2010 ANNUAL REPORT
TABLE OF CONTENTS
TABLE OF CONTENTS ..................................................................................................................... i
LIST OF ACRONYMS ...................................................................................................................... iii
VISION, MISSION AND CORE VALUES ....................................................................................... 1
PROFILE OF DIRECTORS ............................................................................................................... 6
CHAIRMAN’S ACKNOWLEDGEMENT ........................................................................................ 9
REPORT OF CHIEF EXECUTIVE.................................................................................................. 10
1.0 INTRODUCTION ....................................................................................................................... 13
1.1 GOVERNANCE ..................................................................................................................... 13
1.2 MANAGEMENT .................................................................................................................... 13
1.3 NHIS VALUE CHAIN ........................................................................................................... 13
2.0 CORPORATE GOALS AND OBJECTIVES ............................................................................. 15
2.1 CORPORATE GOALS ........................................................................................................... 15
2.2 CORPORATE OBJECTIVES FOR 2010-2014...................................................................... 15
3.0 OPERATIONAL ACTIVITIES .................................................................................................. 15
3.1 SUSTAINABILITY AND COST CONTAINMENT ............................................................. 15
3.2 MEMBERSHIP AND ID CARD MANAGEMENT .............................................................. 16
3.2.1 Membership trend............................................................................................................. 16
3.2.2 Special registration exercise ............................................................................................. 18
3.2.3 Free maternal health care ................................................................................................. 19
3.2.4 ID cards production and distribution ................................................................................ 20
3.3 CLAIMS MANAGEMENT .................................................................................................. 21
3.3.1 Outpatient utilization ........................................................................................................ 21
3.3.2 Inpatient utilization........................................................................................................... 21
3.3.3 Claims payment trend ....................................................................................................... 22
3.4 ICT AND DATA MANAGEMENT ....................................................................................... 23
3.5 PROVIDER ACCREDITATION AND QUALITY ASSURANCE ...................................... 23
3.5.1 Collaboration .................................................................................................................... 24
3.6 ADMINISTRATION AND HUMAN RESOURCE ............................................................... 25
3.7 PLANNING, MONITORING, EVALUATION, RESEARCH AND DEVELOPMENT ...... 25
3.8 PROJECTS AND PROCUREMENTS ................................................................................... 25
3.9 COMMUNICATION AND STAKEHOLDER ENGAGEMENT .......................................... 26
3.9.1 Stakeholder engagement................................................................................................... 26
3.9.2 Policy fair ......................................................................................................................... 26
3.9.3 End of year get-together and awards night ....................................................................... 26
3.9.4 Media engagement ........................................................................................................... 27
4.0 ACHIEVEMENTS ...................................................................................................................... 29
4.1 INCREASED COVERAGE .................................................................................................... 29
4.2 UNDP/WHO EXCELLENCE AWARD................................................................................. 29
4.3 FINANCIAL AND CLINICAL AUDITS .............................................................................. 29
4.4 REVIEW OF MEDICINES LIST ........................................................................................... 30
4.5 ACCREDITATION OF HEALTH FACILITIES ................................................................... 30
4.6 IMPROVED REIMBURSEMENT TO PROVIDERS ........................................................... 31
4.7 GATE-KEEPER SYSTEM AND FREE MATERNAL CARE PROGRAMME ................... 31
4.8 RISK ASSESSMENT ............................................................................................................. 31
5.0 CHALLENGES ........................................................................................................................... 32
5.1 FINANCIAL SUSTAINABILITY OF THE SCHEME ......................................................... 32
5.2 IDENTIFICATION OF THE POOR IN THE INFORMAL SECTOR .................................. 32
5.3 ID CARD MANAGEMENT ................................................................................................... 32
5.4 ICT........................................................................................................................................... 32
5.5 CLAIMS MANAGEMENT .................................................................................................... 32
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2010 ANNUAL REPORT
6.0 OUTLOOK FOR 2011 ................................................................................................................ 33
6.1 ENHANCE FINANCIAL SUSTAINABILITY OF THE NHIS ............................................ 33
6.1.1 Defensive Strategy: .......................................................................................................... 33
6.1.2 Prudent fund management: ............................................................................................... 33
6.1.3 Sourcing Strategy: ............................................................................................................ 34
6.2 STRENGTHEN THE NHIS ICT ............................................................................................ 34
6.2.1 ICT deployment ................................................................................................................ 34
6.2.2 ICT governance ................................................................................................................ 34
6.2.3 Data integrity .................................................................................................................... 34
6.3 PROMOTE QUALITY IMPROVEMENT IN SERVICE PROVIDER FACILITIES ........... 35
6.4 STRENGTHEN CLAIMS MANAGEMENT ......................................................................... 35
6.5 IMPROVE ID CARD MANAGEMENT ................................................................................ 35
6.6 HUMAN RESOURCE CAPACITY AND ORGANISATIONAL REFORMS ..................... 35
6.6.1 Attracting, developing and retaining relevant human resource ........................................ 35
