The Chief Executive Officer of Ghana’s National Health Insurance Authority (NHIA), Dr. Victor Asare Bampoe, has unveiled an ambitious reform agenda aimed at transforming the National Health Insurance Scheme (NHIS) into a more efficient, transparent, and accessible system.
The reforms are anchored on strengthening financial sustainability, leveraging technology to improve service delivery, expanding access to healthcare, and eliminating corruption and inefficiencies within the system.
Discussions also touched on government initiatives, including free primary healthcare and the Ghana Medical Health Fund, popularly known as the “Mahama Cares” programme, which targets chronic disease management.
Concerns were raised about healthcare facilities accredited as primary care providers but offering secondary and tertiary services, a situation that could affect their ability to recover operational costs.
Three-Pronged Reform Vision
Dr. Bampoe outlined a three-part strategy driving the NHIA’s current reform agenda.
First, he emphasized strengthening internal systems to eliminate financial leakages. This includes the use of technology and audits to ensure that funds are properly utilized.
“We believe there are financial leakages, and we intend to use technology and audits to ensure that every cedi goes to the right place,” he said.
He added that improving staff welfare is also a priority, noting that issues such as promotions and career progression will be addressed to boost morale and productivity.
The second pillar focuses on eliminating illegal charges—commonly referred to as co-payments—imposed on NHIS members at the point of service.
“We recognize that co-payment is linked to tariff structures and delays in claims payments. We are working to correct these issues to eliminate out-of-pocket charges,” he stated.
The third aspect of the vision aligns with government policy priorities, including the implementation of free primary healthcare and the expansion of the Mahama Cares programme.
“All these initiatives require funding. We must ensure that every cedi is used efficiently to improve the health and lives of Ghanaians,” Dr. Bampoe stressed.
He added that prudent financial management would boost government confidence and lead to increased support for the Scheme.
Addressing Co-payment Challenges
Deputy Chief Executive for Administration and Human Resources, Raphael Segkpeb, noted that while co-payment is partly driven by tariff rates and delayed reimbursements, eliminating it entirely may require broader stakeholder action.
He called on the GMA to play a stronger advocacy role in addressing the issue, recalling past enforcement efforts that yielded limited long-term results.
GMA Calls for Sustained Reforms
Dr. Serebour congratulated Dr. Bampoe and his management team and commended the NHIA for recent payments to healthcare providers, noting their positive impact on service delivery.
He urged the Authority to sustain timely reimbursements and reiterated the GMA’s longstanding calls for reforms, including the decapping of National Health Insurance Levy (NHIL) contributions and ring-fencing NHIS funds.
He also proposed deeper collaboration between the NHIA and GMA on public education and stakeholder engagement.
Addressing co-payment, Dr. Serebour linked the practice to delayed claims payments, explaining that healthcare providers often resort to charging patients to remain operational.
He assured the NHIA of the GMA’s support in eliminating co-payments, stressing that the Association would take a firm stance against members who engage in the practice once the system becomes fair and transparent.
Strengthening the Scheme
Deputy Chief Executive for Operations, Dr. Senanu Kwesi Djokoto, noted that as a publicly funded social health insurance scheme, the NHIS has inherent limitations.
“The goal is to provide broad coverage, but not necessarily for every condition. There will always be gaps,” he explained.
He added that the NHIA would continue to review actuarial projections and engage stakeholders to improve the Scheme’s sustainability and effectiveness.