Reducing poverty in Ghana through a social health protection system
People who live in poverty have reduced access to health care. In Ghana, communities who live in poverty often experience child under-5 mortality, child over-5 mortality, stunting, no vaccinations, and do not have access to modern medicines and health facilities. This blog will analyze how integrating cash transfers and health insurance could reduce poverty, shrink health disparities, and enhance equality for all people in Ghana by disclosing the challenges and opportunities of such programmes.
In 2013, the Government of Ghana passed the Health Insurance Act (Act 650) (Palermo, T., et al., 2019) to subsidy health expenditures of people in communities and created the Health Insurance Scheme (HIS), which aims to shrink barriers to access health care. Act 650 exempted some groups of people from paying the HIS premiums, including children under 18 years, people over 70 years, and indigents (Palermo, Tia, et al., 2019). The primary objective of the HIS is to ensure equitable access to health care through services related to in-patient and out-patient consultations, maternity care, eye care, dental care, and emergency care services in 110 districts (Dsane-Selby et al., 2017). In 2014, the Health Insurance Levy financed these health care services with premiums between 72,000 Ghana cedis (GHS) (US$ 7.5) and 480,000 GHS (US$ 50) (Garcia-Mandicó et al., 2019) per adults. Ghanaian families have been covered for at least 144,000 GHS (US$ 15) to enhance their health (Garcia-Mandicó et al., 2019) through health care services.
It is vital to keep financing and expanding premiums to protect all households with orphans, elderly, and people with severe disabilities from disadvantaged communities. Ghana’s Government has financed the HIS through value-added tax (VAT) revenue, and this ensures the stability of its revenues as a share of the total government spending. However, the HIS revenues do not increase as the coverage expands to keep protecting more communities, so how do we intervene to make sure that all disadvantaged communities are covered through the HIS? In 2014, the HIS expenditure was 2.5 million GHS (Ministry of Health, 2014) and it covered 10.5 million people - about 40% of Ghana’s population -, and 2/3 of its members (around 6.9 million people) are exempt from premium payments (Dsane-Selby et al., 2017). Among the people who are exempted from paying premiums, there are 4.7 million children under 18, 286,596 pregnant women, 280,157 people over 70 years old, and 1.5 million indigent people (World Bank, 2016). Ghana’s Government, through the Department of Social Development, has increased the number of people in disadvantaged and marginalized communities who qualify for premiums. They also included additional health services in the HIS, related to cancer treatments, dialysis, and vaccines to shrink health disparities and keep protecting disadvantaged and marginalized communities.
Whereas the HIS has increased health protections and access to health services for its members, people who are from disadvantaged and marginalized communities are less likely to enroll in the scheme – especially because the system requires an annual renewal fee. In mid-2014, it was estimated that 41% of people enrolled in the HIS programme dropped the following year (Palermo, Tia M, et al., 2019). Through Act 852, in 2014, Ghana’s Government expanded insurance coverage for more groups of people, such as women with antenatal, delivery, and postnatal health care services (Health Insurance Scheme, 2020). Nowadays, over 60% of people who enrolled in this critical social protection programme were exempted from paying premiums, which represents 3% of the total HIS revenue (Palermo, Tia M, et al., 2019). In late 2015, the Ministry of Health disclosed that the HIS was facing severe financial difficulties (World Bank, 2016); therefore, it is important to talk about financial sustainability to ensure the HIS sustainability to create greater equality by protecting people from the most disadvantaged and marginalized communities.
Health expenditures in Ghana have declined from 2013 to 2015 and reached 2.3% of the GDP and 8% of total health expenditure. Regarding the frontline health care workers’ wages, in 2015 the 57% of the health care budget has declined to about half. Generating sources of funding is paramount and possible through new premiums from subscribers, 2.5% of resources from the Health Insurance Levy, 2.5% from the Social Security and Insurance Trust, deductions from the formal sector, and funds from the Government of Ghana allocated by Parliament. Albeit the cost of premium exceptions, in 2015, was estimated at 4.8 million GHS (World Bank, 2016), there is still the possibility to increase the annual minimum premium range from 216,00 GHS (US$ 21.5) to 480,000 (US$ 50) and frontline health care workers’ wages through the return on investment created by the sources of funding. If we generate new sources of funding, we can enable people from disadvantaged and vulnerable communities to have the possibility to access health care. These new resources will cover the premiums for all women and children, and frontline health care workers’ wages. Ensuring the sustainability of the HIS by generating sources of funding, expanding health care coverage, and increasing wages of frontline health care workers is critical to creating greater equality by protecting all people from the most disadvantaged and marginalized communities, not just a few. Encouraging new enrollments and membership renewals by incorporating health-education focus group sessions, innovative medicine, and pharmaceutical health services will enable to increase the health coverage of all people, lifting 28,83 million Ghanaians, especially women, mothers, and children, are out of poverty with access to all health care services equally.
In conclusion, investing in the HIS would reduce poverty, shrink health disparities, and enhance equality to access health care. Increasing the enrollment of uninsured households who are out of poverty and have the possibility to afford premiums is crucial to protecting all people in the most disadvantaged and marginalized communities. Supporting the HIS through generating sources of funding is also crucial to keeping increasing health care services by incorporating health-education focus group sessions to engage with new members. When we preserve the health of all people in Ghana, especially of women, mothers, and children, health care will become a reality.
References:
Dsane-Selby, L., Otoo, N., & Wang, H. (2017). Ghana National Health Insurance Scheme: Improving Financial Sustainability Based on Expenditure Review. The World Bank Group.
Garcia-Mandicó, S., Reichert, A., & Strupat, C. (2019). The Social Value of Health Insurance Results from Ghana. Policy Research Working Papers.
Health Insurance Scheme (2020). Frequently Asked Questions, www.nhis.gov.gh/Faqs/the-benefits-of-the-national-health-insurance-scheme-2.
Ministry of Health (2014). Parliamentary Statement by the Hon. Minister of Health on the Status of the National Health Insurance Scheme. Banjul: Ministry of Health.
Monchuk, V. (2014). Reducing Poverty and Investing in People: The New Role of Safety Nets in Africa.
Palermo, Tia M, et al. (2019). Impact Evaluation of a Social Protection Programme Paired with Fee Waivers on Enrolment in Ghana’s National Health Insurance Scheme. BMJ Open, vol. 9, no. 11, 2019.
World Bank. (2016). Ghana: Social Protection Assessment and Expenditure Review. Washington, DC: World Bank.
