Date: July 11, 2012, 1:32 pm


A coalition of local and international non-governmental organisations in health in Ghana, is asking the government to reject World Bank's proposal to adopt cost-sharing to sustain its National Health Insurance Scheme (NHIS), which has been operational since 2003.

In its January report titled: "Health Financing in Ghana at a Crossroads", the World Bank said Ghana's NHIS basic benefit package was financially unsustainable and therefore, the government must consider cost-sharing.

The report further recommended the use of co-payments for some covered services and sections of the populations as a strategy for increasing the NHIS revenue and directing utilisation towards more cost effective services.

The NHIS replaced a "cash and carry" health financing system in the country, which makes it compulsory for everybody to pay money immediately before and after treatment but was seen not to be within the means of most Ghanaians.

But the NHIS allows everybody to make contributions into a fund so that in the event of illness contributors could be supported by the fund to receive affordable healthcare in our health facilities.

The coalition, which has been at the forefront of the promoting free universal access to health care in the country, said on Wednesday that it did not agree with the World Bank's suggestion, especially when it acknowledges that government expenditure on health is low.

The World Bank in its report argued that the NHIS Basic Benefit Package (BBP) was financially unsustainable and recommended the use of co-payments for some covered services and sections of the populations, who are able to pay as a strategy to increase NHIS revenue and direct utilisation towards more cost effective services.

The World Bank also expressed dissatisfaction that the NHIS was highly subsidised and therefore recommended that the share of government's allocation to the health sector should remain the same.

It also noted that Ghana's out of pocket payment of more than a third of total health expenditure was more than the World Health Organisation (WHO) recommendation of between 15 and 20 percent.

The coalition has advised the World Bank to reconsider its stand on the cost sharing proposal, saying although it equally shared in the belief that the NHIS as currently constructed could not achieve universal coverage for health care in Ghana, it was of the view that a cost-sharing system would threaten the gains already made by the NHIS.

"While we agree that the economy needs improvement, we also equally agree that Ghana's economy has survived the HIPC era and grown from four percent in 2009 to 14.4 percent in 2011. With revenue from the oil and other sectors, the economy has a great potential to grow," Cecelia Lodonu-Senoo, a member of the coalition said.

She said since the report acknowledged that Ghana's health expenditure, as a percentage of GDP (4.9 percent) was below the average of other low-middle income countries (LMIC), and health expenditure as a percent of GDP had declined since 1995, the coalition rather thought government should increase its financial allocation to the sector.

Lodonu-Senoo, therefore, called on the government to remain focused and ensure that more resources were injected into the health sector by motivating the sector's human resource, improving accessibility to quality healthcare, providing modern health facilities and ultimately working towards making healthcare free at the point of delivery.

Ghana has a well-developed integrated multi-level health system distributed throughout the country, composed of community-based health planning and services (CHPS) zones, health centres, district, regional and teaching hospitals, private health providers, and non-governmental health-related organisations.

Coalition members include the Alliance for Reproductive Health Rights (ARHR), SEND Ghana, coalition of NGOs in Health, Essential Services Platform and the Integrated Social Development Centre (ISODEC).

The Africa Report

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