The Free Primary Health Care Policy: A Major Boost For A Smooth March Towards The Attainment Of Universal Health Coverage

Introduction
In April, 2026, the Government launched the flagship health intervention, the Free Primary Health Care Policy, in the Greater Accra Region. Subsequently, there has been an enthusiastic roll-out of the policy in some Community-based Health Planning and Services (CHPS) Compounds, Health Centers, Rural Clinics, Polyclinics and in some designated District Hospitals located in deprived areas.

In this literature-based article, the writer briefly highlights the significance of the National Health Insurance Scheme (NHIS) as a key national strategy for the attainment of the much-touted Universal Health Coverage (UHC) and its limitations in that direction. A snapshot of the Free Primary Health Care policy is then provided, emphasizing its relevance for closing the accessibility gaps in the NHIS and its potential for helping accelerate the attainment of Universal Health Coverage for Ghana. The article concludes by suggesting important roles that various stakeholders can play in the successful roll-out of the Free Primary Health Care Policy.

The Free Primary Health Care Policy in brief.

The Free Primary Health Care policy covers preventive care, health promotion activities as well as curative care. Effective linkages and timely referrals underpin the policy to ensure well facilitated, coordinated and team-based care across contiguous health facilities. Under the Free Primary Health Care, well equipped health containers are to be deployed to places of high human traffic but with no nearby health facilities. The health containers, aside creating jobs for health staff, would serve as a point for health screening and First Aid in busy areas. Health containers or kiosks are in use globally in some of the world’s developed and developing countries, some even manning them with Artificial Intelligence (AI). With their planned roll-out, Ghana would be joining forward looking countries around the globe using simple but innovative approach to improve access to health for its population. As at mid-September 2026, approximately 5 months after the official launch, the policy was running in 4,574 facilities in 135 districts.

According to policy makers, the significance of the Free Primary Health Care intervention is to remove all forms of financial barriers to health care for health seekers at the first (primary) level of care. In this regard, the Government assumes full responsibility for the bills of all health seekers from CHIPS Compound up to polyclinic level and in the selected district hospitals. In other words, one does not need to present a National Health Insurance Card or make an out-of-pocket payment to access health care at the targeted level of health delivery under the Free Primary Health Care Policy. It is free to the health seeker but at a cost to the Government who reimburses health providers after submitting claims for services rendered. It must be stated, however, that from the district hospital level through the regional hospital level up to the teaching hospital level, the NHIS Card becomes indispensable for accessing health care.

The Free Primary Health Care policy is meant to shift the focus of Ghana’s health delivery efforts from a reactive-based system of ultimately expending hugely on the treatment of diseases to building a more preventive health culture.

Preparation and Roll-Out
Following the launch of the Free Primary Health Care Policy, the sector minister and heads of key health service delivery agencies of the Ministry of Health (MOH) such as the Ghana Health Service (GHS) and the Christian Health Association of Ghana (CHAG) have held series of marathon engagements with relevant stakeholders across the country. Through these high-powered engagements at institutional and community levels, there has been dissemination, awareness creation, clarification of misconceptions, and garnering of the needed support for the successful implementation of the policy.

In addition, for a successful roll-out, there has been a concurrent and generous retooling of health facilities forming the epicenter for implementation of the novel policy. Items distributed to implementing facilities as at the end of September, 2026 included over 7,000 motorbikes and tricycles, 30 prefabricated health kiosks and over 5,000 healthcare bags or outreach kits. Each healthcare bag is stocked with BP apparatus, glucometers, thermometers, MUAC tapes, stethoscope, among others to facilitate screening and treatment of minor ailments.

Furthermore, the Health Ministry is driving the effective implementation of the policy by tirelessly closing identified human resource gaps that can potentially impact the policy negatively. This is being achieved by prioritizing deprived districts and subdistricts for declaration of relevant health human resource vacancies for formal recruitment into the sector. In his latest tour of the Upper West Region this September, the President of the Republic announced the introduction of deprived area incentives, providing a significant boost for the Health Ministry’s attempt at redirecting new staff postings to fill vacancies in deprived districts and sub-districts.

