Ghana’s Pursuit of Universal Health Using NHIS As A Financing Tool

Recently the coverage of the national health insurance scheme has increase in terms of its members, and as to how the system is offering to its client the quality of health care is not clearly known to majority of the public. Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. The National Health Insurance Scheme (NHIS) on the other hand is a social intervention program which was introduced by government to provide financial access to quality health care for residents in Ghana.

Since 2009, the scheme has been in deficit each year, not forgetting the growing membership increasing hospital attendance and healthcare cost. We should not forget that the scheme is funded by 2.5% levy on goods and services collected under the Value Added Tax (VAT) 2.5 percentage points of Social Security and National Insurance Trust (SSNIT) contributions per month, return on National Health Insurance Fund (NHIF) investments, premium paid by informal sector subscribers. We as a nation are worried about the system and service given and the problems the workers within the system are facing. We should then ask ourselves are the funds enough and can sustain the scheme, if yes then why is the scheme facing a lot of financial difficulties, why is the system, as vital as it is, has not being provided with quality internet service for their work and what initiatives is the government taking to see to the delivery of better health care system for the people and I believe NHIS systems effectiveness one way or the other depends on the few elaborated points.

Readily availability of Funds; unlike the government hospital which is being controlled by the government and fund by the government, the Private hospitals one way or the other depend on the payment of the their service to the public via NHIS to run their hospital. Not forgetting the pharmaceutical shops who serve the patients with medicine. I had an interview with a vendor of a pharmaceutical shop who complain of them not receiving their payment for a very long time.as a result of this, assuming this agency rely solely on the payment of drugs to run their business ,indirectly the government who is supposed to create job is rather closing down jobs.so in other for private hospital and other pharmaceutical shops to save their head earning established job, they are left with no other option than to stop accepting NHIS,this will result in killing the interest of the people, killing the aim of establishing NHIS. This will send us back to our old cash and carry health care delivery, which was the primary aim of primary health care.

Increase coverage of the NHIS: There should be an increase in the coverage of drugs of NHIS.I believe that the idea of NHIS was not to cover drugs and health care service which are more affordable for the public if it was to be a cash and carry system. This has really cause a huge declination in the interest of people is the sense that people go to the hospital and are given drug they can buy. The drug being affordable is not what am taking about but it efficacy, how best it can help the sick person. When they go to the counter, some are advised to buy drugs with high efficacy if they only want the best of the drug.

Education to the Public: I believe that for a policy to work and be of great success, much of it is dependent on the involvement of the public or the people. When NHIS was introduced, many people who were not ready to register for the service because they saw themselves as people who hardly get sick and if they pay and never fall sick meaning they have been cheated. I believe am not the only one who heard this. I suggest that the NHIS officials should organise a public education to get more people to register, this can increase the support the registration fees contribute to sustain the system. People should be aware of the things it covers and things it does not. The education should be done by going to the communities but not on television where it is less possible that the information will reach the people.

Regular Evaluation: the system should be checked by making an annual assessment from their records, the general public and other agencies like the hospitals and the pharmacies ,to know their strength and weakness and know how to go about it .The system should be evaluated to if we are getting closer to the primary aim of the scheme. Does the scheme aim to cover 60% quality health care or total, if some percentage for a start, will there be an increase in the coverage of disease and drugs and is it improving our health system or not. We should compare the goal of the scheme to the funds need to make it possible. Since the issues of deficit, has the government taken any initiations to negotiate and do something about it? The ministry and the board in charge of NHIS should not take decision for the people and should include the general assemble into consideration by asking for their opinion on how the system is can be improved, what can be in place to make the system work best for them.

To conclude, I would like to make emphasis on the fact that for NHIS to work efficiently and effectly does not lie in the hands of the government only but also in the hands of invidual and the people of the country as a whole. Our attitude towards it will really make a difference. Again for the system to sustain and reach it aim and goals needs adequate funds. I humbly suggest that instead of allocating small portion of funds to the system, the government can either increase or channel a whole income from lets says cocoa production and other income, because if our health system is really improved our economy will surely improve as a country because health of the citizens affects the socio economic life of the country and if the government is thinking of improving the economy, the health of the people should be their priority.

Jacob Yedonu
2^nd Year Physician Assistant Student
University of Cape Coast