Date: March 11, 2010, 10:37 am


The Essential Services Platform hosted by ISODEC, views with surprise the high pessimism that is being expressed by sections of Ghanaians about the feasibility of the proposed one off premium payment for the National Health Insurance which will allow the poor and vulnerable enjoy access to health services.

 The Platform is even more saddened by the lack of provision of alternatives that will allow the poor to have access to health care and the failure of the media to demand same from the commentators. If the use of the term financial sustainability simply means balancing of the books to account for funds allocated then the larger health goals will be glossed over. Government must feel obligated as its social responsibility to address the health concerns of the teeming number of the poor and vulnerable.

We believe that this issue is a budget constraint that Government must find ways to address.

A careful observation of health financing from the days of cash-and-carry to present, informs us that the situation ends with Government’s willingness or unwillingness to act. If Government views unfettered access to quality health care as a priority then government will take necessary steps to occasion the necessary trade-offs to ensure access. The decision to move from cash and carry to the National Health Insurance Scheme (NHIS) was a political decision that reflected health as a priority area. Similarly, a decision and commitment to reform the annual premium payment to a one off premium payment as presented by the National Democratic Congress (NDC) in the 2008 elections to Ghanaians is a priority area which the people accepted. The conscience of the state will never be free if the poor and vulnerable continue to pay the cost of health care with their lives. The situation where the poor are sent back home with their illness through barriers created by the annual premium payment is not excusable. In view of this an actuarial studies is only important to the extent that it helps to ascertain how much it will cost to implement the one off premium payment policy; it should not be used as a basis for determining premiums that will detract from the social protection intentions informing the policy.

It is important to explain here that though the NHIS is defined as an insurance system, in practice this is not the case, as about 70% of the scheme is tax financed; 24% being social security contributions from formal sector workers and only 5% received by way of proceeds from the mutual health insurance schemes. The view that expanding the base of the NHIS will require more resources is valid.  What is not valid is that nothing can be done about it to ensure unfettered access to health care services. At the end of the day it is a political choice based on the health goals and the willingness or otherwise of the Government.

To begin with, and in finding answers, Government must move to ensure optimal and efficient utilization of current resources made available to the scheme. Can current resources achieve more than is presently being recorded?  Significantly, Government can also explore one way of ensuring a collective benefit of the expected oil revenues through the provision of special levies on oil resources for health financing.


The fact that we are a poor country does not mean that we should allow the poor and vulnerable to die from their diseases. Indeed it is precisely because of this that we have to ensure social protection for the poor. The claim therefore that one-time-off premium payment is not feasible without an accompanying suggestion of how access to the poor could be addressed is most unfair, especially coming from highly placed personalities with huge financial protection and entitlements from the state. Perhaps one possible way of financing the one off premium payment will be to cut out or reduce some of these privileges and entitlement of the elite from the state.

For us of the Essential Services Platform, one off premium payment is not only possible but urgently needed. That which is not sustainable is the thousands of preventable deaths which could be avoided only if health care were to be accessible to all. One off premium payment is possible and achievable if government is willing to chart this path. The people of Ghana clearly demonstrated where they wanted to invest their taxes in the 2008 election when they voted for one off premium payment. Government must respect this mandate.

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