Ghana: Heath care expanded

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Heath care development has been a priority for Ghana for many decades, and the government is now looking to concentrate on the poorest segments of the population and tackle infectious disease rates.

In June, the local press reported that the government was committing $910,203 to prevent and control neglected tropical diseases (NTDs) countrywide, part of an international programme to tackle NTDs backed by the World Health Organisation. Alban Bagbin, the minister of health, said he expected the investment would help eradicate such diseases as small fever, elephantiasis, trachoma, river blindness and buruli ulcer, which afflict the rural poor in particular. As Bagbin noted, efforts to eradicate guinea worm and trachoma have “made gains” but further efforts to “improve on and extend coverage of the control and elimination activities” are needed.

Another extension of coverage for the more vulnerable was implemented in July, as 700 new mentally challenged patients were added to the national health insurance scheme (NHIS), taking the total number of physically and mentally challenged registrants to 10,000.

Sylvester Mensah, the chief executive of the National Health Insurance Authority (NHIA), said the programme was “consistent with the government's social democratic agenda to ensure that the vulnerable and under-privileged are all within the social safety net of health care”, adding that the NHIS was aiming to ensure that all Ghanaians had access to decent health care.

The NHIS is an interesting example of universal public health insurance in emerging markets, and while it is not faultless, it provides a useful model. Operational since 2005, it offers premiums from as low as $3.8, aiming to provide access to basic health care for the whole population. Anyone registered with the NHIS gets free treatment, and those over 75, under 18 and pregnant women get treatment for free, whether they are registered or not. As premiums are low, the NHIS is also supported by other government funds, including value-added tax.

The NHIS, in its efforts to establish a basic system of health insurance for all Ghanaians, has been an important step forward for the country. There are challenges, however, including billing issues from institutions, and, as can happen in systems with such low entry costs, exploitation by some citizens who visit or demand medication when it is not necessary.

Annita Allotey, a research assistant at the Institute of Economic Affairs, pointed out in a recent article that there are a number of moves the authorities could make to tackle the issues: in the short term, an expansion of community care and strengthening the referrals process; and, over the long term, differentiated premiums for those more at risk and encouraging healthier lifestyle choices. Allotey highlights the need for better education on the NHIS, which could both increase the number of subscribers and lower the level of abuse.

As well as extending care and insurance coverage to the greatest possible extent, and lowering the prevalence of lesser-known diseases, tackling more common infections disease remains a health care priority for Ghana. Two of the biggest scourges, here as elsewhere in sub-Saharan Africa, are malaria and AIDS. Malaria cases affect around one-fifth of the population, while the WHO puts the prevalence of AIDS among those aged 15 to 49 at 1.9%, and the AIDS-specific mortality rate is 89 per 100,000 people.

Ghana is in the fortunate position that it has good basic health care services, a developing system of universal health insurance, and it has made great strides in tackling disease in recent decades. Economic growth is also delivering more cash to government coffers and individual pockets, which is helping to broaden provision and access. Ghana still faces many of the health challenges as other sub-Saharan countries, but it has the administrative capacity, international support and, increasingly, the resources, to address them.

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