Nathaniel Otoo, Chief Executive, National Health Insurance Scheme (NHIS): Interview

Interview: Nathaniel Otoo

How would you evaluate the NHIS’s effectiveness in addressing Ghana’s key health indicators?

NATHANIEL OTOO: Ghana has made consistent and significant progress in the areas of maternity and childcare over the past decade. Although we will not meet the millennium development goals (MDGs) in 2015, Ghana’s most recent demographic and health survey shows that we are steadily progressing towards these goals. It is also important to note that Ghana’s progress towards the MDGs shares a trajectory with the development of the insurance scheme in Ghana. We therefore believe that we will be able to rise to the challenge as the system matures.

Ghana is now facing what we call the double burden of disease. Traditionally, infectious disease has been our nemesis, but rates of non-communicable diseases have also consistently been on the rise. Addressing diseases such as hypertension while also battling old epidemics such as malaria has put a strain on the health care system. Nevertheless, our strategy has been to tackle non-communicable disease early by designating universal primary care as one of our main strategic goals.

Can the National Health Insurance Levy become a sustainable source of funding for the NHIS?

OTOO: No one can benefit from a system that will be insolvent, so we are examining ways to increase funding as well as cut spending. We have explored options such as an increase in value-added tax from 2.5% to 3.5%, but that would only be a medium-term option. Ghana covers 95% of the market and there are no limits on the cost of care. The NHIS now covers 10.54m people with an estimated average of 2.7 visits per patient at a cost of GHS93 ($26) per patient, and these numbers are expected to grow. However, the cost of care can range from GHS18 ($5) for malaria medication to GHS15,000 ($4160) for cancer treatments. We are looking to see if we can continue to provide services without co-payments. We are also examining ways that we can partner with the private sector to ensure quality of care while also managing to become more efficient in expenditure.

What is being done to improve health care coverage for underserved segments of the population?

OTOO: The issue of migration into urban areas brings another dimension to health care for the country. The health concerns of the urban poor and rural poor are equally important, but their respective health concerns are very different. Therefore, the NHIS has reshaped its strategy by partnering with other social protection programmes. Joining forces with initiatives such as the Livelihood Empowerment Against Poverty (LEAP) programme and the school food programme, we are better able to identify high-risk individuals. By combining efforts, we are able to reach at-risk individuals early on and prevent the need for more costly interventions later. With this programme, we were able to support the primary health care needs of 1.2m people in 2013 and 1.4m in 2014.

How is NHIS looking to incentivise Ghanaian doctors and nurses to work in remote areas?

OTOO: This continues to be an issue. Surprisingly, compensation is the least common reason that health professionals give for not working in rural areas. Of greater concern is the lack of tools available to give proper care, and the lack of educational opportunities. However, those who take on these challenging roles are rewarded with better postgraduate opportunities and promotions. In terms of medical equipment, the development of better facilities and resources is a cornerstone of NHIS strategy. The Community Health Improvement Services compounds in rural Ghana work to improve facilities. With further development, we soon expect to see more advanced facilities in all parts of Ghana.