Universal Health Coverage (UHC) within the Panoramic View of Primary Health Care

Since its formation in 1945, the United Nations (UN) and its member states have committed themselves to creating a world where all people would be safe from the debilitating impact of diseases, especially epidemics and pandemics. Between 1945 and 1978, the UN progressed from creating relevant institutions such as United Nations International Children Fund (UNICEF) and the World Health Organization (WHO) and fighting diseases vertically to working towards improving access, equity, community participation in health delivery. This culminated in the Alma-Ata Declaration of Primary Health Care as a universal strategy for Health for All by the Year 2000.

Despite its ambitious nature the Primary Health Care concept of 1978 failed to achieve its target of “Health for All” by the year 2000. That notwithstanding, the tenets of Primary Health Care were not abandoned but repackaged. In December, 2012, the United Nations General Assembly unanimously endorsed a resolution urging all member-countries to accelerate progress towards Universal Health Coverage (UHC). Attaining UHC by the year 2030, thereafter, became one of the UN Sustainable Development Goals (SDGs) adopted in 2015. There has, subsequently, been a renewed commitment to UHC at various UN High-Level Meetings. There was a renewed commitment to the tenets of Primary Health Care by the Astana Declaration in October, 2018, in Kazakhstan, reaffirming the Alma-Ata Declaration, with a new energy for Primary Health Care to drive UHC and the Sustainable Development Goals. Primary Health Care is, therefore, still relevant, almost five decades after its declaration. It is up to member-states to use it as an effective vehicle to move towards UHC and Ghana’s approach is to make primary health care services free.

The National Health Insurance Scheme (NHIS) and UHC

The question has been asked why the introduction of Free Primary Health Care when Ghana already has an efficient National Health Insurance Scheme (NHIS) which has become the toast of the global community. Over the years, Ghana has boldly introduced various broad national policies meant to keep it on track towards reaching the goal where all citizens would attain the health status that permits them to lead a socially and economically productive life. The NHIS which was introduced in 2003, with the passage of the National Health Insurance Act, 2003 (Act 650) is one of such national policies. Since its introduction, the NHIS has changed the health financing terrain of the country, significantly, improving health care coverage by reducing direct out-of-pocket payments and eliminating the catastrophic impact of self-financing on individuals and households.

The NHIS has also brought about uniform billing for similar procedures and treatments across provider institutions and serves as a basis and the platform for advocacy for subscribers to get fair and dignified treatment when seeking care. It has also sanitized health care delivery by setting limits to services through classification of provider-institutions based on physical infrastructure, clinical space, equipment and related procedures, human resource capacity and quality systems. What is thrilling is the client-protection nature of the NHIS where clients are insulated against inflated prices of health commodities because of the implementation of an approved tariff regime. Otherwise, inefficiencies in procurement and inflated health commodity prices could easily be passed on to the client translating into astronomical health bills. Indeed, the NHIS remains instrumental to Ghana’s march towards attaining UHC.

Despite the many benefits and prospects that the NHIS offers, some challenges still exist that impede unfettered access to basic health care for a significant portion of the population. These challenges cannot be blamed on the NHIS per se, but they are real.

Firstly, a significant proportion of the population are still not enrolled with the NHIS despite the unwavering attempt by the NHIA at all levels to improve the subscriber rate. In 2013, ten years after its introduction, coverage under the NHIS hovered between 36-40%. Coverage jumped to around 55% in 2023. Today, the NHIS covers over 60% of the population. Some sources, however, put the figure at 76% following deliberate membership drive campaigns and mass registration undertaken across the country since 2025. Whatever it is, we still have over 35% of the population who are still not enrolled unto the NHIS and who are without financial protection against ill-health. This situation clearly undermines the frantic efforts towards achieving UHC.

Secondly, continuous membership of the NHIS is based on annual renewals which many subscribers fail do and which tends to restrict their access to care under the NHIS. Several, incredible, reasons account for non-renewal of NHIS subscription such as lack of awareness of expiration of membership status, failure to renew membership because it feels like waste of money for paying premium year-after-year and not falling sick, etc. This means that, even if the entire population is covered by the NHIS today, many will still lose their active membership status within a year for non-renewal of their subscription.

Thirdly, technical challenges, usually at the point of care, such as health care emergencies and prolonged disruption in network connectivity between health providers and the NHIA may pose an “artificial” barrier to care for a registered member of the scheme, especially where overwhelmed healthcare providers are unwilling to empathize with the clients in such situations. Some NHIS active card bearers have recounted how they have paid for care out-of-pocket one time or another out of frustration or in pursuit of convenience.

