Interview: Nathaniel Otoo

How has health care evolved over the past three to five years with the expansion of the National Health Insurance Scheme (NHIS)?

NATHANIEL OTOO: The implementation of the NHIS in Ghana was a response to the inability of the majority of the country’s population to access health care. In 2005, its first year of operation, the NHIS registered over 1m people. At the end of 2015, 41% of the population, or 11.3m people, were enrolled in the NHIS. The goal one day is to provide coverage for the entire population, a figure currently closer to 30m.

The National Health Insurance Levy funds around 75% of NHIS activities and is statutorily earmarked for this purpose. The number of health care providers enrolled in the NHIS has increased four-fold over 10 years to around 4000 currently. The other aspect is use: outpatient visits have increased from slightly over 500,000 in 2005 to an estimated 33m at the end of 2015. Typically inpatient visits are equal to around 10% of these figures. Of all attendance at public facilities, 90% is on account of the NHIS. In the private sector, for those facilities that have enrolled, up to 80% of attendance is on account of the NHIS. This means that funds flow from the NHIS to these facilities and are an important source of their revenues.

The NHIS has catalysed the financing of health care in Ghana. At the time of the last national health audit, in 2012, 28% of all financing in the health sector was on account of the NHIS. Additional dimensions added to the health sector include the increased use of IT solutions. These advancements have encouraged the private sector to collaborate by using interfaces that are compatible with the claims system.

What can be done to grow the reach of Community-based Health and Planning Services (CHPS)?

OTOO: The government has declared the expansion of CHPS a national priority and delivered a roadmap for its implementation. Coupled with this, a policy to develop the primary health care package is available through these networks to ensure that every Ghanaian has access to a basic set of services from a facility in proximity to their home. The CHPS is the largest network of providers, with over 1400 facilities on the NHIS’s list, which will only increase over the course of the next five to 10 years with the roadmap.

CHPS remains critical because the majority of Ghana’s population is not in urban zones. Two years ago, certain rural areas were investigated in a facility mapping exercise to determine whether underserved areas had the right equipment and human resources. Studying this data allowed the expansion of the CHPS network to take place and improved the delivery of health care nationwide. Information was shared with the Ministry of Health, Ghana Health Service and the Christian Health Association of Ghana to further identify areas for improvement, such as outreach services from the CHPS centres to their catchment areas. Additionally, the NHIS has been collaborating with the Ministry of Gender, Children and Social Protection to extend access to underserved communities.

How successful would you rate Ghana’s efforts thus far at providing universal health care?

OTOO: The Sustainable Development Goals to which Ghana subscribes lay out the aspirations of the entire international community to guarantee universal health care in-country. The NHIS is one tool to achieve universal access to health care, as is private health insurance, in which cardholders pay a premium for secondary and tertiary care.

The 2011 Health Institutions and Facilities Act created the Health Facilities Regulatory Agency (HFRA) to ensure that all public and private facilities are licensed. On the path to universal health care, independent audits by HFRA have helped ensure that licensed health care facilities throughout the country provide a high-grade standard of care to patients.