Dr Kwaku Afriyie, Minister of Health, on Monday gave the assurance that by the end of 2004, more than 40 per cent of Ghanaians would be covered by the health insurance scheme, currently being developed to replace the cash and carry system.

"The government stands by its promises to the people of Ghana to replace the cash and carry system of payment of health care with a health insurance scheme." Dr Afriyie was speaking at a consultative forum on health insurance in Accra. The forum, under the theme: "fashioning out a policy framework-the way forward," was organised by the ministry.

The Minister said although a health insurance bill would be laid before Parliament in March this year, "there is still a lot more to be done in other aspects of health insurance in order to make it operational." He said a committee has been set up to study and make proposals on areas such as, actuarial review and costing.

The cash and carry system, which involves paying for health services at the point of service delivery, has been described as harsh on the poor, who are unable to access health services.

Dr Afriyie said it has been observed that attendance at health care facilities have in most cases either stagnated or declined over the years with the introduction of "fee for service" at the time of use.

"The current mode of payment for health service has, therefore, become a barrier to accessing quality health care." He said 47 organisations are being assisted to set up a mutual health insurance scheme, which involved non-profit organisations in the communities.

Dr S. A. Akor, Director of Policy, Planning, Monitoring and Evaluation at the Health Ministry, said health care financing still involved tax revenues and donor funding of about 80 per cent and 20 per cent of internally generated funds, known as the cash and carry system, which would now have to be replaced with health insurance.

He said within five years, 30 to 40 per cent of the population would be covered with a scheme, while in the medium-term, covering five to 10 years, 50 to 60 per cent of the population would also be covered by the insurance scheme.

"In the long-term, every resident of Ghana shall belong to a health insurance plan that adequately covers him or her against the need to pay out of pocket or at the point of service use," Dr Akor added.