Don’t copy Ghana’s health insurance - Oxfam warns poor countries

New report finds serious flaws with scheme touted as poor country health care model

A major health insurance program in Ghana that the World Bank is pushing as a success model for other developing countries is severely flawed and not working for most Ghanaians, according to a new report by international agency Oxfam and Ghanaian NGOs.

Rather than two-thirds of the population being covered by the program, as the Ghanaian National Health Insurance Authority and World Bank have claimed, in reality fewer than one in five Ghanaians could be benefiting. The report 'Achieving a Shared Goal: Free universal health care in Ghana’, launched today in Accra, says instead that most people are having to continue to pay out-of-pocket for their health care in a parallel "cash-and-carry" system. Or else they turn to unqualified drug peddlers or even give birth at home without any qualified care at all.

"The World Bank should check its facts on Ghana. This inaccurate information should not be used to sell what is actually an unfair and inefficient system of paying for health-care to other developing countries such as Uganda, Zambia and Nepal," said Anna Marriott, Oxfam Health Policy Advisor.

"The Ghanaian government is actually in a very strong position to overhaul the entire insurance scheme and replace it with a tax-based system that would give free health care to all its citizens at a lower cost. It's time for the Bank to take off its blinkers and help Ghana do the right thing, and to stop promoting an inequitable health insurance system to other developing countries."

Oxfam and its Ghanaian partners said that despite every citizen contributing toward Ghana's health insurance scheme through VAT, the country's health care system is unfair, inefficient and un-transparent. "The government must move fast to implement free health care for all citizens. It is appalling that everyone pays for health care in Ghana through their taxes, yet over 80 per cent of the population is denied care from the national program because they can’t afford to pay twice. Nobody should pay with their life or suffer ill health because they are poor but this is still happening in Ghana," said Bishop Akolgo, of the Ghanaian NGO ISODEC.  

The report also raises serious concerns with poor transparency in the National Health Insurance Authority (NHIA). The NHIA’s financial reports are difficult if not impossible to obtain and in 2008, 45 per cent of NHIA funds went unaccounted for. “As the NHIA is responsible for managing a large public budget as well as the individual contributions of NHIS members, its poor transparency is of great concern,” said Akolgo.

Moving away from a health insurance administration alone could save US$83 million each year, the report finds, enough to pay for 23,000 more nurses. The report calculates a 200 per cent increase in health spending is possible through measures including improving taxation of Ghana’s own resources, especially oil.

Important progress has been made in Ghana’s health care system in recent years:

• the introduction of free health care for all pregnant women in 2008,
• Malaria deaths for children under five have been reduced by half, and
• child and infant mortality are on the decline after years of stagnation.

“Government’s clear political commitment to health is very welcome but bolder changes are now urgently required to accelerate progress. The government must move to a national health system free at the point of delivery for all - a service based on need and rights and not ability to pay. Ghana can still build a universal health care system that delivers for all and is the envy of Africa,” said Akolgo.

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Download the report: Achieving a Shared Goal: Free universal health care in Ghana

Oxfam's campaign for Health & Education For All