NHIS: On the road to recovery
Institutional decline is like a staged disease: harder to detect but easier to cure in the early stages, easier to detect, but harder to cure in the later stages. An institution can look strong on the outside but may already be sick on the inside, i.e. dangerously on the cusp of a precipitous fall.
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There have been companies that had once served as paragons of excellence but succumbed to the downward force of gravity. This means that no institution, like a human being, is immune to fall or death.
All is not lost
As Jim Collins posited, “whether you prevail or fail, endure or die, depends more on what you do yourself than on what the world does for you.” Every institution, no matter how great, is vulnerable to decline. There is no law of nature that affirms that the most powerful will inevitably remain at the top. Decline is largely self-inflicted and the path to recovery lies largely within our own hands.
All is not lost. What the National Health Insurance Authority (NHIA) needs to do is to adhere to highly disciplined management and leadership practices. The Authority needs to be transparent, open and sincere with Ghanaians, tolerating and interrogating their comments and criticisms for improvement and taking early warning signs more seriously, as well as taking decisive actions and be ready to review its own decisions.
Indeed, the American Managers Association (AMA) in a research asserts that only 30 per cent of all management’s decisions are accurate and timeless. A whopping 70 per cent of all decisions, according to the research, are either wrong or need modifications with time.
Accreditation
The widespread and palpably unbridled accreditation of private facilities should be guarded against. The MOH’s desired distance between health facilities should be adhered to. Accrediting facilities without very stringent and robust measures against corrupt and fraudulent practices is a juicy conduit for siphoning public funds.
Those caught in such fraudulent practices should not only be dealt with appropriately according to the law, but such facilities should be de-accredited and blacklisted. Merely demanding refunds from such culprits is just a scratch on the problem and would not be deterring enough to would-be perpetrators.
The benefit package should be looked at. If the income available to NHIA cannot cover tertiary services, the package should be limited to only the primary and secondary services, which actually cater for more than 85 per cent of all conditions in Ghana.
Funding the NHIS
The tax bracket of the country should be widened to mobilise enough funds for the National Health Insurance Scheme (NHIS). I also support Dr Richard Anane’s incessant call for an additional one per cent VAT for the NHIS. This would address the huge funding gap conundrum, which is partly attributable to the high dependency ratio.
Capitation will certainly not solve all the woes of the Scheme. In fact, it may be tagged as an intelligent transfer of risks as a result of the Scheme’s inability to pay healthcare providers. Providers may also find ways of reducing levels of investigations, etc. which otherwise should have been done for patients. For the time being, co-payment could be a better alternative.
Moreover, the accrued National Health Insurance Levy (NHIL) should be paid directly into the NHIF monthly and not channelled through the Consolidated Fund, otherwise known as the “bottomless pit”.
Ghanaians should be continuously educated to not abuse health services just because they do not pay directly for them. They should embrace personal hygiene, healthy living and other activities which will promote health and prevent diseases.
Most beneficial intervention
The NHIS has come to stay as the most beneficial intervention for Ghanaians, and posterity and the current generation will not forgive any manager, leader or government by whose acts of commission and or omission could lead to the eventual collapse of the Scheme.
It is noteworthy that failure itself is not bad, but failure or refusal to learn from our mistakes is bad. Indeed, failure is not so much a physical state as a state of mind; success is falling down, and getting up one more time, without end.
We as managers, clients, patrons of the NHIS should not travel again the road that created this debilitating situation. Indeed, according to the World Health Organisation (WHO), and other recognised bodies, Ghana was foretold that its NHIS was going to be in this present moribund state if modifications were not made to its operations.
Albert Einstein defined insanity as doing the same thing over and over again and expecting different results. We need to change. We are not imprisoned by our circumstances, our setbacks, our history, our mistakes, or even staggering defeats along the way. We are freed by our choices.
Let us make the choices which will be beneficial to us. Jim Collins sums it all when he said:
“The signature of the truly great versus the merely successful is not the absence of difficulty, but the ability to come back from setbacks, even cataclysmic catastrophes, stronger than before. Great nations can decline and recover. Great companies can fall and recover. Great social institutions can fall and recover. And great individuals can fall and recover. As long as you never get entirely knocked out of the game, there remains always hope.”
There is certainly hope for Ghana’s NHIS.
The writer is the Hospital Administrator for Oda Government Hospital
Writer’s Email: [email protected]