Dernière mise à jour: 28/2/2024

Informations de base

Pays
Institutions et organismes impliqués
Ghana - Ministry of Health, MOH
Références
(i) National Health Insurance Authority (2018), Annual Report https://nhis.gov.gh/files/2018%20Annual%20Report.pdfm (ii) National health insurance authority. (n.d) Board NHIA. Accessible: https://www.nhis.gov.gh/board Accessed 11 Feb 2024
Groupe de population
Women, Mother, Pregnant, Lactating women

Détails du programme

Objectifs du programme

The object of To attain universal health insurance coverage in relation to: 

  • persons resident in the country. 
  • persons not resident in the country but who are on a visit to this country 
  • provide access to healthcare services to the persons covered by the Scheme. 
Couverture
15,161,655 beneficiaries as of December 2021 Over 16 million active beneficiaries, out of a total population of 31 million. 64.9 percent of these beneficiaries are exempt from paying premiums, of which 1.3 million (or 8.3 percent of beneficiaries) are deemed to be poor or vulnerable. Active membership as at end September stood at 14.4 million, representing 45 percent of the targeted population of 20 million and active card holding indigents was 1.7 million representing 74 percent of the targeted 2.3 million indigent population.
Références
(i) World Bank. (2016). Ghana: Social Protection Assessment and Expenditure Review. Washington, DC: World Bank. Accessible at: https://documents1.worldbank.org/curated/pt/776791491300371576/114004-revised-Ghana-SP-report-Draft-for-public-disclosure.pdf. Accessed 11 Feb 2024 (ii) Joint Learning Network. 2021. Ghana Data Linkage Implementation Case Study in A Health Practitioner’s Handbook and Toolbox for Identifying the Poor and Vulnerable. Accessible: https://jointlearningnetwork.org/ghana-data-linkage-implementation-case-study/ Accessed 11 Feb 2024
Dépenses du programme
The NHIA expenditure on claims reimbursement was GH₵1,396 million in 2017, reaching GH₵ 254,151,943 in 2023.
Références
(i) Heleen Vellekoop, Dr. Emmanuel Odame (Ministry of Health). 2021. An Economic Evaluation Considering the Benefits Package of the National Health Insurance Scheme in Ghana. Accessible: https://www.moh.gov.gh/wp-content/uploads/2018/11/Economic-Evaluation-NHIS-Benefits-Package-FINAL.pdf Accessed 11 Feb 2024 (ii) Ken Ofori-Atta (Minister for Finance). 2023. The budget statement and economic policy of the Government of Ghana for the 2024 financial year. Accessible: https://www.moh.gov.gh/wp-content/uploads/2018/11/Economic-Evaluation-NHIS-Benefits-Package-FINAL.pdf Accessed 11 Feb 2024 (iii)  Kwarteng, A., Akazili, J., Welaga, P. et al. 2020. The state of enrollment on the National Health Insurance Scheme in rural Ghana after eight years of implementation. Accessible: https://doi.org/10.1186/s12939-019-1113-0 Accessed 11 Feb 2024

Ciblage et éligibilité

Groupes cibles
Groups exempt from premium fees: (i) Pregnant women (ii) Indigents (iii) Categories of persons with different abilities determined by the Minister responsible for Social Welfare (iv) Persons with mental disorder (v) SSNIT contributors (vi) SSNIT pensioners (vii) Persons above seventy years of age (the elderly) (viii) Other categories prescribed by the Minister
Références
National health insurance authority. (n.d) Membership. Accessible: https://www.nhis.gov.gh/membership Accessed 11 Feb 2024
Critère d'éligibilité
If the person wants to register as a member of the exempt category, they should note that they will be required to have proof of exemption, e.g.: (i) A pregnant woman will have to present proof of pregnancy such as current antenatal card, a signed note from a doctor or midwife, pregnancy test result endorsed by a doctor or midwife or other prescriber or an ultrasound scan report. (ii) A SSNIT contributor should be active in the SSNIT database presented to NHIA by SSNIT. (iii) A SSNIT pensioner should show his/her SSNIT number. or will be registered without paying premium. (iv) You will then be registered without paying premium. The following people in the exempt categories do not pay processing fee: (v) Pregnant women (vi) Indigents (vii) Categories of differently-abled persons determined by the Minister responsible for Social Welfare (viii) Persons with mental disorder (ix) SSNIT contributors (x) SSNIT pensioners (xi) Persons above seventy years of age (the elderly) (xii) Other categories prescribed by the Minister The following members are exempted from the waiting period: Above 70 years Pregnant Women Children under 5 years
Réévaluation d'éligibilité (le cas échéant)
  The members will be required to renew their membership every year
Références
(i) National health insurance authority. (n.d) Membership. Accessible: https://www.nhis.gov.gh/membership Accessed 11 Feb 2024 (ii) National health insurance authority. (n.d) FAQs. Accessible: https://www.nhis.gov.gh/faqs Accessed 11 Feb 2024

