Nutrition
The true cost of free healthcare: Why NHIS must cover essential nutrition services
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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
Salt, sugar and cooking oil are ordinary parts of many Ghanaian diets. None needs to be treated as an enemy. The concern arises when they are consumed in excessive amounts, often without us realising how much we are actually eating.
The key is not necessarily to eliminate them, but to understand how much we consume, how often we consume them and where they appear in our diets.
Salt contains sodium, an essential nutrient that the body needs. However, consuming too much sodium can raise blood pressure and increase the risk of cardiovascular disease. The World Health Organization recommends that adults consume less than 2,000 mg of sodium per day, equivalent to less than five grams of salt.
Much of the sodium in our diets may come not only from the salt shaker but also from processed and packaged foods, seasoning products, condiments and heavily salted meals.
One simple step is to taste food before automatically adding extra salt. Using herbs, spices, onions, garlic, ginger, peppers and other flavourful ingredients can help meals remain enjoyable without relying entirely on salt.
For people who regularly use packaged seasoning products, checking the label where one is available can also help identify products that contain higher amounts of sodium.
Sugar presents a different but related challenge. Sugary drinks, sweetened tea, confectionery and many processed foods can add substantial amounts of free sugar to the diet.
Drinks deserve particular attention because they can be consumed quickly and may contain considerable amounts of sugar without creating the same feeling of fullness as a meal.
Water is therefore one of the simplest alternatives. Unsweetened drinks can also help people reduce their intake of added sugar. WHO recommends limiting free sugars to less than 10 per cent of total daily energy intake, with further benefits when intake is reduced to below five per cent.
This does not mean that every sweet food has to disappear from the household. It means paying attention to frequency, portion size and everyday habits.
The body needs dietary fat. Fats provide energy and help the body absorb certain vitamins. However, fats are energy-dense, meaning that relatively small amounts contain substantial amounts of energy.
Deep-fried foods can therefore contribute significantly to overall energy intake, particularly when eaten frequently. Fried foods do not automatically become “bad” foods, but frequency, portion size and cooking methods matter.
A useful strategy is moderation. A household does not necessarily need to stop using cooking oil; it can simply avoid using more than necessary and vary cooking methods where practical.
For families, small changes can add up. Using less salt when cooking, reducing added sugar in drinks, choosing water more often and limiting frequent deep-fried meals are practical steps that do not require an expensive diet.
Nutrition is rarely about one ingredient ruining a meal. It is about patterns.
A little salt, sugar or oil does not define whether a person’s diet is healthy. The bigger questions are how much is consumed, how often it is consumed and what the rest of the diet looks like.
Feature Article by Women, Media and Change
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Turmeric (Curcuma longa), the vibrant, golden-yellow spice derived from the rhizomes of a plant belonging to the ginger family, has been a cornerstone of traditional culinary and medicinal practices. The benefits of turmeric are as follows:
-Anti-inflammatory and antioxidant defenses
At the cellular level, tumeric acts as a potent shield against two fundamental drivers of chronic disease: chronic inflammation and oxidative stress. Low-grade, systemic inflammation is linked to many major health conditions. Tumeric mitigates this by blocking major inflammatory molecules, such as tumor necrosis factor-alpha and interleukin-6, helping to arrest the inflammatory cascade at its source.
– Supports joints, heart, and brain
The systemic relief offered by turmeric is perhaps most visibly felt in joint health. For individuals suffering from osteoarthritis, tumeric drastically reduces joint discomfort and stiffness by dampening inflammatory markers within joint tissues.
-Metabolic and visceral regulation:
Turmeric acts as an effective metabolic regulator, particularly in blood sugar management. Research shows that tumeric enhances insulin sensitivity and lowers blood glucose levels by curbing hepatic glucose synthesis and activating cellular.
-Digestion: Turmeric directly aids digestion and visceral detoxification. It stimulates the gallbladder to produce and secrete bile, an essential fluid required to properly emulsify and break down dietary fats.
-Liver detoxification: The liver benefits directly from eating turmeric. Turmeric protects vulnerable liver cells from chemical and environmental damage while upregulating the cellular enzymes responsible for clearing metabolic waste and toxins from the human body. -Health.com
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