I find unpardonable is a certain Dr Anthony Nsiah-Asare's effusions that President Mahama's promise of a Free Primary Healthcare Plan is already being provided by the National Health Insurance Scheme.
No! No!! No!!! This cannot be true and it is not true.
And this man, Nsiah-Asare, is said to be an advisor on health matters to President Akufo-Addo? God save mother Ghana. If this man does not know the difference between a free primary healthcare plan and the current National Health Insurance Scheme(NHIS) being implemented in the country, then we have no business wasting our money on him as advisor on anything health to anybody.
A Free Primary Healthcare Plan means the removal of all barriers including financial barriers to accessing treatment for a category of certain diseases classified as primary diseases in healthcare terms.
But that is not what the National Health Insurance Scheme provides for Ghanaians at the moment. Indeed there are barriers to accessing healthcare under the National health insurance scheme, which includes:
SUBSCRIPTION PAYMENTS OR PREMIUMS.
To become a beneficiary of the National Health Insurance Scheme, you must first become a member of the NHIS by registering to obtain a membership card and to pay a membership fee and a processing fee which last for one year to enable your biometric data to be captured and entered onto the Scheme's IT platform.
ANNUAL RENEWAL OF MEMBERSHIP.
You must renew your membership by paying your subscription and processing fees yearly(annually) in order to continue to access healthcare with your NHIS card.
SANCTION FOR LATE RENEWAL
If you allow your membership to expire, that is, if you don't pay your subscription fee before the due date for expiration you will temporarily lose your membership and not be able to access healthcare with your card for one month even when you re-register. You have to wait. So if you are sick and you suddenly realize that your card had expired a week ago and you rush to renew it and go to hospital you will be denied care unless you pay cash for the service.
So dear reader, you see, there remained the single most important barrier to accessing healthcare even under the National Health Insurance Scheme, the ability to pay or the financial barrier, though it is much better than the "Cash and Carry" that it replaced.
It is also true that certain categories of citizens are exempted from premium or subscription payments such as:
- Children under 18years of age
- The elderly above 70years
- SSNIT Contributors
- Pregnant Women
- Newly born babies are catered for using the cards /membership of their mothers until they are old enough to be given their own membership.
But all these exempted categories of citizens must renew their memberships every year and pay processing fees to remain valid members of the NHIS and to access healthcare..
A Free Primary Healthcare Plan as proposed by President Mahama must, should and indeed remove all these financial barriers to accessing healthcare for primary ailments as will be defined under the plan.
FUNDING PRIMARY HEALTHCARE PLAN
Immediately the announcement was made by President Mahama, of a Free Primary Healthcare Plan for Ghanaians in his next government, his detractors in the New Patriotic Party(NPP) government went up in arms, suggesting that the promise was not feasible because it would be financially prohibitive, and a drain on the country's coffers.
This is not true in the least.
Let me point out to such skeptics that there already exists a source of funding, and additional sources of funding can be crafted by the NDC government.
Which are these sources of funding you may ask?
- National Health Insurance Fund.
There exists already the national health insurance fund (NHIIF) by which 2.5% tax (advalorem) on goods and services is charged and paid into. This is what is used to pay for services rendered by hospitals, midwiferies, pharmacies, laboratories, etc, etc and by the NHIA for the administration of the NHIS.
It is most unfortunate that the Akufo-Addo government has decided to take away 20% of this fund for expenditures completely unrelated to healthcare in this country. This has led to service providers under the NHIS not being paid for a long time lasting for almost a year. A restoration of the 20% is necessary to restore full funding for healthcare expenditure in the country. And such an action by the second Mahama government should free funds for the FPHC programme.
USE OF A PORTION OF OIL MONEY FOR HEALTHCARE FUNDING
Before 2011, Ghana had no income from oil and gas. The exploitation of new oil and gas resources has provided a new financial resource for public expenditure for the people of Ghana. There is a provision under the law regulating the use of our earnings from oil proceeds. Within this provision is the Annual Budget Funding Amount. Out of this amount, government can make necessary expenditures. Using a very small percentage of what accrues to the country to fund healthcare would benefit every Ghanaian as healthcare is a matter that concerns every single Ghanaian. What can be any better equitable use of our oil money than applying a part of it to a programme such as Free Primary Healthcare for every Ghanaian?
Let's pleasantly surprise ourselves by challenging our faculties to rise up to make this project a reality. Let us rise above the often retrogressive "Pull Him Down"(PhD) syndrome in this country and for once give ourselves one programme that benefits each and every Ghanaian.
Free Primary Healthcare is the way to go for equitable use of our resources to raise a healthy nation.
A country such as Cuba with far less resources than Ghana has used Free Primary Healthcare to craft a health system that has become the envy of even the so-called developed countries. I hope we have not forgotten the heroic hand of help that Cuba extended to some Western European countries during this worldwide ravaging coronavirus pandemic.
Let's do it, we can do it. Let's do it for Ghana.
The Writer was a former Deputy Director of Corporate Affairs of the National Health Insurance Authority(NHIA) the managing institution for the National Health insurance Scheme(NHIS)
JEAM INSTITUTE OF ECONOMICS
AND SOCIAL RESEARCH