Mr. Sylvester A. Mensah
Chief Executive Officer, NHIA

Health summit, GIMPA, Accra
Tuesday, 17th November 2009

and the current strategic direction .PRESENTATION OBJECTIVE To present a snapshot of the main themes relating to the success and sustainability of Ghana s National Health Insurance system.

OUTLINE OF PRESENTATION Introduction Implementation outputs Challenges Strategic direction Conclusion .

I.INTRODUCTION NHIS of Ghana established by National Health Insurance Act.all regulated by National Health Insurance Authority (NHIA) Policy objective of the National Health Insurance Scheme (NHIS) is to secure the provision of basic healthcare services to persons resident in the country . 2004 (L. 1809) 3 types of health insurance schemes . 2003 (Act 650) and National Health Insurance Regulations.

146.163 pregnant women under free maternal care since July 2008 .526 total ID cards issued to date ‡ 87.840.IMPLEMENTATION OUTPUTS Membership (cumulative as at June 2009) ‡ 13.110 indigents registered ‡ 721.8% of registered to date issued cards ‡ 309.198 registered (67% population 2004 estimates) ‡ 12.

551 private facilities ‡ Formal accreditation: 618 facilities inspected ‡ Inspection has begun for 1.Implementation Outputs (2) Accreditation of providers ‡ Provisionally accredited: all public and CHAG facilities (about 4.000) and 1.200 more facilities .

Implementation Outputs (3) NHIS ICT platform (870 sites hooked up) NHIS uniform ID card G-DRG tariffs and NHIS Medicines List ‡ Implemented since April 1. tariffs review in preparatory stages . 2008 ‡ Review of Medicines List completed and in effect since 1st October 2009.

CHALLENGES Claims administration Fragmentation and Autonomy of DMHIS ‡ Standardisation and Governance ‡ Weak portability ‡ Weak control systems that provide a potential for fraud Weak enforcement of gatekeeper system (referral system) Difficulty identifying indigents and the poor Misapplication of approved tariffs Prescribing and dispensing of unapproved medicines .

STRATEGIC DIRECTION Goal ‡ To deliver on the NHIS promise of providing access to quality basic health care for all residents of Ghana .

Strategic Direction (2) Strategic Objectives (Sep 09 Dec 10) are to: ‡ Implement one-time premium ‡ Review legislative framework ‡ Improve claims administration ‡ Achieve full portability with fully operational ICT solution ‡ Overhaul NHIS communication strategy .

Strategic Direction (3) Implement one time premium payment ‡ Preliminary actuarial analysis concluded and submitted to Government for study Review legislative framework ‡ Aims to remove implementation bottlenecks ‡ To be completed by the end of 2009 .

Strategic Direction (4) Improve claims administration ‡ Pilot claims centre in Accra ‡ Pilot electronic claims submission with Mamobi Polyclinic Achieve full portability ‡ Address ICT implementation challenges ‡ Improve ID card production-distribution cycle Overhaul communication strategy ‡ Increased engagement with stakeholders ‡ Innovative marketing of the scheme .

one ICT platform ‡ One premium. one corporate entity. one governing board ‡ One ID card.CONCLUSION NHIS has been accepted Achievements and challenges are recognised Strategies have been advanced towards: ‡ One National Scheme. one-time payment ‡ One claims administration system .

Thank you!! .

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