Connect with us

Features

Is the NHIS working effectively at the accredited health facilities at all?

Published

on

NHIS Pix

For the number of times, this year, that I had sought medical attention at my health provider (Clinic), which has been duly registered under the National Health Insurance Scheme (NHIS), I did not receive my medications from the pharmacy even though the prescriptions by the doctors were covered by the scheme.My only benefits were the examination and compilation of my vital information, i.e. taken of temperature, blood pressure and checking of weight by the nurses and finally the medical treatment by the doctors.  The prescriptions for my drugs were issued alright by the doctors, only to be told by the pharmacists on duty that the drugs were not available, therefore, I should go outside and buy them.

‘NO DRUG’ SYNDROME BY ACCREDITED NHIS HEALTH PROVIDERS

I have monitored and observed this situation critically in some of the NHIS health providers in Accra and arrived at the conclusion that I was not the only person suffering from this unfavourable practice but quite a number of people were also being denied their legitimate entitlement.  The mantra has been, ‘please go to the doctor to write a fresh prescription for you to buy your drugs from pharmacies outside’. Such is the scenario in most of the health facilities covered by the NHIS in our dear country.  I have contacted a number of people who have attested to that fact and told me they have been buying their drugs from pharmacies outside at exorbitant prices.  I have come to realise that these health facilities covered by the NHIS, have the drugs alright but then, failure to reimburse them by the government has necessitated their reluctance to supply them to the beneficiaries of the scheme.  The NHIS is indebted to them in huge amount which remains unpaid.

QUESTIONS FOR NHIS ADMINISTRATORS

Advertisement

The few questions we need to ask ourselves are; What is happening to the NHIS? Is the NHIS collapsing? Why is it that medical facilities that are operating under the scheme are not being reimbursed by the government?  Are there no funds to run the scheme properly? Has the economic decline affected the scheme financially?  Somebody must answer these questions to set the records straight.

Ghana was the first Sub-Saharan African country to introduce the National Health Insurance Scheme (NHIS) in 2003 through an Act of Parliament (Act 650 Amended Act 852) and its full implementation started in 2004.  Under the NHIS Amended Act 852 (2012), every Ghanaian is required to enrol in the health insurance scheme. The scheme is regarded as one of the social intervention programmes the government introduced to provide financial access to quality health care in Ghana.

THE EMERGENCE OF NHIS AND HOW IT IS FUNDED

The scheme is largely funded by the National Health Insurance Levy (NHIL) which is 2.5 per cent levy on goods and services collected under the Value Added Tax (VAT), 2-5 percentage points of Social Security and National Insurance Trust (SSNIT) contributions per month.

Advertisement

The idea for the establishment of the NHIS in Ghana was conceived by former President John Agyekum Kufuor who used the scheme as a campaign promise in the 2000 general election and promised to abolish the ‘Cash and Carry’ system of health delivery when he gained power in the country.True to his campaign promise, President Kufuor, after winning the election introduced the scheme in 2003.

The major objective of the NHIS was to ensure that it covered all indigene Ghanaians across the country with the purpose of delivering a comprehensive and affordable health care nationwide.  The scheme was designed to cover employers, unemployed both in the rural and the urban communities across the country.

ACHIEVEMENT OF NHIS UNDER VARIOUS GOVERNMENTS

  Since its introduction in the country, the scheme had witnessed remarkable progress in various regimes after the Kufuor led government.  Former Presidents John Evans Atta Mills, John Mahama and the current President Akufo-Addo, readily embraced the scheme because of its immense benefits to the people and the country in general. They, therefore, adopted it as one of the social interventions in the health sector and gave it the needed push.  The scope of the scheme was widened to rope in more beneficiaries.  Currently, the active membership of the NHIS has risen from 10.8 million in 2018 to over 12 million in 2019.  The Ashanti Region, according to statistics, recorded the highest active membership of 2.2 million followed by the Greater Accra Region in the year under review.  Latest figures on the entire membership as of the end of 2021 is not yet available.

