In 2003, Ghana began implementation of a National Health Insurance Scheme (NHIS) which aimed at universal coverage, despite vocal opposition from donors and technical experts. Five years later, the NHIS provides insurance for almost 60 percent of the population, covering 95 percent of the disease burden. While it has gained increasing attention from other African countries that are seeking to reform their health systems, the complex policy process in developing the NHIS and the current progress in meeting coverage targets of the poor have so far not been well described. In addition the apparent success is met by scepticism in many quarters, for a number of reasons one of them being the problems concerning long term financial sustainability.

This session pulls together the ongoing research on the implementation of the NHIS to present (each presenter will draw on several pieces of ongoing and published work) 1) the political economy aspect, specifically how the complex interactions of actors and organizations led to the development of the National Health Insurance Act; 2) the innovative technical design of the economic (e.g. advances in provider payment mechanisms and quality assurance through accreditation), institutional and wider health systems aspects of the NHIS within Ghana’s low-income country context; and 3) the NHIS’s impact on health care outputs such as improving health care access to the poor. It is through this interaction of political economy, technical design and ongoing institutional reforms that the NHIS has reached its current state of high coverage but ongoing implementation.

Following the presentations, panelists will discuss the following: 1) Although high insurance coverage seems like an indicator of the NHIS’s success, the NHIS has been experiencing implementation problems with paying providers and preventing exemption-creep that could destabilize the financial sustainability. Is it too early to cite the NHIS as a success that can be replicated by other African countries? 2) Can the NHIS be replicated or are there too many critical country-specific factors? 3) Given Ghana’s history of weak targeting through exemptions and high rates of informality, what should be the NHIS’ key priorities for reaching the poor?
Discussants:

Irene Agyepong, Ghana Health Service, Greater Accra Health Directorate

Finn Schleimann, Sr. Health Specialist, World Bank

Andreas Bjerrum, Ghana Health Sector Advisory Office