Features
Should our Health Minister continue to be at post?
Kwaku Agyemang-Manu
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 Amendment Act 852 (2012), every Ghanaian is required to enroll in the health insurance scheme, which is regarded as one of the social intervention programme introduced by the government to provide financial access to quality and affordable health care to Ghanaians.
The scheme is largely funded by the National Health Insurance Levy (NHIL), which is a 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.
BACKGROUND OF NHIS
For the benefit of my readers and to refresh their minds about how this laudable initiative came into being, let me take them down memory lane so they can better understand the emergence of the NHIS. The idea to establish 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. He promised to abolish the so-called “Cash and Carry” system of health delivery in the country when he gained power in the county. True to his campaign promise, President Kufuor, after winning the election, introduced the scheme in 2003, during his first term in office.
The main objective of the NHIS was to ensure that it covered all indigenous Ghanaians with the purpose of delivering comprehensive and affordable health care nationwide. The scheme was designed to cover employees both in the formal and informal sectors, the unemployed in rural and urban communities across the country. Since its introduction, the scheme has witnessed remarkable progress in various regimes that came after former President Kufuor’s administration. Former presidents John Evans Atta Mills, John Dramani Mahama and the current President, Nana Addo Dankwa Akufo-Addo, readily embraced the scheme because of its immense benefits to the people and the country in general, and therefore they adopted it as one of the social interventions in the health sector and gave the scheme the needed push.
EXEMPTION OF CERTAIN CATEGORIES
The scope of the scheme was therefore widened to rope in more beneficiaries and was made compulsory by the government based on past experiences that showed that most of the citizens could not engage in the programme and the fact that the government has the duty to protect the general welfare and well-being of all Ghanaians. The flexible nature of the scheme and its lower registration fees made it quite easy for people to register and enroll as members. The scheme was designed to exempt certain categories of people, including older people, from paying certain charges.
Like all human institutions across the globe, the HNIS, despite its successful implementation over the years in the country, has been confronted with a number of challenges and problems, such as poor coverage, poor quality care, corruption, poor stakeholder participation, a lack of clarity on concepts in the policy, intense political influence, and poor funding. These administrative lapses, coupled with other in-built challenges, are indeed, affecting the smooth operation of this laudable scheme. It may interest my readers and patrons to know that the scheme has passed through the hands of many experts on health issues, but to no avail. The current head of the NHIA, Dr. Bernard Okoe Boye, a young and affable medical officer and one-time Deputy Minister of Health, who was appointed by the government recently to manage the place, is overwhelmed with problems, although he is trying his possible best to streamline operations of the NHIS. He has introduced far-reaching ideas to solve some of the problems within the system, but there is still more to be done to make the system productive.
SYNCHRONIZING NHIS AND GHANA CARDS
For instance, plans are well advanced by the new head to team up with his counterparts at the National Identification Authority (NIA) to synchronize the NHIS card with the Ghana Card as a common medium to access primary health care in Ghana. The scheme has also been digitalised to make registration and renewal of cards easier and more effective. Suffice it to say, the NHIS, unlike the “cash and carry” system, which requires upfront payment of medical care and imposes financial stress on Ghanaians in terms of health care delivery, has been a laudable social intervention that needs to be adequately supported by the government if we are to achieve universal health care for all Ghanaians by the year 2024 and beyond.
Frankly speaking, the NHIS has been a source of hope for the majority of people in rural areas who depend on it to access their health needs. However, this all-important scheme is confronted with huge arrears for the service providers, who are finding it difficult to operate the system effectively. When patients visit some of these service providers, they will only be examined by doctors at the Out-Patient-Department (OPD) and told to buy the drugs (even those covered by the scheme) from the pharmacy shops.
HEALTH MINISTER’S ADMISSION OF NHIS FAILURES
Recently, the Minister of Health, Kwaku Agyemang-Manu on whose bosom the whole NHIS lies, admitted that the scheme was not functioning properly as it should, claiming that instead of benefiting from the scheme, poor subscribers were being overcharged and denied necessary services that they had already paid for. He cited his own experiences, claiming that he had to pay for healthcare services out of his pocket when he visited hospitals like Ridge and the University of Ghana Medical Centre (UGMC), even though he is an NHIS subscriber. That was when the minister addressed the Ghana Health Service Senior Managers Meeting 2023 on Tuesday, April 18, 2023.
