National Health Insurance Scheme (NHIS) is a scheme basically put in place to finance health care in Ghana. The scheme was given birth to in 2003 after successful enactment of NHIS law act 650 of 2003 by Parliament, it was indeed a major electioneering campaign message for former president John Agyekum Kuffor in the year 2000.

Health insurance was introduced first in Ghana by a visionary Dutch doctor Rev. Dr. Inneke Bossman at Nkoranza, St. Theresa's Hospital in 1992, this laudable initiative poked the politicians to actually realize that health insurance is feasible in Ghana.

The health insurance was initially District Mutual Health Scheme that is, it was district centered and not national in character until amendment of act 650 into act 852 of 2012. The insurance mobilizes money through membership premium, 2.5% VAT on selected goods and services, SSNIT contributions from workers in the formal sector etc.

As it is synonymous with the wider majority of Ghanaians, some unscrupulous people are scheming day and night to make sure this saviour doesn't see the light of the day. Surprisingly both educated and uneducated people are scoring the same horrible mark when it comes to this and are very guilty of this unsavory act; this hernious act is either as a result of ignorance or sheer wickedness with malicious and criminal intent.

HEALTH WORKERS FACTOR
Health workers who have been trained with the taxpayers money to safeguard the nation some intended sharing this confidence reposed in them into pieces and dump them into the dustbins. Some health workers deliberately created avenues to dupe the scheme at the slightest opportunity;

1. Polypharmacy, a lot of drugs unrelated to clients condition are intentionally or ignorantly given to patients just to inflate the amount.
2. Substitution of drugs on claim sheet, a drug which causes less is given to a client but an expensive version is written on the claims just to dupe the scheme eg carbocistein is written in place of simple linctus, Arthemeter lumefantrin written in place of Artesunate Amodiaquine or Diclofenac written in place of acetaminophen etc
3. Filling of claims for ghost client, some providers also keep client information and use it with impunity to fill claim sheet when the client hasn't even visited the facility.
4. Abuse of tariff, certain tariff were intentionally abuse for selfish and parochial interest. Typical example is wound dressing, where all minor wounds are indicated by most providers as requiring 14 days treatment just to milk mother Ghana dry.
5. The quantity of drugs given to clients are intentionally given at alarmingly abysmal level with professional negligence in the name of money making.
6. Diagnosis and drug mismatch

CLIENTS FACTOR
1.Provider shopping, clients move from provider to provider with same condition and therefore same medications leading to increase in cost to the scheme.
2. Impersonation, clients with the card takes the complains of their sick colleagues who do not have insurance in order to secure drugs for them.
3. Some Clients have erroneous impression that government would cheat them if they don't access health care with their card throughout the year, therefore feigning sickness in order to get drugs which might not be used at all.
4. Clients refusal to renew their cards on time and dubiously get stickers when sickness sets in thereby denying the scheme the needed timely revenues.

NHIS STAFF FACTOR
1. Improper vetting of claim sheets before effecting payment, therefore allowing visibly erroneous claims to be paid.
2. Shabby claims verification by NHIS staff in the various health facilities, claims with questions are allowed through.
3. Unofficial collusion of NHIS staff and providers for personal gains at the expense of the entire scheme and the country at large.
4. Improper training of NHIS community agents which breeds a lot of nepotism and cronyism and serves as insensitive to people who have genuine desire to promptly renew their insurance on time.
5. A lot of inexperienced temporary staff at the claims office, who do not actually have the capacity to contest any wrong claims.

GOVERNMENT FACTOR
1. Excessive politicization of this noble social intervention program.
2. Immatured and uneducated comments by some politicians, this over shields the civil servants in charge from their wrong decision which they are supposed to be held criminally liable.
3. Failure of government to promptly pay levies collected on behalf of the scheme into the schemes account is sicking, nauseating and detrimental to the survival of the scheme.

WAY FORWARD.
1.It is very important for all of us as citizens to recognize that we are all very important stakeholders in the survival of this flagship scheme
2. Our nation should be placed first in all what we do as Ghanaians, self serving interest should give way for patriotism.
3. Punitive sanction regime should be put in place to check the "greedy Bustards" in the system who wants the downfall of this scheme.
4. A repackaged capitation system should be reintroduced to check provider shopping.
5. Sensitization of the general population on the need for the sustainability of the scheme and it's bountiful returns.
6. Political players should leave technical work for technical brains
7. Proper training of all staff (providers and NHIS) to achieve efficiency.
8. Strengthening of national clinical audit team to recoup all illegally paid money.

If we don't safeguard this God sent policy, the vulnerable and marginalized would be most affected and posterity would never forgive we the few enlightened ones who stood aloof and contributed to it's collapse through our actions and inactions.

Shaibu Issif (Jnr Prof)
Concerned citizen
0548437494