|
Getting your Trinity Audio player ready...
|
Claim: A Facebook post by the NPP Youth Wing, published on April 15, 2026, claimed that healthcare in Ghana is free across all levels of care.
Verdict: FALSE. Healthcare in Ghana is not free across all three levels of care. The National Health Insurance Scheme, which finances the bulk of secondary and tertiary care, requires premiums and carries significant exclusions.
Full Text
A post on the Facebook page of the NPP Youth Wing, published on April 15, 2026, states: “Health care is free in Ghana. Whether primary, secondary, or tertiary.”
The post attracted over 50 reactions and 15 comments. It was published on the same day President John Dramani Mahama officially launched the government’s Free Primary Healthcare Programme, a flagship policy that removes point-of-care costs at the primary level.
It is likely the post was made in response to the public excitement surrounding the launch, conflating a policy limited to primary care with a broader entitlement covering all three tiers of Ghana’s healthcare system.
Verification
To verify this claim, DUBAWA examined Ghana’s healthcare financing architecture from its legislative foundations through to current policy, including the structure of the National Health Insurance Scheme, the scope of the recently launched Free Primary Healthcare Programme, hospital-level evidence of out-of-pocket costs, and Ghana’s own Universal Health Coverage performance data.
Ghana’s healthcare was never universally free
The starting point is history. Before 2003, Ghana operated what was popularly known as the “cash and carry” system, a pay-before-treatment model that required patients to pay out of pocket before receiving any care.
The system became a salient political issue, and the National Health Insurance Scheme was ultimately established under Act 650 of 2003 to provide a broad range of healthcare services to Ghanaians, replacing the cash-and-carry model.
The fact that an insurance scheme had to be created to address out-of-pocket payments is itself evidence that healthcare in Ghana was not free before, and that the NHIS, which requires premiums, did not make it unconditionally free either.
The National Health Insurance Fund, as stipulated in Act 650 of 2003, generates its cash inflows from five sources: a 2.5% VAT levy, 2.5% of SSNIT contributions from formal-sector employees, investment dividends, donations, and premiums paid by scheme subscribers. Premiums are a statutory feature of the scheme.
A healthcare system financed partly through compulsory premiums is, by definition, not free.
The NHIS has significant exclusions
Even for Ghanaians who are enrolled and actively paying into the NHIS, the scheme does not cover all conditions at all levels.
The NHIS covers outpatient, inpatient, oral and eye care, maternity, and emergencies, but excludes cosmetic surgery, HIV drugs, assisted reproduction, echocardiography, angiography, organ transplants, and most cancer treatments.
A healthcare system with these exclusions at the secondary and tertiary levels, where these conditions are typically managed, cannot reasonably be described as free.
A 2024 Ghana NCD Alliance report detailed NHIS coverage for non-communicable diseases and highlighted several gaps in the funding framework, including limited availability of NCD services and medications and high out-of-pocket costs for patients at higher levels of care.
It is precisely because of these gaps that the Mahama administration also launched the Ghana Medical Trust Fund, commonly known as Mahama Cares, to finance NCD treatment for conditions not covered under the NHIS.
Out-of-pocket costs persist even for insured patients
Beyond the formal exclusions, evidence shows that patients with valid NHIS cards are still being asked to pay at the point of care.
Some facilities resort to asking clients to pay top-up amounts due to NHIS indebtedness, meaning only those who can afford these top-ups can seek healthcare in recognised institutions, widening the health inequality gap and undermining the country’s efforts toward universal health coverage.
An investigation by The Fourth Estate found the problem extends to publicly funded hospitals.
Some hospitals built with public loans, tax exemptions, and state resources have been accredited by the state to operate only under private health insurance, turning away NHIS cardholders at their doors and effectively making patients pay twice for care at facilities their taxes helped build.
The National Health Insurance Authority, in response to a Right to Information request, admitted that it has no mandate to compel any healthcare provider to operate under the scheme.
The Free Primary Healthcare Programme does not cover all three levels
The NPP Youth Wing’s post was published on April 15, 2026 — the same day as the launch of President Mahama’s Free Primary Healthcare Programme.
It is likely the post was responding to or conflating that launch with a broader entitlement. But the programme itself does not support the claim. President Mahama, speaking at the launch, said: “At the primary level, everything is free of charge. Screening is free, and basic illnesses such as malaria, cholera, and respiratory infections will be treated at CHPS compounds with available medications.” The qualifier “at the primary level” is deliberate and consequential.
Health Minister Kwabena Mintah Akandoh further stressed that the NHIS remains crucial for referrals and specialised care at district, regional, and teaching hospitals — the institutions that constitute Ghana’s secondary and tertiary tier. Additionally, the programme itself is not yet nationwide: it will be implemented in phases between 2026 and 2028, beginning with 150 underserved districts, with nationwide coverage as the ultimate goal.
Ghana’s own UHC index contradicts the claim
Perhaps the most telling indicator is Ghana’s own performance on Universal Health Coverage. Ghana’s UHC index stands at around 56%, well below the internationally accepted target of 80% by 2030.
A country where healthcare is genuinely free across all three levels, primary, secondary, and tertiary, would not have nearly half its population outside the coverage threshold.
Conclusion
The claim that healthcare in Ghana is free, whether primary, secondary, or tertiary, is FALSE. Ghana’s healthcare has never been universally free.
The National Health Insurance Scheme, which finances the bulk of secondary and tertiary care, requires premiums and carries significant exclusions.
Out-of-pocket payments persist at all levels, including among insured patients.
The recently launched Free Primary Healthcare Programme, which the post appears to reference, covers only primary care, is available only in 150 districts, and is available only in its first phase.
Secondary and tertiary care remain under the NHIS framework. Ghana’s own UHC index of 56% further confirms that the system is far from providing free, universal coverage at any level, let alone all three.
