The National Health Insurance Scheme in Ghana: Implementation Challenges and Proposed Solutions

Abstract

The International Food Policy Research Institute (IFPRI), established in 1975, provides evidence-based policy solutions to sustainably end hunger and malnutrition and reduce poverty. The Institute conducts research, communicates results, optimizes partnerships, and builds capacity to ensure sustainable food production, promote healthy food systems, improve markets and trade, transform agriculture, build resilience, and strengthen institutions and governance. Gender is considered in all of the Institute's work. IFPRI collaborates with partners around the world, including development implementers, public institutions, the private sector, and farmers' organizations, to ensure that local, national, regional, and global food policies are based on evidence. IFPRI is a member of the CGIAR Consortium.

The poverty and inequality nexus in Ghana

“…Individuals are expected to pay an annual premium to enable them receive health care at no cost. The scheme also exempts older population above age 70 and children under age 18 as well as pregnant women from paying premium (Gajate-Garrido and Owusua, 2013). This may explain the low average household spending on health in the country.…”

The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation

“…This finding is consistent with Mishra et al study in Nepal where they posited that SHI revenue collection in large informal sectors is a major economic challenge to successful implementation. 4 It is also an indication that the scheme survives largely on the health insurance levy of 2.5% tax on goods and services, accounting for about 70% of revenues 28 ; making sustainability a challenge as it has not been increased in spite of the growth in membership. The low level of contributions and what was seen as poorly targeted exemptions were argued to be a threat to sustainability, which has been noted as a major challenge in large informal economies.…”

“…Prior studies of implementation challenges of the NHIS in Ghana have also identified politicisation as a major challenge resulting in people not joining the scheme because they either associate the scheme with a political party or a particular politician in office. 28 Added to this is the rapidity with which policy decisions are made as implementation progresses. Indeed, as suggested by an earlier study, the lack of policy clarity and frequent changes in the policy made the scheme confusing to potential members, 28 thereby undermining enrolment and renewals and hence the finances of the scheme.…”

“…28 Added to this is the rapidity with which policy decisions are made as implementation progresses. Indeed, as suggested by an earlier study, the lack of policy clarity and frequent changes in the policy made the scheme confusing to potential members, 28 thereby undermining enrolment and renewals and hence the finances of the scheme.…”

“…17,18 Attention has also been drawn to limitations and challengespredominantly financial sustainability, managerial problems and inadequate technology. 1,[25][26][27][28] Among these challenges, evidence suggests that delays in reimbursement of health facilities resulting in shortages of basic consumables continue to be a huge problem to the effective operations of health facilities as well as limited space within the hospitals to cope with the increasing number of service demands. 1 Agyepong and Adjei 12 and Imurana et al, 29 identified the major implementation problems of the NHIS to include poor leadership, corruption, lack of consensus, rapidity and politicisation of implementation, lack of participation, poor sense of direction, limited understanding and management of the political challenges, weakened checks and balances and use of short cut.…”