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Is the NHIS working effectively at the accredited health facilities at all?
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
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.
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.
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.
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.
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By Charles Neequaye
THE state of feeling rejected, could be a terrifying experience especially for those who have become used to fame. If not properly addressed, it could lead to depression and the consequences, could be disastrous.
When you are on top of your game in whatever profession you find yourself such that you become famous, a lot of people try to associate with you. The phone never ceases to ring and one is tempted to feel loved and very important.
When a disaster strikes and the fame or the money which was the source of the attraction fades away, the circle of friends and fans begin to shrink and the phone will start to stop ringing until the call stops voting completely.
You will be shocked at how people you considered friends, will no longer be calling you or pay casual visits as they used to. You will begin to notice that messages you leave after calling them and not getting a response are not replied to and that is when you begin to know who your true friends are.
One of the most popular movie stars was an actress called Sharon Stone. In an interview with one of the media houses that was published, she spoke about how people who should have come around to encourage her in her moment of depression, shunned her. The calls stopped coming.
This is what the Bible admonishes that the arm of flesh will fail you and therefore we should put our trust in God. It could be a very frightening experience and can easily lead to depression.
Human nature being what it is, people will want to get close if things are okay. Everybody wants to associate themselves with interesting things, famous people, rich people etc for mainly selfish reasons.
We need to develop the habit of putting our trust in God and relying less on human beings. The lesson we have to take along in life is that, no one marries his or her enemy so how come people who took vows that they will love each other become so hostile to each other that they want to go their separate ways in life? Such is the reality of life.
It is therefore prudent for people to recognise that, life is full of uncertainties and so there is the need to prepare your mind for uncertainties so that when they occur, they do not disorganise your mental sanity.
A lot of people have experienced situations where people who they could have sworn will never betray their trust have disappointed them when they were through challenging moments.
If there is one thing famous people should desire, it should be the ability to identify who are true friends are. Countless stories abound regarding incidence of celebrities who have lost their shine and their wives divorcing them soon after.
It is sometimes useful as a famous or rich person to sign a prenuptial agreement before marriage to safeguard or protect yourself from any future unpleasant surprises.
People can be very pretentious these days, it goes both ways. There is this real life story where a man married a divorced wealthy woman and convinced her to sell her house so they could build a new one together, with the excuse that people are gossiping that he is being housed by a woman.
The woman agreed and they put up a new building. After a few years the man asked for a divorce, only for the woman to realise that the land on which the building was situated, was bought in the man’s name.
This can drive a person insane, if you are not mentally tough and this happens to you. When people hear that you are homeless, a lot of your so-called friends will stop calling, so that you do not become a burden on them.
By Laud Kissi-Mensah
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‘But, er …. I don’t even know your name’.
‘Paul. Paul Allotey. I’m Sarah, by the way. Paul, why don’t you leave me here, since this is the last important thing I’m doing today’.
‘Okay. Now Sarah. I was just thinking. You will be here at the cafe for about an hour. By then it will be about twelve thirty. Then, you would be thinking of buying yourself some lunch, to eat here or to take home. So if you would please allow me, I will take you to one of the nicest eating places in town, and after you have sorted that one out, then I can drop you home. Just that one errand, then I won’t bother you again’.
‘You are not bothering me at all. You are being very kind to me. And I just realised you are a mind reader too. The last item on my agenda was lunch’.
‘I’m so glad I appeared at your doorstep, just in time’.
‘Okay. Now Paul, since you say the cafe is a comfortable place, let’s go in together, and you can do your work while I get my application done’.
‘Okay, Sarah. Thanks. Let’s go’.
We got back in the car at eleven forty-five.
‘So where are we going, Paul?’
‘To Royalty restaurant. It’s a twenty minute drive away’.
‘So, do you enjoy your job?’
‘Most certainly. I won’t change it, not even to be President. And am I right to say that you are preparing to enter the university?’
‘That’s my plan. I hope it works’.
‘It will, if you are determined, and disciplined. You look very much like a disciplined person’.
‘Thank you very much’.
We arrived at Royalty in twenty-five minutes, ‘You are joining me for lunch, Paul’.
‘Thanks for the honour, Sarah. But the bill is on me’.
‘Aren’t you taking on too much for one day?’
‘I never do anything that is bigger than me, Sarah’.
Over the next hour and a half, we discussed fashion, local and international politics, and sports, as we ate and relaxed. Finally, he drove me to the shop.
‘I will never forget you, Paul’.
‘I’m glad to have been helpful. But if you don’t mind, I’ll say it again, your husband is extremely lucky. You are really beautiful’.
‘Thanks again. But do you mind if I call you sometime in the future?’
‘Certainly not. Let me write it here. I will not ask for your number, for obvious reasons. But I will be looking forward to hearing from you. And hopefully, I will see you next month, when I call to drop your bill’.
