The Collapse of NHIS and the Return of Cash and Carry Reveal Mahama's Incompetence
The National Health Insurance Scheme (NHIS) was introduced for the first time in Ghana by the Kufuor government in December 2004, with a goal to provide equitable access and financial coverage for basic health care services to Ghanaians. The reason for setting up the health insurance was to allow Ghanaians to have free basic health services and also to enable them contribute a minimal amount into a fund so that in the event of sickness, contributors could be supported by the fund in order to receive free or affordable health care. However, the NDC on assuming power created a lot of controversies around the NHIS. Before they assumed power, they promised all Ghanaians a one-time payment premium. However, when they got power, they argued that the sustainability of the scheme would not be possible if the premium is not paid on yearly basis. This marked the beginning of Mahama's failed or broken promises.
Healthcare financing continues to stir debates around the world. Ghana, under the various governments since the return to civilian rule, also continues to explore different ways of financing the health system. New and innovative ways of funding the health care system are needed due to the fact that our healthcare system is chronically under-funded. In Ghana, most health care is provided by the government and largely administered by the Ministry of Health and Ghana Health Services.
The healthcare system, as presently constituted, has five levels of providers: Health posts – which are first level primary care for rural areas, Health Centres and Clinics, District Hospitals, Regional Hospitals and Tertiary Hospitals. The government, financial credits, Internally Generated Fund (IGF) and funds from donors – Some hospitals and clinics are run by the Christian Health Association of Ghana which provides healthcare. Ghana has about 200 hospitals. Some profit making clinics exist, but they provide less than 2% of healthcare services. Healthcare varies through the country with urban centres having most healthcare facilities, whilst rural areas are often deprived. Patients in the rural areas either rely on traditional medicine or travel great distances for healthcare. The system of health, which was formerly operated, was known as the “Cash and Carry” system, where many people died because they did not have money to pay for their healthcare needs. Under this system, the health need of an individual was only attended to after initial payment for the service was made even in cases of emergency.
A lot of complaints, especially concerning the weakness in the health insurance system, have been lodged by many concerned Ghanaians. Some providers perceived that the introduction of the NHIS had led to service abuse by the insured. The insured frequent the facilities with minor ailments and even attend to collect drugs for their uninsured relatives and friends. Some insured clients even offer their insurance ID cards to the uninsured for a fee to use to access health care. The high attendance and perceived service abuse by the insured had led to an increased workload for providers. Providers experience long working hours with little or no break times. However, providers were not motivated
enough by the NHIS and government to compensate for the heavy workload experienced. Some insured patients also complain of having being turned away and longer waiting times because the provider chose to prioritize those who were ready to pay in cash. Other problems identified included inadequate logistics and human resources, limited space within the hospitals to cope with the increasing number of service users and “moral hazard” on the part of policy makers.
The NHIS has constantly been mismanaged by president Mahama and his administration in terms of their inability or refusal to pay the service providers. As a result, the government’s debt to the service providers has risen from GHC79 million to over GHC100 million. As a result of government’s indebtedness to the NHIS service providers, subscribers of the NHIS now have to pay for essential drugs needed in time of emergency. It is feared that the debt owed by the government will continue to increase which will cause a crippling effect to this laudable scheme. This has created a serious situation where the service providers are unable to pay the pharmaceutical companies. This is worrying, indeed, because the Chamber of Pharmacy has suspended the supply of drugs to the hospitals on credit since August 2014.
There are two schools of thought which explain why the present government is not living up to its promise to continue the NHIS it inherited from the previous government. The first school of thought affirms that the Mahama government has a secret agenda to bring down or collapse every good thing Kufuor did in terms of development. It is not only the NHIS which Mahama is consistently neglecting but also school feeding programme, Zoom Lion and all roads and housing projects which were began by the Kufuor regime have been abandoned by Mahama. The Kumasi Sofo line road expansion and the 400 housing project at Asokore Mampong are cases in point. Mahama’s claim that there is no money cannot be trusted because he has sunk millions of dollars into Nkrumah circle road expansion and Kasoa-Winneba highway. Where did Mahama conjure the dollars from? The second school of thought considers Mahama as corrupt, inexperienced and stubbornly misplacing his priorities all the time. Why should the Black Star players receive a total of about $70,000 each after placing second in the AFCON competitions and still deciding to get each player a brand new jeep Cherokee. Will the money to be spent on these luxury cars not be able to pay a part of the debt owed to Zoon Lion or the school feeding programme? That is Mahama for you. A president elected by the people but says openly says “yentie obiara”.

The National Health Insurance card is gradually becoming useless and ineffective since many pharmacies and private hospitals have refused to accept the card, and essential drugs are now offered on cash and carry basis. Oh Mahama! Health Insurance Service Providers Association of Ghana (HISPAG) has constantly threatened to withdraw their services if the government and the National Health Insurance Authority (NHIA) fail to pay all arrears owed them. To express their anger, frustration and seriousness, they issued a two-week ultimatum to that effect during the latter part of 2014. The Association feels that the government’s debt of over GHC100 million is very disturbing and potentially dangerous for the scheme’s survival. All efforts to compel Mahama and his government to pay have fallen on deaf ears. Mahama is not ready to listen to anyone. The NHIS continues to take a nose dive in almost all the regions in Ghana. Card bearers of national health insurance premium have often been turned away from accessing the facility, especially in private hospitals and pharmacy shops.
When the health insurance scheme was introduced by the Kufuor government, pregnant women were exempted from the health insurance premium. This policy of exemption was a strategy to increase coverage of maternal health services in Ghana. The number of pregnant women that flocked the hospitals received free drugs and ante-natal care. Premium exemption for pregnant women took a nose dive when Mahama became the president of Ghana. Free maternal care was suspended and pregnant women now have to pay for child delivery and care. Those who are not able to afford are retained in the hospital and are only discharged when a family member, a friend or husband, if any, pays on their behalf.
One of the key functions of the health insurance is to provide financial support against high cost of health care, yet evidence of such protection has been inconsistent. To help raise funds to sustain the insurance scheme, a certain amount has been placed on all goods and services. Such amounts are deducted and sent to the national health insurance account. Where have all these monies gone to? The purpose of collecting these monies has been defeated. Will the account ever be audited to show how the money was spent?
The National Health Insurance is on the verge of collapse. If what the government owes to the service providers is not settled, it will not be long, before the NHIS gives way to cash and carry system completely.
Written by Stephen Atta Owusu
Author: Dark Faces at Crossroads
Email: stephen.owusu@email.com