The NHIS and its challenges

; why health care providers must take more of the blame.

Since the establishment of the National Health Insurance (NHIS), its challenges have always been blamed on the National Health Insurance Authority (NHIA) because of the latter’s mandate and oversight responsibility in ensuring the success of the scheme.

However the Universal Access to Health Care Campaign (UHCC) acknowledges that the success of the NHIS hinges not only on the NHIA, but also on important role of health service providers in fulfilling their part of the contract signed with the NHIA - provision of quality health services in a manner that addresses the health needs of each and every patient that seeks health care on the ticket of the NHIS. Hence, poor service delivery by health care providers under the NHIS is an act that defeats the purpose for which the scheme was established. While we do not intend to overlook the critical role of the NHIA, we wish to state that much of the frustrations of the NHIS clients are experienced at service delivery points (Health facilities) and health providers must be blamed for failing to meet their part of the contract. The complains of the ordinary NHIS client from 37 Military Hospital, Korlebu, Komfo Anokye to Brahakekumi, Nakpanduri, Atua, Brong Ahafo are self-evident. Since 2004 to date, NHIS clients across the country have complained of some key issues including the following:

? Charging of illegal fees and exploiting clients. ? Unprofessional attitude to work by way of verbal abuse, and undue delays. ? Referral of clients to some private medical health facilities that are not NHIS service providers, when indeed that such can be obtained from the hospitals they have been referred from. For example the CEO of the Komfo Anokye Teaching Hospital cautioned doctors working at the hospital to desist from such unethical practices since defeats the purse of the NHIS.

? Sale of drugs to clients with the excuse that particular drugs are not included in the medicines list.

? Abuse of clients by hospital front line staff etc.

? Use of unqualified staff by some private health facilities - this is very serious and must be checked

These issues are many and varied, and have contributed to reducing the confidence of a section of the general public in the NHIS. Even though these malpractices have been observed across the country, they are more prevalent in the urban health facilities.

In light of the forgoing, the Universal Access to Health Care Campaign wishes to call on the general public and stakeholders in health to hold health care providers more accountable for the things that do tend to derail the efforts of the NHIA. Service providers should not forget that they have a contract with the NHIA, and the contract stipulates that, the NHIA pays the health providers to provide a certain range of service to clients, and for the Service providers to meet their part of the contract by proving services to clients in an efficient and professional manner.

Another area which needs more attention is the mental health care services. Clients are insured to get the best benefits when ill, but unfortunately private health facilities do not take care of mental health. This is discriminatory to most women and children.

By the Ghana Health Service standards, both private and public health facilities are supposed to have comprehensive health care services available for all who patronize these facilities. Research conducted by MIHOSO in two districts in Brong Ahafo revealed that, all private health facilities do not attend to mental illness. At least, the service providers should be able to provide basic mental healthcare services to clients who need it.

It is with this that the UHCC is calling on the health service providers under the NHIS to up their game in the dispensation of quality healthcare since its impact goes a long way to affect the success of the scheme.

In this regard, health care providers should:

? Demonstrate professionalism in their duties

? Provide prompts and more efficient services.

? Make NHIS clients their number one priority so as to whip up consumer confidence in the scheme.

? Stop inflating claims

? Stop engaging unqualified staff (this is associated with some private health facilities)

Conclusion

Quality health care is what we need, not just health services, and this is the concern of the NHIS clients. Therefore, everybody, must play his part to ensure health care providers give us their best.

All over the world, quality health care is topical and a major concern for the people who pay for it.

It is an undisputable fact that, Ghana has made a lot of head way in ensuring that the NHIS is sustained but the role of stakeholders must be well defined. We also propose a reward and sanction policy for providers. In this regard, we are calling for a strong gate-keeper system that will ensure that NHIS clients and patients in general get the value for their money.

Our Recommendation

• The NHIA must also work more closely with civil society , and support them where possible, to monitor heath care providers. This means that NGOs, faith-based and Traditional authorities must wake up to hold the health care providers to be more accountable to clients. It also means ensuring that health care providers honour their obligations as stipulated in the contract they have signed with the NHIA.

• The NHIA should strengthen its clinical audit units to proactively deal with all the corrupt practices that affect the scheme. If possible, the NHIA should establish an institute or centre to be fully in charge of Investments, Leadership issues, fraud and quality assurance.

• The biometric registration and capitation should be rolled out nationwide to reduce fraud in the system.

• Health care providers must improve the quality of their services to clients.

• The Ministry of Health and Ghana Health Service must monitor private health facilities more regularly to prevent the use of unqualified staff, and to ensure that quality health care is provided.

Signed: Gabriel Benarkuu: Executive Director: MIHOSO (Mission of Hope) Brong Ahafo network of NGOs (BANGO ) 020 8500875

Sidua Hor : National Coordinator : Universal Access to Health Care Campaign Coalition 020 770 8938

Over 120 community members from Kotri, Abessim Brekum, Asutifi, Bechem, techiman, Odumase, Adantia, kotokrom, and Kenyasi ( 7 districts in Brong Ahafo)