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24 November 2009 | Feature Article

National Health Insurance Scheme: How are Persons with Disabilities Benefiting?

The National Health Insurance Scheme (NHIS), established in 2005, I believe was in response of the hardships that Ghanaians were facing in-terms of the cash-and-carry health care system established in 1982. Obliviously, the cash-and-carry health care system was not very beneficial as many Ghanaians struggle to even “put a meal on their table”. The cash-and-carry system, health care became an additional financial barrier to many Ghanaians. It discouraged many Ghanaians from seeking necessary health care services and rather depended on other treatment services, tradition healing, and prayer camps. The NHIS, though, still has some setbacks, is a preferred health care system relative to the cash-and-carry system due to its perceived benefits. There is no doubt that many more Ghanaians are patronising the NHIS currently as compared to when the program first started. Some of the reasons for the increase patronage of the NHIS are: (1) There is no need to pay cash at the point of delivery of health care services, (2). Some medications are covered under the scheme, (3). Children are covered under the scheme when parents have Social Security, and (4). Adults with Social Security can have their parents covered under the scheme. The premium becomes a pool of resource from which every member benefits. One pays only about 12 Ghcedis for the whole year and no more worries about the health care needs. That sounds so relieving, isn't it?

However, poverty trends based on various studies estimate that about 40 percent of Ghanaians are poor and unable to access health facilities, get adequate shelter, clothing and education. And about 14.7 percent out of the 40 percent are classified as "extreme poor" and hence incapable of catering for their basic human needs, including their nutritional requirements. Disability and poverty are said to be intertwined, reinforcing each other. Thus, it goes without saying that majority of persons with disabilities are also poor and hence unable to access health facilities. But, the NHIS is a poverty reduction strategy that would reduce excessive poverty, and enhance the overall quality of life of Ghanaians. It is therefore heart-warming that, the NHIS recognises the need to make provision for the poor and vulnerable in society (include persons with disabilities) to reap the benefits of the NHIS by creating an exempt category.

However, according to a World Bank Document “Although the purpose of the NHIS is to provide a pro-poor alternative to the cash-and-carry system, there are still problems with identifying and registering indigents who are: (i) “exempt” from coverage……..”

The question remains, “Who is an indigent”? The term indigent as indicated in the NHIS policy seems very ambiguous and hence leaves the NHIS staff with a great deal of discretion as to who they consider to be an indigent. Many persons with disabilities are left out of the exempt category due to the excessive discretion of the NHIS staff resulting from the lack of clear criterion for determining who qualifies to be indigent, coupled with the negative perceptions that society holds about persons with disabilities. Persons with disabilities are hence unable to access the NHIS and enjoy its benefits, thus compounding their plight.

Recently, according to the Public Agenda, Mr Andrews Narteh Donkor, Scheme Manager, Manya Krobo District Mutual Insurance Scheme, said “….government had just approved the decoupling of parent/child registration, which meant that all children below age 18 could be registered on their own even if their parents were not registered.” This is indeed good news. However, persons with disabilities will also be very happy if the issue of indigent is clarified in order for them to readily access the NHIS just as children might soon do.

Good health care policies that will provide access for the healthcare needs of persons with disabilities is a necessity which the Persons with Disability Act (715, section 31) emphasizes; “The Ministry of Health in formulating health policies shall provide for free general and specialist medical care, rehabilitative operation treatment and appropriate assistive devices for persons with total disability.” It imperative for NHIS to also endeavour to include assistive devices (e.g., crutches, callipers, wheelchairs, white-canes, hearing aids) and rehabilitative operation treatment in the coverage of NHIS. The general conditions of persons with disabilities are already overburdened with educational, social, architectural, transportation, institutional and information barriers, as well as poverty. Free access to health care might lessened their plight.

The government of Ghana is trying to improve the lives of persons with disabilities in the country; the passage of the disability law, the inauguration of the National Council on Persons with Disability, and the recent appointment of an acting Executive Secretary for the council, all attest to this fact.

I therefore implore the president and the ministry of health to consider the issue being discussed. Health is a basic human right because health has a strong linkage with life. Depriving persons with disabilities from enjoying quality health amounts to depriving them of their right to life.

Augustina Naami
[email protected]

Development / Accra / Ghana / Africa /