6.6.2 Organizational reforms ..................................................................................................... 36
6.6.3 Ghana Health Insurance Institute ..................................................................................... 36
6.7 Communication and marketing strategies ............................................................................... 36
6.7.1 Internal and external communication ............................................................................... 36
6.7.2 Communication with service providers ............................................................................ 37
7.0 CONCLUSION ........................................................................................................................... 38
ANNEXES ............................................................................................................................................ 39
ANNEX 1: Financial Statement .................................................................................................... 40
ANNEX 2: Minimum health care package under NHIS ............................................................... 43
ANNEX 3: Unit heads and managers............................................................................................ 45
ANNEX 4: Regional Managers ..................................................................................................... 46
ANNEX 5: Directory of district mutual health insurance schemes .............................................. 47
ANNEX 6: Training programs organised in 2010 ........................................................................ 54
List of Figures
Figure 1: NHIS Value chain .............................................................................................................. 14
Figure 2: Active membership as percent of population by region in 2010 ....................................... 17
Figure 3: Active NHIS Subscribers by Category 2010 ..................................................................... 18
Figure 4: Outpatient Utilization Trend .............................................................................................. 21
Figure 5: Inpatient Utilization Trend................................................................................................. 22
Figure 6: Claims Payment Trend....................................................................................................... 22
List of Tables
Table 1: Active Membership ............................................................................................................. 16
Table 2: New Members, Renewing and Membership in 2010 Active .............................................. 17
Table 3: Total number of members registered under the special registration exercise ..................... 19
Table 4: ID Cards production and distribution by region ................................................................. 20
Table 5: Accreditation results............................................................................................................ 24
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2010 ANNUAL REPORT
LIST OF ACRONYMS
1TP
Act 650
AMFm
CHAG
CPC
DCEs
DMHIS
DVLA
G-DRG
GH¢
GHS
GMA
HIP
ICT
IPD
LEAP
LPM
M&E
MDAs
MDGs
MOH
NGOs
NHIA
NHIL
NHIS
OPD
PDAs
PRMs
PRO
PW
RAC
R&D
SCAD
SSNIT
UNDP
WHO
One-Time Premium
National Health Insurance Act, 2003 (Act 650)
Affordable Medicine Facility – Malaria
Christian Health Association of Ghana
Claims Processing Centre
Deputy Chief Executive
District Mutual Health Insurance Scheme
Driver and Vehicle Licensing Authority
Ghana Diagnostic Related Grouping
Ghana Cedis
Ghana Health Services
Ghana Medical Association
Health Insurance Project
Information Communication Technology
In-Patient Department
Livelihood Empowerment Against Poverty
Live Presenter Mention
Monitoring & Evaluation
Ministries, Departments and Agencies
Millennium Development Goals
Ministry of Health
Non Governmental Organisations
National Health Insurance Authority
National Health Insurance Levy
National Health Insurance Scheme
Out Patient Department
Personal Digital Assistance
Provider Relationship Managers
Public Relations Officer
Pregnant women
Risk Assessment Committee
Research and Development
Strategy and Corporate Affairs Division
Social Security and National Insurance Trust
United Nations Development Programme
World Health Organization
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2010 ANNUAL REPORT
VISION, MISSION AND CORE VALUES
VISION
To be a model of a sustainable, progressive and equitable social health insurance scheme in Africa
and beyond.
MISSION
To provide financial risk protection against the cost of quality basic healthcare for all residents in
Ghana, and to delight our subscribers and stakeholders with an enthusiastic, motivated, and
empathetic professional staff who share the values of accountability in partnership with all
stakeholders.
CORE VALUES





Integrity
Accountability
Empathy
Responsiveness
Innovation
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2010 ANNUAL REPORT
NATIONAL HEALTH INSURANCE COUNCIL
Hon. Doe Adjaho
Chairman
Hon. Rojo Mettle-Nunoo (Dep. Minister of Health) Member
Mr. Sylvester A. Mensah
Chief Executive
Dr. Elias Sory
Member
Dr. Stephen Ayidiya
Member
Mr. Samuel Akwei
Member
Mrs. Czarina Baeta Ribeiro
Member
Dr. Steve Ahiawordor
Member
Mr. Kwame Owusu-Bonsu
Member
Dr. Mercy Bannerman
Member
Mrs. Nyamikeh Kyiamah
Member
Mr. Kofi Asamoah
Member
Dr. Edward Abbah Foli
Member
Hajia Laadi Ayi Ayamba
Member
Mr. Anthony Dzadzra
Member
Dr. Hetty Asare
Member
Mrs. Aimee Yuori
Secretary
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2010 ANNUAL REPORT
COUNCIL SECRETARY
:
MRS. AIMEE YUORI
REGISTERED OFFICE
:
CDH HOUSE, NORTH RIDGE,
ACCRA
AUDITORS
:
ERNST AND YOUNG,
CHARTERED ACCOUNTANTS
BANKERS
:
GHANA COMMERCIAL BANK
ECOBANK GHANA LTD,
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2010 ANNUAL REPORT
EXECUTIVE MANAGEMENT
Mr. Sylvester A. Mensah
Mr. Nathaniel Otoo
Dr. Nicholas A. Tweneboa
Mr. O. B. Acheampong
Dr. Gustav Cruickshank
Mr. Ben Kusi
Mr. Ahmed Imoro
Dr. Lydia Dsane-Selby
Mr. Perry Nelson
Mr. Winfred Agbeibor
Mr. Francis-Xavier Andoh-Adjei
Mr. Eric Ametor-Quarmyne
Dr. Francis Mensah Asenso-Boadi
Mr. Rudolf Zimmermann
Mr. Anthony Gingong
Mrs. Adelaide Bunatal
Ms. Mary Owusu
Mr. Ben Yankah
Mr. Sam Buabasah
Mrs. Aimee Yuori
Chief Executive
Director, Admin. & General Counsel
Director, Operations
Director, Research & Development
Chief Internal Auditor
Director, ICT
Ag. Director, Finance
Ag. Director, Clinical Audit
Ag. Director, Claims
Ag. Director Strategy & Corporate Affairs
Deputy Director, Strategy
Deputy Director, Corporate Affairs
Deputy Director, Research & Development
Deputy Director, Finance
Deputy Director, Operations
Deputy Director, Claims
Deputy Director, Human Resource
Deputy Director, Actuary
Deputy Director, Procurement & Projects
Deputy Director, Legal (Council Secretary)
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2010 ANNUAL REPORT
SSYYLLVVEESSTTEERR AA.. M
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Sylvester A. Mensah is the Chief Executive of the National Health Insurance Authority. Prior to his
appointment, Mr. Mensah was the Head of Public Sector Banking at the Intercontinental Bank (GH)
Ltd., a full time lecturer at the Institute of Professional Studies (Ghana), and an Adjunct Lecturer at
the Central University Graduate School. He had earlier worked as District Co-ordinator of the
National Mobilization Program, rising through the ranks to the office of Greater Accra Regional
Director of same in 1987/88. He has 24 years working experience in the Public Services, Private
Sector, Banking and Academia. Mr. Mensah was elected Member of Parliament by the people of
Dadekotopon in the Greater Accra Region in 1997.