Indeed, the unfortunate statement from the Health Minister goes to prove he is not on top of issues regarding his outfit, especially the health issues of Ghanaians, which should be his major concern. The entire NHIS programme falls within your purview, and you have to take a keen interest in the scheme and ensure that it works efficiently and satisfactorily. If, as a sector minister, you are complaining and condemning the NHIS as not working, then, as a minister, you don’t know your job and, therefore, you have failed completely. Who do you expect to come and fix the problem when those working there, especially the bosses, take instructions from you, the political head of that place? Elsewhere in certain jurisdictions, you will lose your job immediately for that unguarded and unsavory comment.
MINISTERS MUST OPERATE RESPONSIBLY
Ministers of state are appointed by the President to represent his interests in the portfolios they have been assigned. They are expected to see to the smooth operations of establishments under their various ministries by ensuring that they remain efficient and effective in their daily operations. Failure to ensure that the establishment under their control as ministers of state and political heads is potent and smooth-sailing means they have failed completely and, therefore, are not fit to be in that office.
As a matter of principle, Ghanaians expect people placed in positions of authority by the government to be more responsible and proactive in their daily activities instead of apportioning blame, which is unnecessary. These service providers need money to purchase drugs and other equipment to serve subscribers of the NHIS efficiently. However, if the government defaults on reimbursement, how can they operate effectively?
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By Charles Neequaye
Features
Tears of Ghanaman, home and abroad
The typical native of Sikaman is by nature a hospitable creature, a social animal with a big heart, a soul full of the milk of earthly goodness, and a spirit too loving for its own comfort.
Ghanaman hosts a foreign pal and he spends a fortune to make him very happy and comfortable-good food, clean booze, excellent accommodation and a woman for the night.
Sometimes the pal leaves without saying a “thank you but Ghanaman is not offended. He’d host another idiot even more splendidly. His nature is warm, his spirit benevolent. That is the typical Ghanaian and no wonder that many African-Americans say, “If you haven’t visited Ghana. Then you’ve not come to Africa.
You can even enter the country without a passport and a visa and you’ll be welcomed with a pot of palm wine.
If Ghanaman wants to go abroad, especially to an European country or the United States, it is often after an ordeal.
He has to doze in a queue at dawn at the embassy for days and if he is lucky to get through to being interviewed, he is confronted by someone who claims he or she has the power of discerning truth from lie.
In short Ghanaman must undergo a lie-detector test and has to answer questions that are either nonsensical or have no relevance to the trip at hand. When Joseph Kwame Korkorti wanted a visa to an European country, the attache studied Korkorti’s nose for a while and pronounced judgment.
“The way I see you, you won’t return to Ghana if I allow you to go. Korkorti nearly dislocated her jaw; Kwasiasem akwaakwa. In any case what had Korkorti’s nose got to do with the trip?
If Ghanaman, after several attempts, manages to get the visa and lands in the whiteman’s land, he is seen as another monkey uptown, a new arrival of a degenerate ape coming to invade civilized society. He is sneered at, mocked at and avoided like a plague. Some landlords abroad will not hire their rooms to blacks because they feel their presence in itself is bad business.
When a Sikaman publisher landed overseas and was riding in a public bus, an urchin who had the impudence and notoriety of a dead cockroach told his colleagues he was sure the black man had a tail which he was hiding in his pair of trousers. He didn’t end there. He said he was in fact going to pull out the tail for everyone to see.
True to his word he went and put his hand into the backside of the bewildered publisher, intent on grabbing his imaginary tail and pulling it out. It took a lot of patience on the part of the publisher to avert murder. He practically pinned the white miscreant on the floor by the neck and only let go when others intervene. Next time too…
The way we treat our foreign guests in comparison with the way they treat us is polar contrasting-two disparate extremes, one totally incomparable to the other. They hound us for immigration papers, deport us for overstaying and skinheads either target homes to perpetrate mayhem or attack black immigrants to gratify their racial madness
When these same people come here we accept them even more hospitably than our own kin. They enter without visas, overstay, impregnate our women and run away.