In addition to the above, the NHIA still points to unauthorized co-payments in health provider institutions as obstructing smooth access to care for NHIS Card bearers. Health providers, other than denying the existence of co-payment, have often argued that they are pushed to implement co-payment when there is delayed reimbursement of their claims or when the approved NHIS tariff become unrealistic as a result of prevailing market dynamics.

Achieving more with the Alignment of NHIS and Free Primary Health Care

It is undisputable that the NHIS is a major national health care strategy for propelling Ghana towards the attainment of UHC, but it is also a truism that at any point in time, there may exist a portion of the population who remain without financial cover as far as health care is concerned. That unfortunate gap, which may take time to close, definitely serves as a serious drawback to the nation for a complete and timely attainment of UHC. The Free Primary Health Care Policy, therefore, comes in as a complementary and catalyst policy. Together with the NHIS, the two significant policies offer a better and more robust health protection for the population through a synergy that each of the two policies cannot deliver separately.

Since seeking health care under the Free Primary Health Care policy does not require an active membership card of the NHIS or a direct out-of-pocket payment, it makes a huge difference at the first level of care as far as access is concerned. Holding all other things constant, no one should, henceforth, feel reluctant to visit the nearest Free Primary Health Care CHPS compound, health center, clinic or polyclinic or any of the designated hospitals when they need health care for the mere reason that they lack money to pay the health bill. Even where transportation cost is envisaged to create a barrier to health care, the Free Primary Health Care policy makes provision for regular community and home visits, such that health care would be made available to citizens as closest to them as possible. The Free Primary Health Care Policy is, therefore, a boost as far as attaining UHC is concerned.

The policy also brings a huge relief to individuals such as chiefs, district chief executives, assembly members, members of parliament, pastors, siblings, friends etc., who are called upon regularly to send money to pay the health bills of relatives, acquaintances and others. The Central Government now takes over that role by covering all bills at the Free Primary Health Care level.

The role stakeholders
The policy should, therefore, be embraced and supported for a successful implementation. It requires collective action and top-level commitment and support to make it effective. To ensure continuity of care beyond the sub-district level, there should be a modality in place by the NHIA to promptly capture all beneficiaries of the Free Primary Health Care policy who are not covered by the NHIS for instant enrolment onto the NHIS. This will ensure that beyond the Free Primary Health Care policy space they can still enjoy health services unhindered.

The Ministry of Health should not relent on its efforts to ensure redistribution of staff by closing the gaps in human resource deployment in deprived areas. Also, government should be committed to the implementation of deprived area incentives, including granting early promotion and early release for further studies to loyal staff who accept posting to the deprived areas. Furthermore, there should be parity in the distribution of Free Primary Health Care Policy resources between implementing agencies of the Ministry to engender sustained action by all. There should also be an effective and well-coordinated Planned Preventive Maintenance (PPM) and programmed replacement scheme for the items supplied under the policy.

Local government authorities should also maintain roads linking their respective communities to facilitate smooth community outreaches by health staff. In areas where health workers are to gain access to communities on rivers and lakes, there should be safe boat services. Traditional leaders should collaborate with their respective district and sub-district team leaders and join forces with identifiable bodies such as churches, schools, the local youth association etc., to ensure periodic mobilization of the people for health education and screening, bearing in mind that “Health is Wealth”.

Health providers and their staff who operate within the Free Primary Health Care space should serve with dedication as their patriotic duty to the development of the country. They should endeavor to avoid the abuse, misuse, and diversion of Free Primary Health Care equipment and logistics. The submission of claims for reimbursement for services rendered under the Free Primary Health Care should be guided by accuracy and honesty.

Finally, every Ghanaian should make it an obligation to support the smooth and successful implementation of the Free Primary Health Care Policy in whatever way possible. Citizens in particular should know that they can now walk into any Free Primary Health Care Facility and get care without presenting NHIS active card or having to pay out-of-pocket. Citizens should therefore take advantage to do screening periodically and seek early treatment when necessary. The Free Primary Health Care must not only succeed today but should be made to remain through dedicated annual budgetary allocations because together with the NHIS, they provide the population with an enhanced coverage and financial protection, securing for everyone a peace of mind.

The Writer, Okatakyie Osei Yeboah Ansurowia is the Twafohene of Buoyem, Bono East. Known in official circles as Fred Effah-Yeboah, he is a Professional Health Service Administrator, a Public Administrator and a Development Expert.

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