Mr. Mensah holds an MBA in Finance from the UK, Bsc. in Administration (Ghana), Diploma in
Political Economy (Germany) and a Diploma in Public Administration (Ghana). He is a Member of
the Institute of Business Consulting (MIBC), UK and a Council Member of the Global Marketing
Network, Ghana. He serves on a number of private and public boards including the National
Identification Authority of Ghana. He is an alumnus of the University of Ghana Business School,
the University of Leicester in the UK and the Harvard University School of Public Health, where he
pursued a number of health (insurance) financing related competency courses.
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2010 ANNUAL REPORT
PROFILE OF DIRECTORS
NATHANIEL OTOO: DIRECTOR, ADMINISTRATION AND GENERAL COUNSEL
Mr. Otoo has over 19 years work experience spanning both the public and
private sectors. Prior to assuming the position of Director of Administration &
General Counsel at the Authority, he was Corporate Secretary at the Social
Security & National Insurance Trust, an Export Development Officer at the
Ghana Export Promotion Council and Projects Coordinator at Promasidor Ghana
Limited.
A Lawyer by profession, Mr. Nathaniel Otoo completed his Professional Law Studies in 1988 after
obtaining a Bachelor’s degree in law from the University of Ghana. He also holds a Master of Arts
Degree in International Relations from the International University of Japan, and has undertaken a
Professional Training Course in Marketing and Management under the auspices of the Carl
Duisberg Gesellschaft of Germany. He has participated in various health leadership courses.
DR NICHOLAS A. TWENEBOA: DIRECTOR, OPERATIONS.
With over thirty years working experience spanning several fields, particularly
in the practice of medicine and in management, Dr Nicholas Tweneboa has
over the years gained deep insight into the health sector, having worked in
management capacity in several organizations and hospitals in the public,
private and quasi-public sub-sectors. He has facilitated many workshops and
undertaken consultancy services in health care quality management, strategy
and systems development on behalf of a number of local and international
organizations. He has intense interest in writing and health education which have won him a Valco
Literary Award in poetry and an international award in diabetes education.
Dr Nicholas A. Tweneboa holds an MB, ChB degree from the University of Ghana Medical School
and an MBA from the University of Leicester, UK.
OSEI B. ACHEAMPONG: DIRECTOR, RESEARCH AND DEVELOPMENT
Prior to joining NHIA, Mr. Acheampong worked for pharmaceutical companies
developing contracting and marketing strategies for hospitals and health
insurance companies. He also worked for health insurance companies where he
managed provider networks and contracts, and developed and managed drug
formularies.
Mr. Osei Boateng Acheampong holds a Master of Science degree in Health
Policy and Management from Harvard School of Public Health specializing in healthcare
financing, health insurance and international health. He had earlier studied at Brown University
where he obtained a Bachelor of Arts degree in Urban Studies/Planning and Yale School of
Management.
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2010 ANNUAL REPORT
AHMED IMORO: AG. DIRECTOR, FINANCE
Mr. Ahmed Imoro joined the Controller and Accountant General Department in
1995 and was seconded to National Health Insurance Authority as Principal
Accountant in 2005. He was later appointed the substantive Deputy Director of
Finance and has since 2006 been the Acting Director of Finance.
Mr. Ahmed Imoro has a Masters Degree in Business Administration (MBAFinance) and a Bachelors degree in Business Administration (Accounting and
Finance) from European University of Lefke.
BEN KUSI: DIRECTOR, ICT
Prior to his present appointment, Mr. Ben Kusi worked with Bank of Ghana as
Head of Infrastructure and Project Manager on the IMPACT05 ICT project,
between 2004 and 2005. He had also worked with the British National Health
Service in the UK as ICT professional between 1998 and 2004. His expertise
ranges from People Management, Information Systems analysis and design,
project management and implementation of Enterprise Architecture solutions.
Mr. Ben Kusi holds a Bachelor of Science degree in Electronic Engineering
from Middlesex University, UK and a Post Graduate Diploma in Management Information Systems
Design from the University of Westminster, UK.
DR. LYDIA DSANE-SELBY: DIRECTOR, CLINICAL AUDIT
A Medical Doctor by profession, Dr. Lydia Dsane-Selby worked as Medical
Officer at Korle-Bu Teaching Hospital, Achimota Hospital and in the UK prior
to taking appointment at the NHIA,
She holds an MBChB from the University of Ghana Medical School, Korle-Bu
and a Post Graduate in ENT Surgery from the Royal College of England. She is
an ICT Trained Microsoft Certified Professional.
DR. GUSTAV G.L. CRUICKSHANK: CHIEF INTERNAL AUDITOR
Prior to his present appointment, Dr. Gustav G.L Cruickshank was a lecturer in
MBA, MSc and BSc degree programs in various institutions in the UK. He also
worked with organizations such as Arthur Andersen representative office,
Intercontinental Bank, LCBM (UK), Gabem Group (UK), Zenith Aegis Ltd
(UK and Ghana). He has over fifteen years international experience in
management consultancy, accounting, finance, auditing and operations and
strategic planning.