‘Okay Paul. See you then’. What a lovely day, I said to myself as I opened the front door. I closed the shop and got home by seven. I went straight to the bedroom, stood in the mirror and took a good look at myself. ‘You are a very beautiful woman, Sarah. Never forget that’. I will not forget that, again.
Over the next several weeks, Martin and I had very little to do with each other. In the morning he ate his breakfast and after a shabby ‘I’m going’, he left. He came home around eight at the earliest, ate his dinner and, already soaked in beer, went off to sleep.
He spent the greater part of the weekends at the club house with his friends, playing tennis and partying. My mind was focused on furthering my education, so I didn’t complain to him, and didn’t bother to inform my parents about what was happening. I had decided that I would only take action if he lifted his hand against me again. I spent my free time reading all manner of interesting stuff on the internet, and chatting with my sister on WhatsApp.
One evening, he came home at about eight, rushed to the bedroom and rushed out. An envelope, obviously containing money, dropped out of his pocket, and I picked it up and followed him. I was going to call him and give it to him, but I noticed that there was a young woman in the car, so I went back in, counted it and put it in a drawer in the hall. He came back after some ten minutes.
‘Excuse me, I dropped an envelope containing money. You must have seen it’.
‘Yes, I saw it. Actually, I followed you, and was about to call you and hand it over to you when I realised that there was a woman in the car, so I came back in. I counted it. One thousand cedis.
‘Well let me have it. I have to be going’.
‘I will let you have it if you will tell me who the woman in the car is, and why you are going to give her that amount of money’.
‘Listen, if you waste my time, I will teach you a lesson you will never forget. Give me the money now!’
‘Here’s what we will do, Martin. I know you will give money to her anyway, so I will give it to you, if you will withdraw the threat you just issued. But I want you to know that I will be taking some steps from tomorrow. Things are getting out of hand’.
‘Okay, I’m sorry I threatened you. Can you please give me the money’. I handed it over to him, and he ran out’.
The following morning, I waited for him to finish having breakfast, and told him I wanted to have a word with him urgently.
‘You better be quick. You know I’m going to work’.
‘Well, I want to inform you that I will inform my parents, and your parents, about the situation in this house. As I said yesterday, things are getting out of hand. You spend most of your time drinking. You get drunk every evening, and through the weekend. And you are also spending your time and money on a prostitute’.
‘How dare you? One more stupid word from you …’
‘Am I lying, Martin? You have just started life, yet you are behaving like a rich, elderly man who has already seen his children through university, and can afford a life of fun. As I said, I’m going to inform our parents. Maybe your parents can straighten you out before it is too late’.
‘Look, we can talk this evening. It’s nothing like what you are saying’. He walked away, shocked.
That evening, I was expecting to have a meaningful discussion with him, but his mother called early in the evening to offer me some ‘advice’. Her son had called to say that certain developments at home were disturbing him so much that they were beginning to affect his work.
And, ‘as a loving mother to her daughter’, she was advising me to submit to my husband, and support him in prayer, and not ‘drive him from home’. Men would always be men, and she was telling me ‘from experience’ that no matter how much time Martin stayed away from home, he would always come home to me.
She had been a young wife before, so she understood the challenges I was facing. So I could be assured that if I followed her advice, all would be well. And, of course, she didn’t allow me to tell my side of the story.
Martin came home very late, and very drunk. And from the next morning, he carried on as before. With some hesitation, I called my dad and told him all that had gone on.
‘Well, my daughter. I’m not going to say “I told you so”. I was only trying to protect you. So here’s what we’ll do. Continue doing the best you can, and try not to give him any excuse to harm you, but if things continue to deteriorate, I will take you back.
A couple of days later, my cousin Dinah arrived in Accra from Brussels, having completed her medical course. With Martin’s agreement, I went to Koforidua and spent a couple of days. I spent most of the time chatting about her experiences in the US, but we also discussed my relationship with Martin, and she endorsed Dad’s decision to take action if Martin’s behaviour did not change after two weeks Elaine informed Mom and Dad. We endorsed Dad’s decision to take action if there was no change in two weeks.
Dinah returned with me to Takoradi. Her plan was to spend a couple of weeks, and return to Accra to be posted. I called Paul Allotey, and asked if he would meet her for lunch and, if possible, show her some interesting spots. Delighted, he suggested that we meet at Royalty the next day.
I told Martin about it, to remove any possibility of future disagreement over ‘going out with men’.
‘It’s fine with me’, he said, ‘if, of all the people who could show your sister round this town, you chose a borla man. Doesn’t that indicate the kind of person you are?’
‘ First of all, Martin’, I’ve spoken to him a few times, and he comes across as a decent guy, so I think it is rather unfortunate that you are writing him off when you don’t know him’.
By Ekow de Heer
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