Nutrition
The true cost of free healthcare: Why NHIS must cover essential nutrition services
Ghana’s National Health Insurance Scheme (NHIS) has transformed healthcare access for millions of people. Since its establishment, the scheme has reduced out-of-pocket health spending and increased the use of healthcare services. For many families, an NHIS card means the difference between seeking treatment and delaying care. Yet this promise of accessible healthcare encounters significant limitations when families face nutrition emergencies.
Consider a mother whose child develops severe acute malnutrition (SAM). This life-threatening condition affects an estimated 68,000 children in Ghana and carries a mortality risk up to nine times higherthan that of well-nourished children. The good news is that SAM can be treated effectively. Ready-to-Use Therapeutic Food (RUTF), a peanut-based therapeutic food that allows children with uncomplicated malnutrition to recover through community-based treatment. Recovery rates typically range between 75 and 90 per cent, with very low mortality when treatment is delivered early. RUTF is not an experimental intervention. It is included in Ghana’s Essential Medicines List and the Standard Treatment Guidelines, and health workers across the country are trained to use it.
Yet RUTF is not covered under the NHIS benefits package.
This means that even when a mother holds a valid NHIS card, the scheme may cover consultation fees and routine medicines but not the one treatment that could save her child’s life. Access often depends on whether a donor-funded program happens to be operating in her district. If supplies run out, or if her district is not part of a project, treatment may simply not be available. This is the hidden cost of healthcare that appears free on paper but remains inaccessible in practice.
The pattern repeats with maternal nutrition. An estimated 37 to 63 per cent of pregnant women in Ghana experience anemia, depending on the stage of pregnancy. While iron and folic acid supplements help address two nutrients, pregnancy increases the body’s demand for many more vitamins and minerals. Multiple Micronutrient Supplements (MMS) provide 15 essential vitamins and minerals in a single daily tablet. Evidence shows that MMS can reduce low birth weight by about 12 per cent, preterm birth by about 11 per cent, and small-for-gestational-age births by around 8 percent.
Despite these benefits, access remains limited. A full course of MMS during pregnancy costs about $2.50 in public-sector procurement, yet current pilot programs reach only a small fraction of pregnancies. Most pregnant women enrolled in NHIS receive antenatal consultations and iron-folic acid tablets, but comprehensive micronutrient supplementation is not yet routinely available through the system. As a result, women who can afford supplements from private pharmacies may receive more comprehensive care, while others rely on more limited options. These gaps create what economists call “false savings”.
When children with severe malnutrition cannot access RUTF early, their condition may worsen, requiring costly hospitalisation and medical care. When pregnant women lack adequate micronutrient support, complications during pregnancy and childbirth can generate healthcare costs far greater than the cost of prevention.
In other words, excluding essential nutrition interventions from NHIS may appear to save money in the short term, but it often raises healthcare costs later while worsening health outcomes. The encouraging news is that the infrastructure to address this gap already exists. A large majority of mothers with young children in Ghana are already enrolled in NHIS. Health facilities have trained staff, established antenatal care systems, and experience delivering nutrition services.
What remains is a policy decision. Integrating RUTF and MMS into the NHIS benefits package would ensure that families enrolled in the scheme can access these essential services when they need them most.
Healthcare that appears free but excludes life-saving nutrition services is healthcare that fails at critical moments. Including these interventions under NHIS would not simply expand the benefits package. It would complete the promise of universal health coverage, ensuring that Ghanaian mothers and children receive the care they need to survive and thrive.
Feature article by Women, Media and Change under its Nourish Ghana: Advocating for Increased Leadership to Combat Malnutrition project
Egg stew is a traditional dish from Ghana. It is very healthy and easy to prepare. The dish is traditionally served with rice, plantain and any other meal of one’s choice.
Ingredients
-1 litre of vegetable oil
-2 fresh salmon
-10 large tomatoes
-5 large onions
– 6 eggs
-3 tablespoonful of pepper
-1 tablespoonful of powdered garlic and ginger
-1 tin of mackerel
– I large green pepper
-3 tablespoonful of tomatoes paste
Preparation
-Wash tomatoes, onion, green pepper and blend
-Put oil on fire and add onion and powdered pepper to it
-When onions turn golden brown, add blended tomatoes and tomato paste to it. (Allow it to cook for 3 minutes.)
-Add eggs and salmon to stew and leave it for a minute before stirring.
– Add seasoning to the stew and serve.
By Linda Abrefi Wadie
Every baby deserves a healthy start. But in Ghana, too many children are being born already behind, too small, too fragile, and at far greater risk than their peers. Low birth weight, defined as weighing less than 2.5 kilograms at birth, affects an estimated one in seven newborns in this country.
That is a significant proportion of children beginning life at a disadvantage, often due to preventable causes.
Children born with low birth weight face a steeply uphill journey from their very first breath. They are more susceptible to birth asphyxia, infections, hypothermia, and respiratory complications.
They are more likely to die in their first month of life. Those who survive face higher risks of stunting, impaired cognitive development, and a greater likelihood of developing non-communicable diseases including type two diabetes, hypertension, and heart disease later in life.
Low birth weight does not just harm the child today. It shapes their health for decades.
The most powerful determinant of a baby’s birth weight is what the mother eats, and how healthy she is before and during pregnancy. Research in Ghana has consistently shown that maternal anaemia, poor dietary diversity, and inadequate antenatal care are all strongly linked to low birth weight.
A study in Cape Coast found that mothers with low dietary diversity during pregnancy were significantly more likely to deliver low birth weight babies. In Northern Ghana, maternal anaemia in both the first and third trimesters of pregnancy increased the risk of low birth weight. What a woman eats is what her baby weighs.
Education matters too. Mothers with secondary or higher education have been found to be less likely to deliver a low-birth-weight baby, a difference attributed to better nutrition knowledge, improved antenatal care attendance, and healthier health-seeking behaviour overall.
This points clearly to the need for a whole-of-society response, not just a clinical one.
Ghana has made some progress on low birth weight, but the burden remains unacceptably high and in some parts of the country, it is worsening. Other important risk factors must not be overlooked.
Adolescent pregnancy, which remains prevalent in several regions, is strongly associated with low birth weight because young mothers are often still growing and competing with the fetus for nutrients.
Malaria infection during pregnancy, particularly in endemic areas of Ghana, damages the placenta and restricts nutrient transfer, further increasing the likelihood of a low-birth-weight baby.
These risk factors compound the effects of poor maternal nutrition and limited antenatal care. Leaders in government, health facilities, and communities must prioritise maternal nutrition before, during, and after pregnancy.
Reducing low birth weight is not complicated. It requires feeding mothers well, supporting them through antenatal care, ensuring access to iron-folic acid supplementation and malaria prevention during pregnancy, and treating their health as a national priority, not an afterthought.
Feature article by Women, Media and Change under its Nourish Ghana: Advocating for Increased Leadership to Combat Malnutrition project
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