Dr. Gustav Cruickshank is a Chartered Accountant and has an MBA in Finance and PhD in
Strategic Management. He is a Fellow of the Association of Chartered Certified Accountants, UK
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2010 ANNUAL REPORT
(FCCA), the Institute of Financial Accountants UK (FFA), the Institute of Business Consultancy
UK (FIBC), a member of the Institute of Chartered Accountants, Ghana (ICAG) and the Institute of
Internal Auditors (IIA).
PERRY NELSON: AG. DIRECTOR, CLAIMS
Mr. Perry Nelson was appointed Ag. Director of Claims in 2010 after serving
briefly as ICT Consultant to the NHIS and Deputy Director of ICT. He has over
21 years working experience in the ICT industry. He has been a key player in the
entire cycle of IT systems review, system requirements definition, design,
development, implementation and support in major IT projects across the USA,
United Kingdom, Africa, and Europe. Mr Nelson has been a freelance ICT
Consultant for over 15 years during which he worked on many multi-million pounds ICT projects
around the world.
Mr. Perry Nelson earned his Bachelor of Science degree in Computer Science from the Kwame
Nkrumah University of Science and Technology in 1980.
WINFRED AGBEIBOR: AG. DIRECTOR, STRATEGY & CORPORATE AFFAIRS
Winfred is a business planner and marketing communicator with over 12 years
experience in strategy, brand management, training and market research, from
Banking & Finance, through International Development & Medical Industry to
Consulting; both within and outside Ghana.
Before joining NHIA, he was the Commercial & Country Manager of The
Nielsen Company (ACNielsen) Ghana, and also served as Head of Strategy &
Corporate Affairs of Intercontinental Bank.
He has an MBA in Corporate Planning & Marketing from Vrije Universiteit Brussels, Belgium, a
Master of Human Ecology from same, and a BSc. Agriculture (Agricultural Economics) degree
from the University of Ghana.
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2010 ANNUAL REPORT
CHAIRMAN’S ACKNOWLEDGEMENT
Many of the achievements mentioned in this report would not have been possible without the
support and selflessness of equally busy colleague Council members who take time off their
schedules to attend meetings and hold deliberations even at short notice. I appreciate their
commitment and contributions.
I am equally grateful to management and staff of the NHIS and the Ministry of Health for their
continued support. On behalf of the Council, I thank our subscribers, service providers and other
stakeholders for their cooperation.
Together, let’s look forward to a healthier and stronger NHIS in 2011.
Thank you.
Hon. Doe Adjaho
Council Chairman, NHIA
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2010 ANNUAL REPORT
REPORT OF CHIEF EXECUTIVE
INTRODUCTION
The National Health Insurance Scheme (NHIS) is a social intervention program intended to provide
financial risk protection against out of pocket health care expenditure for all residents in Ghana.
The scheme is currently operational in 145 districts across the country with a total cumulative
membership of over 18 million, out of which over 8 million, representing 34% of Ghana’s current
population are active card bearing members.
RESTRUCTURING AND SIGNIFICANT ACHIEVEMENTS
Following on from 2009, Management continued the process of restructuring the NHIS in order to
secure the sustainability of the scheme. Some of the reforms that were made include the following:
Creation of Clinical Audit Division
The Clinical Audit Division was created and became operational in January 2010 to ensure the
provision of quality healthcare service to NHIS subscribers. The division is mandated to audit
claims at both the health facilities and at the scheme level. During the period under review, the
division, with the active collaboration of service providers, conducted audit in 450 health facilities
in 76 districts across the country. The audit exercise resulted in the recovery of GH¢16.8 million
from service providers. It also serves as a useful way of effecting behavioural change among health
care providers and district scheme officials.
Elevation of Internal Audit Unit
The Internal Audit Unit was elevated to a divisional status to empower it in order to deliver on its
mandate. During the period under consideration, the division conducted a full scale audit in all the
145 district schemes across the country. Scheme officials who were found to have misconducted
themselves were duly sanctioned.
Establishment of Claims Processing Centre
A world-class ultra modern Claims Processing Centre (CPC) was established to ease the burden of
claims management at the district schemes. The centre is fully staffed with qualified health
professionals to properly adjudicate claims submitted by accredited service providers. The centre
currently vets claims from all the eight (8) regional hospitals, the three teaching hospitals and some
selected health facilities across the country. The CPC has contributed to a considerable reduction in
claims processing turn-around time from an average of 90 days to 60 days. It has also contributed to
cost savings of 6.8 million Ghana Cedis representing 19% of total claims submitted in 2010.
Introduction of Capitation
NHIA had a successful negotiation for stakeholder acceptance of capitation as an additional
provider payment mechanism. It is expected that the new payment mechanism when introduced
would simplify claims management and improve the quality of care rendered to subscribers because
of continuity of care.
Capitation will be used to re-imburse providers for primary care OPD services while Ghana
Diagnostic Related Groupings (G-DRG) will continue to be used to re-imburse them for inpatient
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2010 ANNUAL REPORT
and specialized services. For a start, capitation would be piloted in Ashanti Region. It is expected
that preparatory work would be completed for official launching in the third quarter of 2011.
One Time Premium Payment
The government has stated its commitment to assuring unhindered financial access to quality health
care for residents of Ghana through a universal health care programme that allows for a One Time
Premium Payment. To make the dream a reality, the Minister of Health commissioned a task force
comprising representatives from Ministry of Health, Ghana Health Service and NHIA to draft the
policy document for the implementation of the new policy. The committee has completed its work
and submitted the document to the Minister of Health for onward submission to Cabinet.
OUTLOOK FOR 2011
One Time Payment would be operational in 2011. In this regard, NHIA will focus on developing
implementation modalities and commence implementation as soon as official communication is
received from government.
It is also envisaged that the legislative review process would be completed in 2011 to streamline the
operations of the scheme. Other key activities that will be undertaken include the following:
1.
2.
3.
4.
5.
Deploying the CPC to its full capacity with the introduction of all software and equipment.
