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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
When Abigail Fremah steps up to the Armwrestling table, the noise fades, the tension settles, and order takes over.
Despite a calm, but firm and meticulous disposition, she has become one of the quiet forces shaping Ghana’s growing reputation in the sport, not as an athlete, but a referee trusted on the continental stage.
Abigail’s journey into Armwrestling did not begin at the table. Like many Ghanaian sports enthusiasts, she grew up playing several disciplines. Football was her first love, but she also featured in volleyball and basketball during her school years. Sports, she says, was simply a way of life not just for her.
“It runs through the family. All my siblings are into sports,” she stated.
“I was involved in almost every sport in school, football, volleyball, netball, hockey; I did everything,” she recalls.
Her academic background in Health, Physical Education and Recreation laid a solid foundation for her sporting career. While on scholarship at the university (University of Cape Coast), she often used her modest budget to support young athletes, sometimes sharing skills and even T-shirts at programmes she attended. Giving back, she explains, has always been part of her motivation.
However, as she matured as an athlete, Abigail made a critical self-assessment.
“Armwrestling involves a lot of strength,” she admits. “Looking at my body type, I realised I couldn’t fit properly as a competitive athlete.”
That moment of honesty pushed her to a different trajectory but equally important path in sports; which is officiating.
During her National Service, she was encouraged by Mr Charles Osei Asibey, the President of the Ghana Armwrestling Federation (GAF), to consider officiating. He introduced her to a technical official, Mr Hussein Akuerteh Addy, who formally took her through the basics of Armwrestling officiating in 2021.
“I started as a case official,” she says. “We moved from region to region every week, officiating competitions. That’s where it all began.”
By 2022, Abigail was actively involved in national assignments, though she missed the African Championship that year. Her breakthrough came in 2023, when Ghana hosted the African Armwrestling Championship.
It was her first experience officiating at a major international competition and it changed everything.
“That was my first national and international exposure at the same time,” she says. “It really opened my eyes.”
Today, Abigail is a World Junior Armwrestling Referee, a status earned through performance, consistency and discipline. She explains that progression in officiating was not automatic.
“It’s all about performance, your appearance at African Championships, your conduct, how you handle pressure; that’s what takes you to the world level,” she stressed.
As a referee, Abigail’s priority is safety and fairness. Armwrestling, she notes, comes with risks, particularly injuries to the wrists, elbows, shoulders and arms.
“If athletes don’t follow the rules or refuse to listen to officials, injuries can happen,” she explains, adding that focus was everything.
Before every match, she ensures that all equipment which includes elbow pads, hand pegs and table alignment were properly set. Athletes are not allowed to cover their elbows, must grip correctly, and must follow the referee’s commands precisely.
“We make sure everything is fixed before the grip,” she says. “Once we say ‘Ready… Go’, there should be no confusion.”
She is also firm on discipline. Warnings are issued for infractions, and repeated misconduct attracts penalties.
“The referee must be respected, if you don’t listen, the rules will deal with you,” she says.
Abigail credits her confidence partly to her sporting family background. Her mother was a volleyball player, while other family members also participated in sports. Though they were initially concerned about her safety, her rise to the top reassured them.
“They were afraid at first,” she admits. “But they were also very proud, especially because some of them never got the opportunity to reach this level.”
Looking ahead, Abigail is optimistic about the future of Armwrestling in Ghana. In less than a decade, the country has produced African and world-level medalists, a sign, she believes, of great things to come for Ghana.
“Whenever we go out, we come back with medals such as gold and silver,” she says, and to her that was a sign of growth.
In the next five to ten years, Abigail sees herself rising to become a World Master Referee, the highest officiating level in the sport. Until then, her routine remains intense, training four times a week, working closely with athletes, standing on her feet for hours, and constantly refining her understanding of the rules.
“I love this sport,” she says simply. “That love is what keeps me going.”
Abigail encouraged women to be bold and intentional about their place in sports saying “don’t limit yourself because of fear or stereotypes.”
She also urged women to invest in learning, discipline and consistency, stressing that respect was earned through performance.
For Abigail, as Ghana’s armwrestlers continue to make their mark, she will remain where she is most effective at the table, ensuring the game is played right.
By Esinam Jemima Kuatsinu
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As he had promised Aperkeh, the elderly man and his wife and three daughters stopped by Aperkeh’s parents’ house. Mr Amando and his family were preparing to settle in for the night.
“Brother Ben and family”, Mr Joshua Amando said warmly, “although I know you are here on a matter that can hardly be described as joyous, it is still good to see you. You are welcome. Please sit down while I bring you water”.
“Yes, we will take water, even though we are hardly thirsty, because this is our home”.
“Okay, Ben”, he started after they had drank, “Let me go straight to the point. My daughter Priscilla has told me about the goings on between her brother Aperkeh and our daughter Stella.
