Interview: Kwaku Agyeman-Manu

How is the government increasing capacity in line with population growth?

KWAKU AGYEMAN-MANU: Ghana is an outward looking and globally focused country, committed to providing modern health care services and facilities. In line with this we are looking to achieve the targets laid out in the UN’s Sustainable Development Goals, related to universal health coverage and improved health financing. We want the same level of care to be available across rural communities and hard to reach areas as in central Accra.

To achieve this we have had to rethink our funding structure. At the start of the new millennium the government introduced the National Health Insurance Scheme (NHIS), the goal of which is to reduce the direct spending burden on the government and create a co-funding model via a national insurance tax system, much like that behind the UK’s National Health Service. As the population grows, so do the contributions to the NHIS, so it is a system that can scale up in line with increasing demand. Regarding operations, we have found that an emphasis on primary health care is the most effective way to ensure availability and efficiency.

At the village level we have a Community Health Planning Service, which serves to assess, treat and prevent easily treatable or early-stage illnesses, while passing on more complex cases to specialists at the district level. For example, a patient presenting symptoms of malaria for more than 24 hours will progress up the treatment chain to a specialist clinic. The benefits of this first line of defence are that the burden on hospitals and clinics is lessened, while effective service provision is generated over a wide and socio-economically diverse territory.

What is the state of health technology provision?

AGYEMAN-MANU: Our aim is to make Ghana a regional centre for health care, and indeed in terms of technology the country already ranks highly. Central to our technology strategy is digitisation. For instance, the introduction of digital X-rays allows radiologists to work remotely, bringing technical skills to areas where there might have been a shortfall previously. In addition, total digitisation of patient records will aid in operational efficiency and allow for a more accurate decision-making process.

The ministry also receives support from international partners such as the Global Fund to Fight AIDS, Tuberculosis and Malaria; the US Agency for International Development; the Japan International Cooperation Agency (JICA); the UK Department for International Development; and the Korea Foundation for International Healthcare, among others. These international partners support us with equipment provision, retooling and maintenance. In particular, JICA is working to help bring in advanced technology, such as urine analysis, that will aid in the speed and accuracy of the diagnosis process.

What role does private health insurance play in the sector, and how can it be expanded?

AGYEMAN-MANU: We have an active private health insurance industry, although it is a young sector on a steep learning curve. Due to generally low personal income levels, it is the high-income bracket of the population that utilise private services: less than 30% benefit from such policies, and within this percentage the largest share of demand comes from corporate clients who take out general policies for their employees. For providers, corporate clients are easy to identify, administer and bring to scale.

Aside from the income factor, low uptake is the result of a lack of familiarity with the concept of insurance. Faced with this challenge, it is difficult for private insurers to secure and leverage the retail market. Technology is a powerful tool for creating awareness, and it will be central in solving this issue.