Addressing the low claims management capacity outside the CPC operation/ coverage.
Strengthening the poor gatekeeper system.
Enforcing the MOH’s Medicine prescribing levels.
Implementing the new prescription form regime in collaboration with the GHS and the
MOH.
6. Addressing the low premium collection at the scheme level, accounting for less than 5% of
our total inflows.
7. Implementing the consolidated premium account regime.
8. Strengthening performance monitoring and measurement regime at the regional and scheme
levels.
9. Implementing Capitation pilot in Ashanti Region.
10. Developing an efficient ID card distribution regime.
11. Developing an operational asset allocation policy.
12. Engaging in equity investments for long term sustainability.
13. Establishing a Social Health Insurance Institute for South-South learning and income
generation for the National Health Insurance Fund.
14. Establishing an outsourced Call Centre to give a meaningful voice to customers and
stakeholders – subscribers, providers and the general public.
15. Develop an effective and efficient media communication strategy that would open up and
adequately ventilate the NHIS success story.
16. Improving data integrity.
17. Enhancing subscriber authentication.
18. Implementing a new claims module that links clinical diagnosis to therapy/ treatment.
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2010 ANNUAL REPORT
The following projects would be undertaken:
1)
2)
3)
4)
5)
Complete and relocate into the new Head Office Premises.
Re-locate data centre from STL to NHIA head quarters premises.
Develop & maintain Data Recovery Site within STL for at least 12 months.
Construct ten (10) new regional offices.
Construct twenty (20) new schemes and satellites offices across the country.
CONCLUSION
The ongoing reforms in NHIS call for strategic thinking, benchmarking with best practices, team
work, efficient use of resources, sacrifice and commitment. Management of NHIA is determined to
build a scheme that would stand out as a model in Africa and beyond, providing access to
affordable and quality health care services for all residents in Ghana with highly motivated
professionals. I appreciate the team spirit and cordial working relationship with a technically
efficient management team who have always kept their “eyes on the ball”.
Let me use this opportunity to thank all NHIS stakeholders for your continued support and
commitment to building a sustainable health insurance scheme. All views on how to improve the
NHIS are welcome.
Thank you.
Sylvester A. Mensah
Chief Executive
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2010 ANNUAL REPORT
1.0 INTRODUCTION
The National Health Insurance Authority (NHIA) is a statutory body mandated to secure the
implementation of the National Health Insurance Scheme. It is responsible for the registration,
licensing and regulation of health insurance schemes in the country. It also has the role of
supervising the operations of District Mutual Health Insurance Schemes (DMHIS), grant
accreditation to healthcare providers and to monitor their performance for efficient and quality
service delivery. It is responsible for managing the National Health Insurance Fund and devising
mechanisms to ensure that indigents are adequately catered for under the NHIS.
1.1 GOVERNANCE
The scheme is governed by a 16-member Council drawn from various stakeholder organisations.
The Council is under the chairmanship of Hon. Doe Adjaho, First Deputy Speaker of Parliament
and Member of Parliament (MP) for Ave-Avenor constituency.
1.2 MANAGEMENT
The Executive Management of the scheme is led by Mr. Sylvester A. Mensah, the Chief Executive.
Other members include technical directors of various divisions, deputy directors and other senior
managers. To ensure accountability to stakeholders, NHIS is decentralised to the regional and
district levels. The full lists of Unit Heads and other Managers, including Regional Managers of the
NHIS are attached as Annexes 3 and 4.
1.3 NHIS VALUE CHAIN
The value chain demonstrates how NHIS delivers value to subscribers through its primary and
supporting activities.
The primary activities are membership registration and ID card management, provider accreditation
and quality assurance, claims management and provider payments. These are supported by
secondary activities which include research and development, monitoring and evaluation, an ICT
infrastructure and data management, financial and clinical audits, effective communication with
internal and external publics, human resource management, conflict resolution and stakeholder
management. Another key supporting activity is financing, which refers to how funds are mobilised
from different sources to pay for services rendered under the NHIS services.
Figure 1 shows the value chain captured in a framework for securing financial risk protection, client
satisfaction and improved health status for residents in Ghana.
Additionally, the NHIS in collaboration with stakeholders develops and maintains the NHIS
medicines list and tariffs system in accordance with the benefits package.
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2010 ANNUAL REPORT
Figure 1: NHIS Value chain
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2010 ANNUAL REPORT
2.0 CORPORATE GOALS AND OBJECTIVES
2.1 CORPORATE GOALS
The key corporate goals of the National Health Insurance Scheme are:
1. To attain a financially sustainable health insurance scheme.
2. To achieve universal financial access to basic health care.
3. To secure stakeholder satisfaction.
2.2 CORPORATE OBJECTIVES FOR 2010-2014
The NHIS has developed a strategic plan to provide direction for the period 2010-2014 to enable
management focus on its core mandate. The plan envisages to achieve the following corporate
objectives:
1.
2.
3.
4.
5.
6.
7.
To mobilise 100% of the required funds by the end of 2014.
To increase efficiency in the financial operations of the scheme.
To increase active membership to 60% of the population by 2014.
To increase coverage of the vulnerable including the poor and the indigent to 70% by 2014.
To provide support to increase access to quality basic health care services in all districts.
To strengthen governance systems and improve human resource capacity.
To improve the quality of services accessed by members in the national health insurance
system.
8. To improve the level of provider experience within the NHIS.
9. To improve involvement and participation in health insurance programmes.
3.0 OPERATIONAL ACTIVITIES
Operational activities for the year 2010 are derived from the corporate objectives outlined above.
This section discusses the key activities undertaken within the year.
3.1 SUSTAINABILITY AND COST CONTAINMENT
Sustainability and cost containment were major issues that engaged management’s attention during
the year under review. Pursuant to that, a Clinical Audit Division was set up to embark on regular
claims verification exercises to assure provision of quality health care services and to minimize
financial leakages resulting from provider-side moral hazards.