About half of foreigners in this country do not have valid resident permits and was not a bother until recently when fire was put under the buttocks of the Immigration Service
In fact, until recently I never knew Sikaman had an Immigration Service. The problem is that although their staff look resplendent in their green outfit, you never really see them anywhere. You’d think they are hidden from the public eye.
The first time I saw a group of them walking somewhere, I nearly mistook them for some sixth-form going to the library. Their ladies are pretty though.
So after all, Sikaman has an Immigration Service which I hear is now alert 24 hours a day tracking down illegal aliens and making sure they bound the exit via Kotoka International. A pat on their shoulder.
I am glad the Interior Ministry has also realised that the country has been too slack about who goes out or comes into Sikaman.
Now the Ministry has warned foreigners not to take the country’s commitment to its obligations under the various conditions as a sign of weakness or a source for the abuse of her hospitality.
“Ghana will not tolerate any such abuse,” Nii Okaija Adamafio, the Interior Minister said, baring his teeth and twitching his little moustache. He was inaugurating the Ghana Refugee and Immigration Service Boards.
He said some foreigners come in as tourists, investors, consultants, skilled workers or refugees. Others come as ‘charlatans, adventurers or plain criminals. “
Yes, there are many criminals among them. Our courts have tried a good number of them for fraud and misconduct.
It is time we welcome only those who would come and invest or tour and go back peacefully and not those whose criminal intentions are well-hidden but get exposed in due course of time.
This article was first published on Saturday March 14, 1998
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Features
Decisions have consequences
In this world, it is always important to recognise that every action or decision taken, has consequences.
It can result in something good or bad, depending on the quality of the decision, that is, the factors that were taken into account in the decision making.
The problem with a bad decision is that, in some instances, there is no opportunity to correct the result even though you have regretted the decision, which resulted in the unpleasant outcome.
This is what a friend of mine refers to as having regretted an unregretable regret. After church last Sunday, I was watching a programme on TV and a young lady was sharing with the host, how a bad decision she took, had affected her life immensely and adversely.
She narrated how she met a Caucasian and she got married to him. The white man arranged for her to join him after the marriage and processes were initiated for her to join her husband in UK. It took a while for the requisite documentation to be procured and during this period, she took a decision that has haunted her till date.
According to her narration, she met a man, a Ghanaian, who she started dating, even though she was a married woman.
After a while her documents were ready and so she left to join her husband abroad without breaking off the unholy relationship with the man from Ghana.
After she got to UK, this man from Ghana, kept pressuring her to leave the white man and return to him in Ghana. The white man at some point became a bit suspicious and asked about who she has been talking on the phone with for long spells, and she lied to him that it was her cousin.
Then comes the shocker. After the man from Ghana had sweet talked her continuously for a while, she decided to leave her husband and return to Ghana after only three weeks abroad.
She said, she asked the guy to swear to her that he would take care of both her and her mother and the guy swore to take good care of her and her mother as well as rent a 3-bedroom flat for her. She then took the decision to leave her husband and return to Ghana.
She told her mum that she was returning to Ghana to marry the guy in Ghana. According to her, her mother vigorously disagreed with her decision and wept.
She further added that her mum told her brother and they told her that they were going to tell her husband about her intentions.
According to her, she threatened that if they called her husband to inform him, then she would commit suicide, an idea given to her by the boyfriend in Ghana.
Her mum and brother afraid of what she might do, agreed not to tell her husband. She then told her husband that she was returning to Ghana to attend her Grandmother’s funeral.
The husband could not understand why she wanted to go back to Ghana after only three weeks stay so she had to lie that in their tradition, grandchildren are required to be present when the grandmother dies and is to be buried.
She returned to Ghana; the flat turns into a chamber and hall accommodation, the promise to take care of her mother does not materialise and generally she ends up furnishing the accommodation herself. All the promises given her by her boyfriend, turned out to be just mere words.
A phone the husband gave her, she left behind in UK out of guilty conscience knowing she was never coming back to UK.
Through that phone and social media, the husband found out about his boyfriend and that was the end of her marriage.
Meanwhile, things have gone awry here in Ghana and she had regretted and at a point in her narration, was trying desperately to hold back tears. Decisions indeed have consequences.
NB: ‘CHANGE KOTOKA INTERNATIONAL AIRPORT TO KOFI BAAKO INTERNATIONAL AIRPORT’
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