Implementation Challenges of the National Health Insurance Scheme in Selected Districts in Ghana: Evidence from the Field

ABSTRACT

Ghana’s National Health Insurance Scheme, introduced in 2003, aims to remove financial barriers to health-care access and bridge the inequality gaps in health care. This paper reports on a study of the implementation process in four local government areas in southern and northern Ghana. The paper profiles key institutional actors and draws on qualitative interview data from 33 in-depth interviews. Findings highlight the gaps and challenges that have emerged in the implementation process. Issues of managerial capacity, inadequate and uneven distribution of medical facilities and health-care professionals, cost escalation, fraud and abuse, and reimbursement of providers threaten the sustainability of the scheme.

KEYWORDS:

• Accessibility
• challenge
• Ghana
• health insurance
• implementation

Notes

¹ Active members are subscribers with valid insurance cards and can access health care under the NHIS.

² See Ghana revises figures on NHIS coverage at: http://edition.myjoyonline.com/pages/news/201303/102239.php. Last accessed on 10-04-2013.

³ These comprise hospitals, polyclinics, health centers, clinics, pharmacies, chemical sellers, maternity homes, and community-based health planning and services.

⁴ A complete list of the benefits package and exclusion list can be found at www.nhis.gov.gh.

⁵ Cedi is the name of the Ghanaian currency, and the exchange rate as of February 9, 2013, was US$1 to 2.14. Thus, 20 GHS = US$9.3; 35 GHS = US$16.3 in southern Ghana while 7.5 GHS = US$3.5 and 12GHS = 5.6 in the north based on the day’s exchange rates.

⁶ Press Release: NHIA Begins Biometric Registration and instant NHIS ID Issuance at: http://www.nhis.gov.gh/_Uploads/dbsAttachedFiles/30(1).pdf. Last accessed on 1 August 2013.

⁷ See myjoyonline on stakeholders reject one-time premium; call for increase in NHIS levy published on 21 December 2012 at: http://edition.myjoyonline.com/pages/news/201212/99080.php. Last accessed on 2 September 2013.

⁸ This is a form of direct cash transfer or payout to the core poor in the Ghanaian society as a way of ameliorating their poverty.

⁹ See Missionary Hospitals to suspend NHIS services from Monday at: http://edition.myjoyonline.com/pages/news/201303/102452.php. And also NHIS crisis: Parliament summons Health Minister: http://edition.myjoyonline.com/pages/news/201303/102711.php Last accessed on 1 August 2013; NHIS Suspended in Mission Hospitals! … 4.8 Million Lives in Danger. Last accessed on 1 August 2013; Cash and Carry Returns as NHIS Crashes: http://www.dailyguideghana.com/?p=75971. Last accessed on 1 August 2013.