The internal audit department was also upgraded to a division to empower it to effectively monitor
the financial and operational processes within the NHIS. The activities of these two divisions have
contributed immensely to the reduction in financial leakages and strengthening of internal controls.
They have also contributed to the stimulation of behavioural change among health care providers
and schemes officials. Providers and scheme officials who were found to have abused the system
were sanctioned.
The free maternal health policy was reviewed in order to inject some sanity into the system. An
ultra modern claims processing centre was established to process claims emanating from the
teaching and regional hospitals. The year under review also witnessed the commencement of
initiatives to introduce capitation as an additional provider payment mechanism to allow providers
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2010 ANNUAL REPORT
and subscribers to share the risks associated with the provision and utilisation of health care
services at the health facilities.
3.2 MEMBERSHIP AND ID CARD MANAGEMENT
3.2.1 Membership trend
The NHIS has made significant progress towards extending health insurance coverage to residents
of Ghana. The cumulative membership of the scheme has increased from 1.3 million in 2005 to 18
million in 2010. This represents an average annual growth of 68% over the entire period.
The NHIA undertook methodology and data validation exercise, during the first quarter of 2011, to
ascertain the accuracy of the 2010 membership database. During the exercise, it was realized that
the old methodology of calculating active membership was riddled with inherent challenges. The
old methodology calculates active membership by subtracting the number of all expired ID cards
since inception of the scheme from the sum of all ID cards issued and ID cards renewed since
inception of the scheme.
The challenges indentified with this methodology are as follows:
1. The cumulative number of ID cards issued includes members who have engaged in
multiple registrations and thus over estimated the number of ID card holders.
2. The cumulative number of ID cards issued includes members who have died and thus also
over estimated the number of ID card holders.
3. The cumulative number of expired ID cards was not accurately tracked and therefore was
underestimated.
Clearly, due to these challenges, the number of active members reported over the years may be
inaccurate. In order to mitigate these challenges, a new and appropriate methodology was used to
determine the 2010 active membership. This new approach is based on the sum of the number of
new members registered for a given year and the number of renewals made for that year.
To further improve the quality of the data, the ICT platform was used in the extraction of the
number of new and renewing members for 2010. Previously, active membership reports were based
on manual reports submitted to Operations division from the schemes. Table 1 gives the trend for
active membership based on the old methodology up to 2009. Given that we could not apply the
new ICT-based methodology in retrospect to report active membership for the previous periods, the
new methodology was used for reporting only the 2010 active membership, and will be applied
going forward.
Table 1: Active Membership
Methodology
2005
2006
2007
Old
1,348,160
2,521,372
6,643,371
New
N/A
N/A
N/A
2008
2009
9,914,256 10,638,119
N/A
N/A
2010
N/A
8,163,714
The new active membership figure of 8.16 million for 2010 does not necessarily represent a drop, as
there is no comparative historic data based on the new methodology.
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2010 ANNUAL REPORT
While the perceived drop in active membership is largely due the application of the new
methodology for reporting, other sub-standard practices from the schemes such as the issuing of old
ID cards, the granting of validity period exceeding three months for temporary cards and the
printing of temporary ID cards outside the NHIS ICT system make the reported new active
membership data look lower than expected. Table 2 shows the number of new members, renewals
and active membership distribution by region.
Table 2: New Members, Renewing and Membership in 2010 Active
2010
2010
Region
New Members
Renewals
606,349
978,748
Ashanti
323,092
691,462
Brong Ahafo
303,592
189,125
Central
316,861
613,482
Eastern
492,443
469,012
Greater Accra
349,899
421,436
Northern
238,935
278,932
Upper East
158,911
202,154
Upper West
263,050
318,255
Volta
466,458
481,518
Western
Ghana
3,519,590
4,644,124
2010
Active Members
1,585,097
1,014,554
492,717
930,343
961,455
771,335
517,867
361,065
581,305
947,976
8,163,714
The total active membership of 8,163,714 as at December 2010 represents 34% of the total
population in 2010. Upper West Region had the highest active population coverage rate of 53%
whiles Central Region recording the lowest active coverage rate of 23%. Figure 2 shows the NHIS
active membership coverage by region.
Figure 2: Active membership as percent of population by region in 2010
60%
53%
50%
50%
44%
41%
40%
36%
34%
31%
28%
30%
25%
23%
20%
10%
0%
Ashanti
Brong
Ahafo
Central
Eastern
Greater Northern
Accra
Upper
East
Upper
West
Volta
Western
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2010 ANNUAL REPORT
Figure 3 shows the distribution of active members of 8,163,714 as at December 2010 by category Informal, SSNIT Contributors, SSNIT Pensioners, Under 18 years, 70 years and above, Pregnant
women and indigents.
Figure 3: Active NHIS Subscribers by Category 2010
Non-exempt
group (Informal
sector)
31.8%
Under 18 years
47.7%
Pregnant
women
8.6% SSNIT
pensioners
0.4%
SSNIT
contributors
4.7%
Indigents
1.4%
70 years &
above
5.4%
3.2.2 Special registration exercise
In September 2010, the National Health Insurance Authority embarked upon a special registration
exercise as a means of increasing NHIS membership coverage. The programme predominantly
targeted the poor and vulnerable in their local communities and at large congregation centres such
as churches, mosques and markets. The exercise was conducted across the country to allow new
members to register and old members to renew their membership. Registered members were issued
NHIS cards within a period of one month. This arrangement encouraged many people to patronise
the special registration exercise.
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2010 ANNUAL REPORT
National Chief Imam, Sheikh Osman Nuhu Sharabutu (seated, middle), being registered at Old Fadama,
Accra during the special registration exercise.
