Ghana revises figures on NHIS coverage

Ghana’s official delegation to a global ministerial conference on universal health access in Geneva, Switzerland, last week has conceded that a status report on the National Health Insurance Scheme (NHIS), issued by a coalition of NGOs and other civil society actors last year was useful input into government’s own assessment of its healthcare coverage.

The campaign group’s report had maintained that even though the NHIS was introduced to improve access to healthcare Ghana, there are many challenges that have culminated in the defeat of the objective of the scheme.

The Ghana Campaign on Universal Healthcare in Ghana, there are many challenges that have culminated in the defeat of the objective of the scheme.

The Ghana Campaign on Universal Healthcare, made up of the Alliance for Reproductive Health Rights (ARHR), ISODEC, SEND Ghana, Oxfam GB and several others contended in its report that the manner in which the NHIS is funded is unfair.

This, they said, is because it is funded mainly from revenue generated from VAT which is regressive, and imposes a higher tax burden on low income households.

The group’s report put enrolment rates of the NHIS as at 2010 at a mere 18 per cent of the population.

The report also cited the second major obstacle to achieving universal healthcare under the NHIS as the high level of out-of-pocket (OOP) payment that still dominate healthcare financing in Ghana, eight years after the launch of the scheme.

OPP payments according to the report accounted for just over a third (37%) of the total national health expenditure in 2009.

Higher OOP payments at point of service, it said, have been noted to impoverish poor patients and limited access to live-saving care.

It observed that, in order for countries to reduce the burden of health expenditure on low income households, the WHO has recommended that countries must reduce OPP payments to around 15% of total health expenditure.

In response to the report, the Ghana Health Service and the National Health Insurance Scheme managers have until the Geneva meeting put up a spirited defence of the scheme’s performance, and in the process, have casted doubts on the integrity of the data provided in the report.

During his submission on the agenda item relating on monitoring and evaluation in governments’ efforts at achieving universal health coverage, the Chief Director at the Ministry of Health, Dr Sylvester Anemena, who led the Ghana delegation observed: “I am sure you all know about what has come to be known as ‘the Oxfam Report’.

This report declared that coverage of the NHIS was as low as 18%. This was actually very helpful and prompted us to revise our figures. We now know that 34% of the population is covered not 67% as previously thought.

In Ghana, we are now doing a lot more to improve our monitoring and evaluation and in this way civil society is helping us”.

For the Coordinator of the Ghana Universal Healthcare Campaign, Sudua Hor, who sat in the meeting, the admission that the report that was so much basterdised was after all useful in revising government’s own data was a sobering moment.