Healthcare – 5 Ideas to make Nhis work

Healthcare delivery in Ghana is bedevilled with several bottlenecks; from insufficient healthcare practitioners across the country to infrastructure and systemic failures and challenges.

Not a day passes by without several patients dying out of sheer negligence, bad infrastructure or bureaucratic challenges. The needless deaths we experience on the healthcare front can be largely prevented by changes in policy. Below are five simple but instructive ideas which can make the National Health Insurance Scheme (NHIS) more efficient and effective in its role as a largest social protection scheme in the country. 

Raise premiums

As of the end of 2013, the NHIS had a subscriber base of about 10.2 million, according to the Health Minister’s statement on the status of the NHIS to parliament on 11th February 2015. In the said report, the minister asserted that claims payments were in arrears of an average of 5 months across the country. Also, there has been consistent funding gaps at the scheme; in 2014, the funding gap was in excess of GH¢299 million and is projected to reach an astonishing GH¢ 803 million in 2018. 

No insurance scheme can survive with such funding gap; it is bound to collapse at some point. The NHIS funding currently comes from five major sources; the NHIS levy, premiums, grants, donations (usually foreign aid) and from the Social Security and National Insurance Trust (SSNIT). Any country worth its sort cannot depend on outside funding for its healthcare. 

It is such an important and delicate area that to assign cost to external partners has very serious national security implications.

To close these funding gaps and become independent, the NHIS should increase premiums on high income earners. According to the NHIS website, the minimum premium is set at GH¢7.2 to GH¢48.00 (maximum) per year. These amounts are woefully inadequate to provide any meaningful healthcare delivery. The proposal is for income earners above GHC1000 to contribute relatively higher premiums. This will help subsidise that of low income earners while increasing revenues for the scheme. Currently, most high income earners prefer to subscribe to private insurance schemes where they pay in excess of GHC100 per year. However, to increase premiums will be a function of service efficiency.

Let NHIS manage its own funds

Under the present arrangement, all the NHIS levy’s collected by the Ghana Revenue Authority goes into a consolidated fund, where payments to service providers of the NHIS are paid from. This presents administrative challenges and inefficiencies. To prevent corruption, the government can seed off the management of the NHIS funds to independent trustees who will manage and oversee the financial generation and commitment of the scheme. 

Resolve image problems

The NHIS has an image problem when it comes to middle to high income earners. This is usually due to the drugs provided by the scheme. The NHIS medicines list caters for mostly low/cheap generic drugs and the perception about cheap drugs is that they are of lower quality.Though this is debatable, many middle to high income earners, do not feel comfortable taking NHIS prescribed medications. 

To resolve this problem, the scheme can introduce an element of co-pay at the point of drug purchase by the patient. Here, the patient pays for the difference between the costs of the NHIS preferred drug and the preferred choice by the patient. This idea has a latent opportunity for people to abuse the scheme; however, with proper monitoring and institutional checks and balances, it should be possible. 

Do not elect the CEO 

(politicisation)

The NHIS Chief Executive Officer (CEO) is appointed by the government in power. Previous governments and the present have seen a gold mine at the NHIS so they are quick, like most state institutions, to put their favourites at the helm of affairs. The result has been CEOs who sing to the tune of their masters, hence their inability to institute corrective and brave ideas to enhance the scheme’s operation. 

To resolve this, the CEO position should be an open application to all qualified people in the world, especially Ghanaians. The performance indicators for the position should be clearly spelt out and assessed to see on a regular basis if the CEO is delivering according to his/her mandate. This will make the office of the CEO more efficient and effective in the execution of its duties.

Make the NHIS website a healthcare support system

Looking at the current design and content of the NHIS website (www.nhis.gov.gh), it is used more as propaganda machinery for the government and the NHIS. Administrative and current affairs news should not be the major content of the website; that is if they are even important to the main reason for the scheme. 

The website should be a directory of several ailments, their causes, prevention measures and other educational content which could get Ghanaians to be more health conscious. It should be a tool which becomes a reference point for anybody wanting to know about diseases, medications and healthcare advice.

Conclusion

The NHIS holds the potential to make Ghanaians enjoy a good life. However, politics and administrative challenges can take us back to the days of cash and carry. The health of a nation cannot be treated as an afterthought; it is a serious issue which borders on national security and should be treated as such. GB

• The writer works at Creative Trends, Organisers of the African SME Summit Email: dreamingafrica@africansme.org