The special registration brought an additional 276,300 people unto the scheme.
breakdown of members registered during the exercise is shown in table 3 below.
Regional
Table 3: Total number of members registered under the special registration exercise
Region
Total number of members registered
ASHANTI
6,830
BRONG AHAFO
23,192
CENTRAL
31,882
EASTERN
4,993
GREATER ACCRA
39,048
NORTHERN
11,031
UPPER EAST
47,216
UPPER WEST
8,296
VOLTA
80,152
WESTERN
23,660
TOTAL (NATIONAL)
276,300
3.2.3 Free maternal health care
The free maternal care programme was introduced in July 2008 to help Ghana meet Millennium
Development Goals (MDG) 4 and 5. Under this programme pregnant women are to receive free
medical care. However, due to abuse of the system, NHIA revised the implementation guidelines in
2010 to encourage pregnant women to register with the scheme before accessing healthcare. As at
the end of 2010, a cumulative total of 1,394,445 pregnant women (PW) representing 7.7% of total
number registered had subscribed to the scheme.
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2010 ANNUAL REPORT
3.2.4 ID cards production and distribution
During the year under review, a total of 3,950,502 ID cards were printed, out of which 3,450,822,
representing 87.35% were distributed. A total of 499,680 ID were not distributed as at the close of
the year (see table 4).
Table 4: ID Cards production and distribution by region
Number of ID Number of ID Cards Number
of
Region
Cards printed
distributed
Undistributed
cards
Ashanti
734,946
695,517
39,429
Brong Ahafo
379,099
350,449
28,650
Central
261,092
215,909
45,183
Eastern
476,746
410,743
66,003
Greater Accra
462,583
405,373
57,210
Northern
374,128
320,694
53,434
Upper East
223,774
164,063
59,711
Upper West
258,133
253,469
4,664
Volta
351,557
275,568
75,989
Western
428,444
359,037
69,407
3,950,502
3,450,822
499,680
Total (National)
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2010 ANNUAL REPORT
3.3 CLAIMS MANAGEMENT
3.3.1 Outpatient utilization
Outpatient utilization has increased by over twenty-eight fold from 0.6 million in 2005 to 16.9
million in the year 2010. Figure 4 presents outpatient utilization trend from 2005 to 2010.
Figure 4: Outpatient Utilization Trend
18,000,000
16,629,692
16,931,263
2009
2010
16,000,000
14,000,000
12,000,000
9,339,296
10,000,000
8,000,000
6,000,000
4,648,119
4,000,000
2,000,000
2,434,008
597,859
0
2005
2006
2007
2008
3.3.2 Inpatient utilization
Inpatient utilization increased over thirty fold from 28,906 in 2005 to 973,524 in 2009 but dropped
to 724,440 in 2010. The decline in utilization in 2010 could be attributed to the following reasons;




Members are seeking early treatment and thereby reducing inpatient cases
Primary healthcare is becoming more efficient
Detentions were being billed as inpatients in prior years instead of outpatient
Providers are changing their behaviour due to effective clinical audit
Figure 5 presents Inpatient utilization trend from 2005 to 2010.
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2010 ANNUAL REPORT
Figure 5: Inpatient Utilization Trend
973,524
1,000,000
900,000
800,000
724,440
700,000
627,795
600,000
500,000
400,000
303,930
300,000
200,000
100,000
135,221
28,906
0
2005
2006
2007
2008
2009
2010
3.3.3 Claims payment trend
Claims payment is the major cost driver of the scheme. Claims payments has increased from
GH¢7.60 million in 2005 to GH¢ 394.27 million in 2010. The total amount of GH¢ 394.27 million
disbursed for the payment of claims represent 76.2% of the total expenditure of the scheme. Figure
6 shows the trend in claims payment from 2005 to 2010.
Figure 6: Claims Payment Trend (Ghøm)
450.00
394.27
400.00
350.00
322.91
300.00
250.00
198.11
200.00
150.00
100.00
79.26
35.48
50.00
7.60
0.00
2005
2006
2007
2008
2009
2010
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2010 ANNUAL REPORT
3.4 ICT AND DATA MANAGEMENT
During the period under review, management sought to improve the ICT system and its data
management by improving existing claims module to encourage usage by the schemes, introducing
rule-based engine for effective electronic claims processing and rolling out electronic claims
submission.
Printing of temporary ID cards from the NHIS ICT application was started to minimize the
extension of benefit period of members. A template for linking diagnosis to treatment was also
designed.
3.5 PROVIDER ACCREDITATION AND QUALITY ASSURANCE
The National Health Insurance Scheme Act, 2003 (Act 650) mandates the NHIA to accredit service
providers before they can provide service to NHIS members. The primary goal is to ensure that
healthcare services offered to card bearing members are of good quality. In pursuance of this,
inspection of the first and second batches of health facilities was carried out in 2009. In 2010, a
third batch of 915 facilities were inspected out of which 849 were accredited. Total accredited
health facilities as at 31st December 2010 were 2,647. Table 5 summarizes the accreditation results.