Advertisement

The scheme has been made compulsory by government based on past experiences which showed that most of the citizens could not engage in it and the fact that the government has the duty to protect the general welfare of all the citizens in our dear country.  The flexible nature of the scheme and its lower payment of registration, made it quite easy for people to register and enrol as members.  It has been designed to exempt certain category of people including the older persons from the payments of certain charges.

EMERGING CHALLENGES OF THE NHIS

Like all human institutions across the globe, the scheme despite its successful implementation over the years in the country, is challenged with a number of problems such as poor coverage, poor quality care, corruption, poor stakeholder participation, lack of clarity on concepts in the policy, intense political influence and poor financing. These administrative lapses are, indeed, affecting the effective operation of this laudable scheme.

It is worthy of note that National Health Insurance Authority (NHIA), the administrative body of the scheme in collaboration with the National Identification Authority (NIA), is determined to ensure that all residents in Ghana use one card which will be the Ghana Card to access health care.  Consequently, steps are in progress to synchronise the NHIS card with the Ghana Card. That will be a positive development and a step in the right direction.

Advertisement

THE SUCCESSFUL STORY OF THE NHIS

Suffice it to say, the NHIS unlike the ‘Cash and Carry’ system which requires up-front payment of medical care and imposes a financial stress on Ghanaians in terms of health care delivery, is a laudable social intervention which needs to be supported adequately by government if we are to achieve health for all by the year 2024 and beyond.  The scheme has come to serve and continues to serve a useful purpose in our dear country and we need to nurture it to flourish.  It has been a source of hope for the majority of people in the rural areas who depend on it to access their health care needs.  It is, therefore, necessary for the government to clear the outstanding arrears of the service providers and invest heavily in the programme to enable the scheme to cater for the millions of patients under the scheme.

A healthy nation, they say, is a wealthy nation. Health care is important to society because people get ill, accidents and emergencies do arise and the hospitals are needed to diagnose, treat and manage different types of ailments and diseases.  Many of our people’s aspirations and desires cannot be met without longer, healthier and happy lives.

Contact email/WhatsApp of author:

ataani2000@yahoo.com

Advertisement

0277753946/0248933366

By Charles Neequaye

Continue Reading
Advertisement

Features

International character of Ghanaman and more

Published

on

Ghanaians can be found in every part of the world

The average modern Gold Coaster born and bred in Sikaman is an adventurous creature. Go to any part of the world and you’ll find Ghanaman diligently slugging it out either in the snow or in hot sweltering weather, earning a decent living.

Go to Guinea and see Ghanaman in the garb of a herbalist, curing the sick of various ailments. He makes the Guinean understand that not all diseases are caused by James Lucifer alias Jimmy Satan. On the contrary, most diseases are caused by kooko which can even attack the human nose and turn it upside down.

That kooko is also the cause of poverty and the internal bleeding of personal back-pocket economies. And that kooko can be cured using the chemistry underlying Sikaman herbal medicine which has been blessed by the gods of Larteh.

And before Ghanaman starts dispensing his herbal concoctions, he must attract the passing crowd with some Sıkaman-originated choreography, akin to a combination of adowa and agbadza, such that the dancer can easily dislocate a shoulder and start crying for his mother.

Advertisement

When the crowd is enough to form a quorum, Ghanaman must perform magic as a side-attraction, and proceed to sell his drugs. The drugs are genuinely made from potent herbs which the Pharmacy Board of Sikaman says it has no confidence in. Believe me, Ghanaian herbalists are practising in neighbouring countries like Guinea, Cote d’Ivoire, Sierra Leone and Benin, while we are discouraging them from practising in Sikaman.

Go to Las Palmas and see Ghanaman as a fisherman. He sails on Korean-owned boats and is forced to eat garlic and raw tuna for radiant health. The garlic is also supposed to protect him against witches. But sometimes, he is not good bedfellows with some Korean crew members, and once in a while a fight breaks out.

