Corruption risk factors affect operations of NHIS — Study

The Ghana Integrity Initiative (GII) has identified conflict of interest, overbilling, abuse of power, insider peddling and discretion as some corruption risk factors in the claim management process of the National Health Insurance Scheme (NHIS).

It said the corruption risks affected the efficient service delivery of the scheme in ensuring quality healthcare services to women, girls, the weak and other marginalised groups, putting them at risk of discrimination.

The organisation has, therefore, called on the National Health Insurance Authority (NHIA) and the Ghana Health Service, which are the service delivery points, to put in place risk mitigation measures that would prevent staff from taking advantage of those loopholes.

Event

The Executive Director of GII, Mary Awelana Addah, made this known on the sidelines of a two-day workshop on corruption risks assessment dissemination and training on mainstreaming anti-corruption in the delivery of healthcare services for women, girls and other groups at risk of discrimination.

The workshop, which was organised by the GII, shared results and recommendations from a corruption risk assessment which was conducted on the health sector, specifically focusing on claims management processes of the NHIS for senior government officials in the healthcare sector.

Mrs Addah also shared the findings of the study in an interview with journalists.

Study

She said the study, which was a crucial component of its All-Inclusive Services Delivery Africa (ISDA) project, looked at how claims were processed and if there were gaps within the systems, including mitigating measures that could be put in place to address them.

The project was being implemented in five African countries, including Ghana. The others are DR Congo, Rwanda, Zimbabwe and Madagascar.

The goal of the project is to ensure that there is an increase in transparency and accountability in service delivery, particularly for women, girls and other groups at risk of discrimination. 

Corruption

Mrs Addah further said that corruption presented a significant challenge to the effective delivery of public services in the country’s health sector, adding that while the sector was crucial for development, it was particularly vulnerable to corrupt practices due to its value and demand.

“Corruption in this sector poses a stumbling block to the realisation of the sustainable development goals Three and Five, hinders the provision of essential services, impedes access to quality health care and education, and creates vulnerabilities that have the tendency of disproportionately impacting negatively on the well-being of vulnerable groups such as women, girls and persons living with disability,” she said.

The Finance Manager of GII, Benedict Doh, who presented the findings of the study, said, among others, that the majority of key informants sampled — 71.2 per cent — indicated that providers submitted all their claims electronically through software and that after the claim had been submitted, a copy was printed and signed by both the provider and the district office for reconciliation purposes.

He said with the introduction of the software called Claim-it, the processes of fulfilment and reconciliation, vetting, data entry, vetting report, approval and payments were all done electronically.

In an overview of the ISDA project, Petra deGraft-Johnson of the Advocacy and Legal Centre of GII also said that the focus of the project was on education and health, which were implemented in 12 districts in three regions in the country.