Couverture et autres informations

Type de bénéfices
Health care benefits
Références
National health insurance authority. (n.d) Membership. Accessible: https://www.nhis.gov.gh/membership Accessed 11 Feb 2024
Montant des bénéfices
  The NHIA has a pre-defined benefit package of about 95% of the most common diseases seen at health care facilities in Ghana. The services covered include general out-patient and in-patient care, reproductive and maternal care (normal and caesarean delivery), eye, dental and emergency care. A list of essential drugs pre-qualified by the NHIA is also covered. However, expensive procedures such as dialysis for chronic renal failure, treatments for cancer (other than cervical and breast cancers), organ transplants and cosmetic surgery are not covered. Treatment for HIV/AIDS (Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome), immunization and family planning services are also not covered under the scheme but provided for under other government vertical programs.
Références
 Kwarteng, A., Akazili, J., Welaga, P. et al. 2020. The state of enrollment on the National Health Insurance Scheme in rural Ghana after eight years of implementation. Accessible: https://doi.org/10.1186/s12939-019-1113-0 Accessed 11 Feb 2024
Mécanisme de versement des bénéfices
 Indirectly and to health providers (The National Health Insurance Authority (NHIA) engages healthcare providers to offer services to insured members through a process called credentialing. The credentialing process is to ensure that healthcare providers are in a position to provide basic quality health services to insured members in Ghana in accordance with the Benefit Packages within the National Health Insurance Scheme and/or Private Health Insurance Scheme.)
Références
 National health insurance authority. (n.d) Credentialing. Accessible: https://www.nhis.gov.gh/credentialing Accessed 11 Feb 2024
Bénéficiaires de prestations
Children, elderly, Indigent people, pregnant women and LEAP beneficiaries.
Références
  National health insurance authority. (n.d) Membership. Accessible: https://www.nhis.gov.gh/membership Accessed 11 Feb 2024
Legal Framework
The National Health Insurance Authority (NHIA) was established under the National Health Insurance Act 2003, Act 650. Act 852 has replaced ACT 650 in october 2012
Références
  National health insurance authority. (n.d) about NHIA. Accessible: https://www.nhis.gov.gh/nhia Accessed 11 Feb 2024
MIS
Smart office Workplace implemented formed part of the NHIA’s (5D Strategy) including  eMemo and eCorrespondence Management Systems (The National Health Insurance Authority (NHIA) Membership and Regional Operations (MRO) and Management Information Systems (MIS) Directorates on October 16, 2023, began a nationwide training of some selected staff of the National Health Insurance Scheme (NHIS))
Références
(i) Abdul Karim Naatogmah. 2024. NHIA Staff trained on E Memo and Correspondence Management System. Accessible: https://www.nhis.gov.gh/News/nhia-staff-trained-on-e-memo-and-correspondence-management-system-5559 Accessed 11 Feb 2024 (ii) Abdul Karim Naatogmah. 2023. MRO and MIS trains NHIS staff nationwide. Accessible: https://www.nhis.gov.gh/News/mro-and-mis-trains-nhis-staff-nationwide---5539 Accessed 11 Feb 2024