The typical Korean is a Kung Fu expert and before displaying a golden dragon data. He must first terrify Ghanaman with a Korean dance which consists of wild arms and leg throwing. But Ghanaman is usually not daunted. Why has he been eating cancer kenkey all years without developing cancer? It mean is a superhuman capable of countering Kun fu side-kicks to the ribs.

Anyhow Ghanaman’s most potent arsenal lies in his fists. If he is a southpaw, it mean left fist is probably insured and can cause damage. When Ghanaman lands a cassava blow and it lands on a Korean chest, it has the effect of a cruise missile. If there is no ceasefire a funeral cannot be ruled out.

Advertisement

Greenland

Go to Alaska and find Ghanaman there. Greenland, Iceland, Brazil, Argentina, Madagascar, everywhere and you’ll find him. He has become an international citizen and is generally lauded for his hardwork, sincerity and honesty.

However, some bad nuts are also condemned and despised.

The world and all its parts and corners are for the human race, and anyone can choose to live anywhere and earn a decent living so long as he doesn’t misconduct himself or become a social misfit and a law unto himself.

Advertisement

Sıkaman for instance accepts foreigners, and we are so liberal that people just come in through our borders and we welcome them with the best palmwine in town and goat light soup. Who cares about passports and visas? Our hospitality is, as it were legendary.

So we have Liberians, Nigerians, Sierra Leoneans, Togolese, Europeans, Americans, Scandinavians and Koreans in Sikaman.  And some of them have misinterpreted our overzealous accommodation to mean “foolishness” and are misconducting themselves.

The newspapers carry stories of some unscrupulous Nigerians stealing, defrauding and collaborating with their Sikaman counterparts to rob people. You’ll find some good and law-abiding Liberians around but some other Liberians are in the business of fraud, robbery, money printing, money doubling, anything criminal.

Ghanaian hospitality can no longer be extended to such people. I do not think Ghanaians will be treated kindly either, when they misbehave anywhere in the world. Those who come from outside with the intention of bringing down their evil deeds and to practise them here professionally must be getting ready because Ghanaians are getting fed up with the menace.

Advertisement

These days, you’ll find strange people following you as soon as you emerge from a bank. If you are not careful, they’ll wrestle your briefcase from you and speed away in a waiting taxi.

Someone was just saying that many foreign criminals are flocking to Ghana because in their countries, they are enable to operate either because they are being looked for by the police for offences committed or fear instant justice at the hands of mobs. Ghanaians, it is said, are humanitarian in dealing with criminals.

Well, in some African countries, a thief who is being chased runs directly to the police station in his own interest and begs the officer at the counter to lock him up. Otherwise he’ll be lynched or be burnt to death. In Ghana, it is the opposite. The thieves run far away from the cop stations.

The criminals must reform and stay peacefully in Sikaman or quit. No court case!

Advertisement

This article was first published on Saturday September 5, 1998

Continue Reading

Features

The architecture of existence: How we live and die

Published

on

​The human condition is defined by two absolute, biological bookends: the commencement of complex cellular animation and its ultimate, irreversible cessation.

For centuries, medicine treated life and death as strictly separate states. Today, modern pathology and molecular biology reveal a more profound truth: the mechanisms that allow us to live are the exact same mechanisms that dictate how we die.

​Understanding this relationship is no longer just a philosophical pursuit. It is a clinical necessity for managing public health in the 21st century.

Part I: How we live – The mechanics of animation

Advertisement

​At its core, biological life is a continuous, high-stakes battle against entropy (the natural tendency of systems to degrade into disorder). To maintain form, consciousness, and function, the human body relies on three fundamental pillars:

1. Cellular respiration and energy production

​Every second of human life is powered by the conversion of oxygen and glucose into Adenosine Triphosphate (ATP), the universal energy currency of our cells. This process occurs within the mitochondria.

