Ghana’s health insurance system not working for many – Oxfam

Ghana’s most hailed health insurance system, the National Health Insurance Scheme has been criticised as being inefficient and not working for many.

Oxfam International says the reported official coverage is also exaggerated. The system according to Oxfam is not benefiting many poor Ghanaians who need the system most.

Oxfam indicates in a report on Ghana’s health system which was released today March 9, 2011 that the “major health insurance system that the World Bank is pushing as a successful model for other developing countries is severely flawed and not working for many Ghanaians.”

The CEO of the National Health Insurance Authority (NHIA), Mr. Sylvester has said on TV Africa recently that 16.8 million Ghanaians are registered on the scheme, but Oxfam says that figure is exaggerated. According to Oxfam however, the actual figure of Ghanaians who are actively covered by the scheme “could be as low as 18%” of Ghana’s population.

Speaking to on the phone, Oxfam’s Ghana Country Director, Mr. Sebastian Tiah said the data as kept by the NHIA doesn’t allow for estimation of the actual number of people who are benefitting from the scheme. He said the NHIA uses cumulative data to tell the number of subscribers of the sheme. He argued that many people are registered on the scheme, but not all of them are active members of the scheme because not all subscribers renew their membership when it expires.

The Oxfam report said some people have registered more than once and these are all captured as new subscribers.

According to the report titled; Achieving a Shared Goal: Free Universal Health Care in Ghana, analysis of available data indicates that membership of the largely tax funded National Health Insurance Scheme could be as low as 18% – less than a third of the coverage suggested by the NHIA and the World Bank.

It says despite the introduction of the NHIA, the majority of citizens continue to pay out of pocket for their health care in the parallel ‘cash and carry’ health system, or resort to unqualified drug peddlers and home treatment due to lack of funds.

“The richest women are nearly three times more likely than the poorest to deliver at a health care facility with a skilled birth attendant,” the report said.

According to the report every Ghanaian citizen pays for the NHIS through VAT, but as many as 82% remain excluded, adding that twice as many rich people are signed up to the NHIS as poor people.

“64% of the rich are registered compared with just 29% of the poorest,” it says.

The report also criticizes the NHIA for lack of transparency. It says as the NHIA is responsible for managing a large public budget as well as the individual contributions of NHIS members, its poor transparency is of great concern.

“Financial reports are difficult if not impossible to obtain and in 2008, 45% of NHIA funds went unaccounted,” it says.

Based on its findings as outlined in the report Oxfam urged the government of Ghana to overhaul the system.

“The Ghanaian government is actually in a very strong position to overhaul the entire insurance scheme and replace it with a tax-based system that would give free health care to all its citizens at a lower cost. It’s time for the Bank to take off its blinkers and help Ghana do the right thing, and to stop promoting an inequitable health insurance system to other developing countries,” it says.

By Emmanuel K. Dogbevi

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