Before informing me, Priscilla had expressed concern to Aperkeh about some habits he is adopting, especially the late nights and the drinking. She tells me that one Saturday morning, she was there when Stella complained about his drinking and some girls who had come to the house to look for him, and he assaulted her.
I called him and complained, but all he could say was that I don’t know what caused him to react that way, so I could not judge him. Now he does not answer my calls.
I have sent Priscilla to his house to call him, but he has refused to come. Unfortunately, Ben, my son is a much different person than the young boy who completed university and started work at the bank. I am really embarrassed about his treatment of Stella”.
“Joshua, let me assure you that even though what is happening is very unfortunate, it will not affect our relationship.
We have been friends since childhood, and I thought that with their parents’ blessing, the relationship between Aperkeh and Stella would grow to become a blessing to all of us. But there appears to be a real challenge now.
Stella thinks that Aperkeh wants her out of his house, and indeed Aperkeh himself told me that, about an hour ago.
So I’m taking my daughter home. I suggest that you do what you can to straighten him out, but if it does not work out, let’s accept the situation and continue to be one family.
I am sure that being the well behaved girl that she is, Stella will meet a young man who will cherish her. Fortunately, this problem is happening early in the day, so they can sort things out if possible, or move on with their lives if they are unable to stay together”.
“I’m really grateful for that, Ben. I will do my best in the next few days to reason with him, because apart from the relationship with Stella, Aperkeh is risking his job and career with this lifestyle.
A good job and salary offers an opportunity to gather momentum in life, not to destroy yourself”.
“Okay Brother Joshua. We will say goodnight. I hope to hear positive news from you”.
As he descended in the lift from the fourth to the ground floor, Aperkeh wondered who would be waiting at the reception to see him at nine on Monday morning. He had spent good time with both of his new girls during the weekend, so it had to be someone else. He got out of the lift and pulled a face when he saw Priscilla.
“Priscilla”, he said as he sat down by her, “what do you want here? You know Monday morning is a busy time at the bank. I am a very busy person, so say what you want, I have work to do”.
“You are very funny, Aperkeh. You are telling me, your sister, that you have work to do, so I should hurry up? Okay, Dad says I should advise you to come home tonight, because he wants to discuss the issue of Stella with you. He sent me to you twice, and you did not come.
He has tried to call you quite a number of times, but you have refused to answer his calls. He says that if you do not come tonight, you will be very surprised at what he will do. He says you will not like it at all, so better come.
“What is all this? Why won’t you people leave me alone? Stella is very disrespectful. I told her that if she wanted to continue to live in my house, she must obey me. It is that simple.
She chose to continue ordering me about, controlling me in my own house, so I told her that if she could not live under my conditions she should leave. And she left. In fact, her own father came and took her away. So what again?’’
“How did she disobey or control you? Was she complaining about your continuous drinking and late nights? And did you slap her on several occasions because of that? Did you tell her that if she could not live under your conditions she should leave? You actually said that to her father? You have forgotten that before she came to live with you, our two parents met and agreed, and gave it their blessing?’
“Why don’t you leave, Priscilla? I don’t have to listen to all that”. “Okay, I will go. Your father who gave birth to you and educated you to university level sends me to you, and you ask me to leave? I wish you would defy him, and refuse to come home as he’s telling you, because he is planning to give you the discipline you badly need. Let me tell you. Stella is such a beautiful and decent girl, and I assure you that someone will grab her before you say Jack. You are only 30 years old, and you have already become a drunkard”.
As he walked towards the lift, Aperkeh decided on what to do. He would go home, and calmly listen to what his father had to say. The old man was very unpredictable, and he wouldn’t dare ignore him. So he would take all the insults and threats, but as for Stella she was history. According to Priscilla, Stella was beautiful and all that, but she had not seen the two curvaceous princesses who were all over him, ready to do anything he asked. And these were not barely literate waakye girls, but university graduates from wealthy homes, really classy girls. With stuff like that, who needs a waakye girl? He smiled as he took his seat.
A few minutes to five, Aperkeh was packing up to leave for home to meet his dad when his phone rang. It was Priscilla.
“Aperkeh, Dad says you don’t need to bother to come. Stella’s dad says she came to him early this morning to plead that she would rather stay at home than return to your house. She thinks you are already decided to be rid of her, and she does not want to risk being assaulted again. So it’s done. You can go ahead and enjoy the nice life you have started”.
Before he could tell her to go to hell, Priscilla hanged up the line. He was partially stung that his dad had virtually cut him off. The last thing anyone would want was to fall out of relationship with his own family, which had always supported him.
But the truth was he was no longer interested in Stella. What was wrong with going by one’s feelings? He could only hope that one day, his parents and sister would try to reason with him.
By Ekow de Heer
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