When the National Health Insurance Scheme (NHIS) was launched in 2003 to take over from the “cash and carry” system, the program was aimed at improving the health status of Ghanaians.

Barely a decade on, it has become clear that the increase in hospital attendance has led to improvement in the health status of Ghanaians culminating in improvement in good life expectancy level.

Apart from the premium payment by subscribers that is negligible, the NHIS is funded mostly by a 2.5% value-added tax and is the only health insurance scheme in sub -Saharan Africa that aims to provide a standardized, nearly comprehensive package of health services to all residents with no fees at the point of service.

Over the past 11 years, the NHIS has achieved very high population coverage, increased user access to curative services, and reduced out-of-pocket payments for those who are enrolled.

Despite these extraordinary gains, Ghana’s National Health Insurance Authority (NHIA) – the governing body of the NHIS – still faces a number of challenges, including escalating costs that threaten the long-term sustainability of the NHIS and inadequate use of evidence and monitoring and evaluation tools that would allow management to improve the quality and efficiency of health care for Ghanaians.

Owing to good initiatives being taken by the current management of NHIA there seems to be a hope that there could emerge “light at the end of the tunnel”.

The Opportunity

Health provider payment mechanisms – the way health care providers are paid to deliver the covered package of services – are an important but often under-utilized tool in the overall health financing policy tool kit.

As coverage expands in most countries, issues of financial sustainability, efficiency, and quality of care quickly rise to the surface. In 2010, Ghana’s NHIA began piloting capitation – a payment mechanism in which health providers are paid a uniform per capita fee for a set of health services – in an effort to control escalating costs, as well as improve the efficiency and effectiveness of health services and simplify claims processing.

As the NHIA is in the process of scaling up capitation in three additional regions, and later the whole nation, the officials of the NHIA would surely reflect on lessons learned from the Ashanti Region pilot.

That would ensure that the NHIA, regional health officials and the providers themselves have information about the capacity of providers to deliver the capitation services, where capacity gaps exist, and what options are available for closing capacity gaps through such as forming Preferred Primary Care Provider Networks.

Routine and systematized generation and use of data is necessary to successfully reform provider payment and achieve the NHIA’s other priority goals. The NHIA, which already regularly collects clinical, financial and membership data is developing tools and policies to make better use of data to inform decisions at all levels of the organization.

Our Work

To achieve the aim of sanitizing procedure for billing and receiving payments by the NHIA from service providers the authorities engaged various organizations and consultants to provide help.

After going through the pilot with the capitation, there seem to be hope that things would improve regarding health care and the roles of the service providers and their relationship with the NHIA.

The biometric registration is another tool of ensuring that only registered subscribers to the NHIA would be served at any of the NHIA registered hospitals and clinics.

As part of USAID’s five-year Health Finance and Governance (HFG) Project, it is working to support the NHIA’s transition to a more strategic and evidence-based health purchaser to promote financial sustainability of the scheme.

To this end some organizations are advising on the implementation of capitation scale-up around the development and management of Preferred Primary Care Provider networks and alignment of performance-based financing mechanisms with capitation.

The NHIA is also being supported to put in place routine tools to better manage and align all provider payment systems, including the institutionalization of routine provider mapping to track provider capacity to deliver essential services, an early warning system to manage provider responses to the incentives of capitation, and a national unified costing system to inform provider payment rate-setting and improve the efficiency of provider internal management decisions.

The NHIA is also being helped to build capacity to generate and use data for effective health purchasing through four interconnected tasks:

1) co-developing data dashboards that track key performance indicators for managerial action and feature real time access to data;

2) strengthening capacity in the foundations of monitoring and evaluation at all levels of the NHIA and facilitating the development of an organization-wide policy that will coordinate M&E activities across directorates;

3) improving the use of short-term operations research projects to address inefficiencies identified by the dashboards;

and 4) supporting a learning exchange with Taiwan’s National Health Insurance Administration, one of the world’s leaders in evidence generation and use in health insurance.

Source: NHIA WEBSITE AND

EANFOWORLD FOR SUSTAINABLE DEVELOPMENT

244 370345/ 0264370345/0208844791

abdulai.alhasan@gmail.com/eanfoworld@yahoo.com