The NHIS: Avoiding a Total Collapse

To avoid being cited for plagiarism as happened in the recent investiture of Ghana’s new president for failing to give credit to former American presidents for paraphrasing their words, I will diligently quote the words of the committee members of Ghana’s Parliament on the vetting of Mr. Kwaku Agyeman-Manu for the position of Minister for Health.

And now to the question and a quote, “On page 117 of NPP's manifesto that the NHIS has collapsed. How can you describe a scheme with a membership of 11m as a collapsed scheme?” Mr. Sampson Ahi enquired.

The response from the Minister designate with reference to collapse went like this: “Collapsing might have been a very harsh word.” Mr. Agyeman-Manu presupposes that the NHIS is not crumbling as such performing its role as prescribed by the Act that gave birth to it. Indeed he further went on to indicate that the NHIS is not about registering citizens, but rather the quality of health that citizens who obliged to the Act and got registered are required to receive.

He intimated further that there were times he was called upon by members of his constituency who have signed up to the NHIS who sought after medical services to come over and bail them out by way of making payment on their behalf before they will be released from health facilities. Thus contradicting his “collapsing might be a very hash word,” a presupposition that the NHIS is not meeting its mandate—making prompt payment to healthcare organizations within the country. And by further extension denoting that the NHIS program is collapsing by the Minister designee’s explanation.

To ascertain whether the NHIS is collapsing or otherwise, it is important to go into history and verify, this will give credence as to whatever conclusion we/I may come to. The National Health Insurance Scheme (NHIS) Act was passed in 2005, since then Ghanaians have from time to time signed up to the program with the intent of benefitting from it, since it will reduce the burden of paying out-of-pocket. Indeed the NHIS became the then candidate Kufour’s campaign slogan because a majority of Ghanaians complained about the high cost of healthcare services within the country. Upon ascending the throne of power in 2000, President Kufour kept to his promise by passing and implementing a health insurance program for the citizens of Ghana and christened it the National Health Insurance Scheme. A similitude of the British social health insurance model. Ghanaians welcomed this development, and whole heartedly put their trust in the new “savior.”

A peek at the Ghanaian media landscape, talks in the taverns, funeral places and other social gatherings indicated that Ghanaians were losing confidence and trust in the savior that was to salvage them from various ailments. The NHIS was failing or in most cases failed to execute its mandate as spelt out in the Act that established it. That is prompt payment to healthcare givers became a mirage as such patients were in some instances made to pay before services were rendered to them. Thus cash-and-carry begun to rear its ugly head in the NHIS regime from the Kufour era to the John Mahama government.

As the NHIS begun to underperform during the Kufour period, and as politicians have the propensity to anchor on issues that inures to their benefit, then candidate Atta Mills capitalized on the poor performance of the program and asked Ghanaians to vote for him to revitalize the program. “One time premium payment” became the slogan for his campaign. He promised to make funds available to the program so as to make Ghanaians access healthcare services delivery from providers without any form of hindrance.

Professor Mills won the 2008 elections and took over the mantle of government; remittances to healthcare providers remained the same as it was under President Kufour’s era. Late remittances to healthcare providers meant that resources to run healthcare facilities were getting depleted, and to avoid the situation of closure of facilities, management of most health institutions resorted to cash-and-carry.

This scenario replicated itself into the John Mahama era, and as usual the NPP under candidate Nana Akufo-Addo made a campaign slogan out of it. It was mostly highlighted by his vice Dr. Bawumia—the NHIS started under Kufour is collapsing under the “incompetent John Mahama regime.” Vote for the NPP and we will rejuvenate the program was the cry of Nana and his vice.

From the above, we/I may conclude that the NHIS failed to execute one of its main functions as spelt out in the Act—failure to make prompt payment to providers except for President Nana Addo’s regime which is still in its early months if not year.

The way forward is to avoid total collapse of the NHIS so as to secure Ghanaians from out-of-pocket payment for healthcare services. The NHIS was/is a commendable policy but its implementation was poorly executed hence the situation it finds itself. Nevertheless once the problem has been identified, and the necessary remedies followed, the program/policy will be able to sustain itself financially. The main issue of the Ghanaian program is its “Father Christmas” nature for all beneficiaries; this is not to suggest that the “social” feature of the NHIS should be done away with.

A glance through health insurance literature across the world indicates that to make the Ghanaian system financially sustainable so as to meet the demands of citizens and needs of providers; it is incumbent upon President Nana Addo to gather all Ghanaians both home and abroad with background in health insurance policy to recarve a program that befits the Ghanaian situation, with the private sector taking a lead role and government taking up the regulatory responsibility so as to avoid overexploitation of the private sector.

Government must also maintain the present regime to take care of the poor and vulnerable in society. I strongly believe that if this suggestion is adhered to, the Ghanaian model will become the best in the world. Sticking to the present path of the policy will spell its doom in no time.

(The writer is a freelance policy advocate practitioner)