Without a constant supply of ATP, the microscopic pumps that maintain electrical gradients across our cell membranes fail, causing cellular collapse within minutes.

Advertisement

2. Homeostasis: The balancing act

​To survive, the internal environment of the body must remain incredibly stable, regardless of external chaos. This balancing act, known as homeostasis, regulates:

​Blood pH: Strictly maintained between 7.35 and 7.45.

​Core Temperature: Ideally kept around 37°C (98.6°F).

Advertisement

​Electrolyte Balance: Precise ratios of sodium, potassium, and calcium that allow nerves to fire and muscles to contract.

​3. The Autonomic Nervous System (ANS)

​The ANS acts as the invisible conductor of life, split into two complementary branches:

Part II: How we die – The path of cessation

Advertisement

​Death is rarely a singular event; it is a progressive biological cascade. Whether caused by old age, chronic illness, or sudden trauma, the final pathways of mortality generally follow a predictable trajectory.

​1. The cellular horizon: Senescence and Apoptosis

​Every time a human cell divides, the protective caps at the ends of its chromosomes-telomeres-shorten. Eventually, telomeres become so depleted that the cell can no longer divide safely. It enters senescence (a state of permanent arrest) or triggers apoptosis (programmed cell death). This gradual, systemic loss of cellular renewal is the underlying engine of aging.

​2. The clinical cascade of somatic death

Advertisement

​When the body can no longer maintain homeostasis, somatic death (the death of the organism as a whole) begins. This occurs in a distinct sequence:

1

Clinical Death

Zero to four minutes

Advertisement

The heart stops pumping blood, and respiration ceases. While breathing and circulation have ended, the body’s tissues still contain residual oxygen and cellular energy reserves. At this stage, resuscitation is often still possible.

2

Brain Death (Infarction)

Four to six minutes

Advertisement

Deprived of fresh oxygenated blood, the brain’s highly sensitive neurons begin to starve. Lacking ATP, the brain cells lose their electrical charge, swell, and begin to burst. Permanent, irreversible neurological damage occurs within minutes.

3

Biological Death

Hours to days

Advertisement

The organs fail entirely. Without central control or blood flow, individual cells throughout the body consume their final energy reserves. Enzymes that once aided digestion begin to break down the body’s own tissues from the inside out, a process known as autolysis.

Part III: The modern collision of life and death

​In the modern era, the boundary between how we live and how we die has blurred. Historically, humanity died primarily from infectious diseases and acute trauma. Today, global mortality is dominated by non-communicable, chronic lifestyle diseases.

Modern Pathology: How we live (the cause) how we die (the result)

Advertisement

Cardiovascular disease, chronic stress, poor diet, and lack of sleep keep the sympathetic nervous system hyper-activated, damaging blood vessels .Occlusion of coronary arteries leads to myocardial infarction (heart attack) or ischemic stroke.

Metabolic syndrome over nutrition and physical inactivity overwhelm cellular mitochondria, leading to systemic insulin resistance. Multi-organ failure, chronic kidney disease, and severe vascular complications.

Neurodegenerative Disorders Chronic systemic inflammation and sleep deprivation prevent the brain from clearing metabolic waste. Gradual loss of synaptic connections, leading to dementia and the eventual loss of basic autonomic functions.

Conclusion: The unified theory of health

Advertisement

​Ultimately, how we live directly shapes the path of how we die. The micro-choices of daily existence-how we manage emotional stress, the quality of our rest, our communal connections, and our nutrition-either preserve the integrity of our homeostatic systems or accelerate their decline.

​True medical advancement is shifting away from merely extending the final, frail stages of biological death. Instead, the focus is turning toward optimising our living years-ensuring that the intricate, beautiful machinery of human animation runs smoothly until its natural, quiet conclusion.

By Robert Ekow Grimmond-Thompson

Advertisement
Continue Reading
Advertisement

Trending