By: Israel D. K. Agorsor (iagorsor@ucc.edu.gh)
Ghana has sunken so low from years of retrogression, resulting from indecisive action on the part of her leaders, so that very tough decisions have to be taken now and going forward, to turn her situation around. And the presidents who will take those tough decisions must be prepared to be one-term presidents. Essentially, they will have to be "dead goats" because by the time they finish taking those difficult but necessary decisions, virtually no one will be prepared to vote for them.
The following represents an example of where a decisive action is needed but has been lacking. Ghana’s National Health Insurance Scheme (NHIS) is now dysfunctional because no one is prepared to take those decisions necessary to save it from collapsing. Where on earth will one come across a health insurance scheme that operates the way our NHIS does? Or are there really examples? The origins of our NHIS are rooted in the desire to help lift masses out of poverty. And so, its planning and implementation gave it ‘a rather broad’ social-intervention outlook, rather than letting it focus on closing the gap between the 'haves' and 'the have nots'; once a premium-paying adult is on the scheme, his or her children under 18 years or so are exempted from paying premium, no matter whether or not the fellow is so wealthy that he/she can afford to pay for all her children. Please notice this. Social interventions are usually targeted at some disadvantaged groups, not ‘mass rolled out’. That is why they are called 'interventions'.
Hence, if the present operators of the NHIS keep talking about funding-gap as the reason for the scheme's current difficulties, it follows that either the right premiums are not being charged, or there are too many exemptions in terms of those who should pay premium under the scheme, in addition to the fraudulent claims being made by some of the service providers. This is why it was even more bizarre that before the time was up for a holistic review of the scheme, a political promise was let loose upon us; the “one-time NHIS premium” promise emerged, and has since been abandoned. Years before we arrived here, I argued against a one-time NHIS premium, because it sounded rather populist and unrealistic, just like I have argued against free SHS promise in the past and will always argue against it. I understand the need for targeted social-intervention programmes, but I do not see the point in rolling out on massive scale social-intervention projects we have demonstrated lack of capacity to handle.
Many years ago, some persons went to university in Ghana and had two rooms for each person. On top of that, they were fed in ‘dining halls’. But what they left for generations to come after them is a shortage of rooms in our universities, a result of lack of foresight and preparation for the future that was to come. Somehow, they forgot that to whom much is given, much is expected. Years ago, when Ghana’s population was small, she had enough electricity supply to go round. But while they benefitted from it, they forgot that they needed to ensure that the future that was to come would need electricity too, to power its homes and industries. Several years ago, we introduced allowances for our compatriots in training colleges. Years down the line, we have had to cancel those allowances. Why? No sustainability is built in our programmes. We appear not to know the pathways to sustainable societies. We fail to take the path towards building a sustainable society.
Even then, the NHIS is still struggling, which only means it is time to review the scheme. The question is, who do the operators expect to close the so-called funding-gap? Understandably, the review that may hopefully see us closing the gap will come with some shocks, the kind only ‘presidents willing to be one-term presidents’ will be able to take, hence this decision and many more tough ones remain to be taken.
Admittedly, today, a tough decision has been taken. Sodom & Gomorrah is no more. In fact, I do not know whether the decision to pull it down is legally right or not. But one thing is clear. The decision and the action resulting in Sodom & Gomorrah's disappearance from the Ghana map must have been a tough one. The political ramifications cannot be lost on anyone. We have already seen placards by our compatriots now made homeless by the Sodom & Gomorrah demolition extolling the ‘virtues’ of Ghana’s leading opposition figure. These are the mind games that have over the years effectively boxed our presidents into a corner, forcing their hands off taking the difficult but necessary actions to make our nation great and strong. We are all poorer for it.
But honestly, a lot of tough decisions, and the political will to sustain them, are required to make Ghana work, to put her on a path to sustainable development. And the presidents who are prepared to take these decisions must have their eyes only on the next generation, not on the next election, because they obviously won’t be the favourites going into the next election. And that is the problem, see? Whatever it is, one-term presidents are needed in Ghana. And urgently too.
