Ghana must ensure NHIS financial sustainability as scheme expands – World Bank

The World Bank is calling for sustainable funding for Ghana’s National Health Insurance Scheme (NHIS) as the programme keeps expanding in terms of subscribers.

Since its establishment in September 2003, the NHIS as at 2012 has a membership base of nine million which is about 35% of the country’s total population, according to officials.

According to a Lead Health Specialist at the Bank’s Africa Office, Patricio V. Marquez, as the scheme evolves into the future, a widely acknowledged critical challenge is how to accelerate the enrollment of the rest of the population, particularly the poor and vulnerable, so that the universal health coverage ideals are realized.

In realizing the universal health coverage, Mr Marquez, in a blog post titled “Ghana: Towards Universal Health Coverage” to celebrate the NHIS’ 10th Anniversary, said it must done “in a manner that ensures the financial sustainability of the scheme”.

The World Bank Specialist expects that after the successful completion of the pilot project to register new beneficiaries onto the NHIS and to process membership renewals biometrically that began in mid-2013 in two districts, Ayawaso and La, in the Greater Accra region, a nation-wide scale-up of this exercise will follow.

“While this measure will help increase population coverage, the long term sustainability of the scheme would perhaps require a broader discussion on the content of the benefits package, measures to promote the rational use of drugs, and possible complementary funding sources,” Marquez wrote.

With the expansion of coverage, he indicated that a concerted effort to improve the supply of quality health services across the country would also be required—from “infrastructure and technology improvements to medical care delivery in accordance with evidence-based norms and guidelines that promote integrated health service arrangements along a care continuum”.

Some have called for a private participation in the scheme. The Oxford Business Group (OBG) is of the opinion that the NHIS should be run in a way that will attract private investment to ensure sustainable funding options despite the programme been run as a pure social one.

Despite facing many challenges and criticisms, Mr Marquez noted the celebration of NHIS’s 10th anniversary is “justified as a lot has been accomplished in a short period of time”.

“While a good share of problems and challenges exist, Ghana’s experience has a lot to offer to other countries still struggling to find a path towards universal health coverage.  So, a warm “happy birthday” to the Ghana NHIS is amply deserved,” said Marquez.

He mentioned some of the achievements the NHIS has chalked so far since its establishment. He highlighted the development of an ICT platform in 2007, the introduction of the Free Maternal Programme in 2008, the development of a formal accreditation system for service providers in 2009, the institutionalization of a clinical audit system to improve patient care and outcomes, the establishment of the Claims Processing Center in 2010, and the creation of a Call Center in 2012 to facilitate the interaction with the members of the scheme.

Mr Marquez, who is based in Accra, said arrangements are underway to undertake electronic claims processing to pay services providers on time, introduce uniform prescription forms, and review capitation as a provider payment mechanism.

By Ekow Quandzie