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Ghana’s National Health Insurance Scheme: It’s introduction and implementation process

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Claim: A Twitter User by name Mahama2024 says the National Health Insurance Scheme(NHIS) was started by Late President Rawlings and the NDC

The NHIS was introduced by the Late former President, Jerry John Rawlings

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The Ghanaian political system is faced with the ‘who started what’ syndrome where political parties play blame games and tease one another with achievements during their tenure. 

One such accomplishment to come under the radar is the National Health Insurance Scheme (NHIS).

On February 2, 2016, the National Women Organiser of the National Democratic Congress (NDC), Anita De-Soso, stated that the ‘National Health Insurance Scheme (NHIS) is not the brainchild of the New Patriotic Party (NPP). She said that the idea was conceived by the Catholic Church, and the late former President Jerry John Rawlings decided to pilot the concept in Dodowa and northern parts of Ghana.

A year later, the current speaker of parliament and then Member of Parliament (MP) for Nadowli North constituency in the Upper West region, Alban Sumana Kingsford Bagbin, claimed during a discussion on Accra-based Class FM on June 8, 2017 that the NHIS was introduced by Late President Jerry John Rawlings. 

Fast forward to 2021, what seemed to be a revelation some four years ago has been raised by Mahama2024, a Twitter user who also shares the same claim.

This claim has been retweeted by several users. One other user had the caption:

“Assuming power they tried stealing it for themselves by running it as a mutual (district-based) scheme instead of the ‘national’ as proposed and piloted by the NDC.

The Mills/Mahama government reverted it to the ‘National Health insurance scheme’.

Shameless elephants.”

Verification

What was the norm before the introduction of NHIS?

According to a working paper titled Ghana’s National Health Insurance Scheme in the Context of the Health MDGs – An Empirical Evaluation Using Propensity Score Matching, Ghanaian citizens enjoyed free medical services after independence in 1957 but economic and health infrastructural challenges in the early 1980s led to the introduction of a ‘cash and carry’ system as part of conditions of the Structural Adjustment programme, also referred to as the user fee policy, the ‘cash and carry’ system meant that patients or clients had to make direct payment at health facilities when they accessed health care.

Attempts were made during the period to introduce some form of health insurance to address some of the challenges of the ‘cash and carry’ system. For instance, according to research by Terence Darko in 1999, the government of Ghana, in partnership with the Ghana Health Care Company, piloted a tax-funded health insurance scheme with the aim of using revenue from taxes to pay for medical bills but not a single person was registered.

Other health insurance schemes without state backing, however, operated successfully. This included NGO-initiated community-based health insurance schemes (CBHIS), implemented by different actors including the St Theresa’s Catholic Mission Hospital at Nkoranza, the bilateral donors DANIDA (the Danish International Development Agency), the United States Agency for International Development (USAID), faith-based organisations, and other NGOs were said to be working successfully.

When was the NHIS Act passed?

The Parliament of Ghana passed the National Health Insurance Act in 2003 to outline plans for a healthcare system that would provide universal coverage to all Ghanaians and bring an end to the ‘cash and carry’ system.

The scheme was passed into law during the John Kufuor administration to secure financial risk protection against the cost of healthcare services for all in Ghana.

Currently, a new law, Act 852 has replaced Act  650 which was passed in 2003 to consolidate the NHIS, remove administrative bottlenecks, introduce transparency, reduce opportunities for corruption and gaming of the system, and make for more effective governance of the schemes.

When was the scheme introduced?

According to a research titled Kwame Nkrumah, vision and tragedy, the scheme, inaugurated in 2003, is the successor to the attempt by Ghana’s first president, Kwame Nkrumah, to provide free universal healthcare [Until the enactment of the new NHIS Act, 2012 (Act 852) that established the NHIA, the scheme operated semi-autonomously district-wide (public) mutual health insurance schemes (DMHIS)]. 

Which government implemented the scheme?

According to a Capacity Development Consult (CDC) research findings, when the NPP government assumed power in 2001, they had no clear road map on the structure and funding of the health insurance policy in their election manifesto and therefore provided a broad range of healthcare services to Ghanaians through district mutual and private health insurance schemes. 

A Ministerial Task Force, upon inauguration by the government in the first quarter of 2001, advised the Ministry of Health (MoH) on the development of a national health insurance scheme, and how the ministry will regulate and mobilize extra resources to support the scheme. 

The Task Force later presented the draft policy to the government for further stakeholder consultations at both national and local government levels. After reviewing the concerns and proposals raised in various stakeholder consultation forums, the Task Force updated the zero draft.

According to a research titled politics of accountability in Ghana’s National Health Insurance Scheme, conducted by Capacity Development Consult(CDC) in June 2016, the proposal proved contentious, as did other aspects of the basic structures of the scheme. Nonetheless, by the last quarter of 2003, the NHIS Act (Act 650) was passed into law. 

Jennifer Singleton’s research paper titled Negotiating Change: An Analysis of the Origins of Ghana’s National Health Insurance Act indicates the NHIS implementation began in 2004 before the presidential and parliamentary elections that same year. 

Another research work titled ‘The state of enrollment on the National Health Insurance Scheme in rural Ghana after eight years of implementation’ conducted by the International journal for equity in health on December 31 2019 states that, before the implementation process began, the Kuffour government piloted what they termed as the District and Mutual Health Insurance Scheme (DMHIS) across all Districts in the ten regions.  

The second phase of implementation according to Terence Darko’s research findings states that the NDC upon winning the 2008 elections set up a legislative process by the NHIA that culminated in the review of Act 650, which was duly superseded by Act 852 in 2012.

Another research conducted by the Economist Intelligence Unit reveals that the NHIS is also funded through individual annual premium payments; a value-added tax (VAT) levy contribution from those in the formal sector. 

New additions onto the NHIS

The National Health Insurance Scheme currently covers over 546 medicines from all district and regional hospitals across the country. The Authority has a total of 166 district offices & five registration centres. These centres report to the Membership and Regional Operations Directorate through the regional offices and are headed by managers. Registration of members and renewal of membership of the scheme is done at the district offices.

The Authority has also introduced new Biometric Cards which contain basic biographic information as well as biometric data of the subscriber. The card is valid for five years subject to yearly membership renewals. The card is now more electronic than physical due to the biometric nature of the data which is embedded in the memory of the card.

The benefits package includes outpatient and inpatient services and review, eye care, emergencies, oral health, and maternity care.

With the introduction of digitization and technology, subscribers can renew their membership using shortcodes on all telecommunication networks.

Conclusion

By the findings above, Dubawa concluded that the NHIS was introduced by late President Jerry John Rawlings of the NDC, but implemented by the NPP government led by former President John Agyekum Kuffour.

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