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2010 ANNUAL REPORT
Table 5: Accreditation results
SUMMARY OF NHIA ACCREDITED FACILITIES AS AT DECEMBER 2010
FACILITIES
BY TYPES
1ST
2ND
3RD
BATCH BATCH BATCH TOTAL
FACILITIES
BY GRADE
1ST
2ND
3RD
BATCH BATCH BATCH TOTAL
CHEMICAL
SHOPS
50
69
60
178
GRADE A+
2
4
0
CHPS ZONE
74
343
308
714
GRADE A
21
35
19
CLINICS
82
107
58
255
GRADE B
86
267
151
DENTAL CLINIC
DIAGNOSTIC
CENTRES
0
0
2
3
GRADE C
139
536
380
0
13
6
19
GRADE D
278
330
279
EYE CLINIC
HEALTH
CENTRES
0
3
3
6
48
52
20
887
106
73
347
242
658
574
1224
849
2647
22
21
15
59
120
58
22
198
76
94
65
238
LABORATORIES
MATERNITY
HOMES
PHARMACIES
POLYCLINICS
PRIMARY
HOSPITALS
1
9
2
12
58
150
54
267
0
0
0
4
3
0
TOTAL
FACILITY BY
OWNERSHIP
GOVERNMENT
FACILITIES BY
REGIONS
ST
ND
1
BATCH
2
BATCH
RD
3
BATCH
TOTAL
138
268
50
456
0
45
99
138
282
2
9
CENTRAL
107
82
28
217
1
0
1
86
181
91
358
14
6
10
30
EASTERN
GREATER
ACCRA
64
126
98
574
1224
849
2647
NORTHERN
27
161
83
UPPER EAST
38
77
40
288
271
155
UPPER WEST
1
31
102
VOLTA
22
89
83
WESTERN
46
110
136
574
1224
849
ST
ND
1
BATCH
2
BATCH
RD
3
BATCH
TOTAL
167
741
564
1460
11
106
29
149
PRIVATE
QUASI
GOVERNMENT
395
367
250
1022
1
10
6
16
TOTAL
574
1224
849
2,647
MISSION
TOTAL
ASHANTI
BRONG
AHAFO
PYHSIOTHERAPY
SECONDARY
HOSPITAL
TERTIARY
HOSPITAL
ULTRASOUND
PROVISIONAL
6
75
507
1066
TOTAL
134
194
292
2647
3.5.1 Collaboration
NHIA is collaborating with PharmAccess, a Dutch Non Governmental Organization (NGO) in the
accreditation exercise. The NGO has supported the training of accreditation surveyors, provided
Personal Digital Assistance (PDAs) and software for analyzing the data as well as 10 laptop
computers for capturing data on the field, and a server to house accreditation data.
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2010 ANNUAL REPORT
3.6 ADMINISTRATION AND HUMAN RESOURCE
In 2010, the National Health Insurance Council approved an organisational structure proposed by
management. As at the end of the year, 358 employees of diverse skills were at post at both the head
office and the regional offices. Employees also benefited from various training and development
programmes. In all, 48 different training programmes were organised for a total of 265 participants
(see annex 6).
The year also witnessed salary rationalisation exercise that sought to address distortions in the
salaries of employees. 75 employees faced various disciplinary actions, ranging from queries to
dismissals, on grounds of deviant behaviour.
3.7 PLANNING, MONITORING, EVALUATION, RESEARCH AND DEVELOPMENT
To provide strategic direction to the operations of NHIA, a ten-member Technical Committee was
formed by NHIA management with SCAD as the lead division to draft a strategic plan for the
NHIA. The committee started work in September and will continue in the ensuing year to complete
the process.
Weekly management meetings were held throughout the year to review activities and plan for
ensuing weeks to ensure management was on course. Two management seminars were also held as
part of the monitoring and evaluation process to keep the organization on course.
Besides routine monitoring and supervision by the regional office staff, the head office operations
division embarked on support visits to nine regions and 57 schemes. On the average, four health
facilities per region were also visited.
Research was conducted to find out the views of major stakeholders on the NHIS medicines list.
The results of the research informed the revision of the list and prices. Ministry of Health approved
prescribing levels were also incorporated into the NHIS medicines list. A uniform prescription form
was also designed in collaboration with the MOH and major provider groups. This will be piloted in
Greater Accra Region in 2011.
3.8 PROJECTS AND PROCUREMENTS
The construction of the Head Office continued and reached 93% completion during the year.
Contracts were awarded for the construction of ten regional office buildings. The Claims Processing
Centre was established and furnished for centralised claims processing to commence during the
year. Six million NHIS ID cards were procured during the year. 64 bicycles were also procured for
schemes who needed them for their outreach programmes.
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2010 ANNUAL REPORT
3.9 COMMUNICATION AND STAKEHOLDER ENGAGEMENT
Prior to 2010, irregular communication between NHIS and its major stakeholders was identified as
a challenge at almost all forums which were organized. Hence, management saw improvement in
communication with stakeholders as very important. Efforts were therefore made to enhance
communication and engagement with stakeholders.
3.9.1 Stakeholder engagement
In line with the objective of strengthening collaboration between NHIA and its key stakeholders, a
two-day stakeholders meeting was held in Kumasi in April. Participants for the meeting included all
Medical Superintendents of Ghana Health Service, Christian Health Association of Ghana, Private
Health facilities and representatives of Pharmacy Council. Key issues discussed were the clinical
audits findings, claims management experiences, abuse and fraud in the system, among others. The
meeting ended successfully with participants resolving to contribute positively towards the
sustainability of the scheme.
3.9.2 Policy fair
As a way of showcasing the achievements of NHIS, the Authority participated in a five-day policy
fair organized by the Ministry of Information from the 27th April to 1st May, 2010. The purpose of
the fair was to offer Ministries, Departments and Agencies (MDAs) the opportunity to showcase
their policies, programmes and activities and to enable the general public have direct contact with
the leadership of those MDA’s. On display at NHIS stand were the NHIS benefit package, major
reform initiatives and other ongoing activities. The Chief Executive of NHIA made a presentation
at the policy fair during which he explained the operations of the NHIS to the general public.
Group picture of Chief Executive and
Directors at the fair
Participants at NHIA stand
3.9.3 End of year get-together and awards night
NHIA held its maiden awards night to show appreciation to its cherished service providers and
district schemes that performed creditably during the year. The awards ceremony took place on the
10th of December 2010 at the Dome, Accra International Conference Centre. In attendance were all
26
2010 ANNUAL REPORT
staff of NHIA, District Schemes in the Greater Accra Region, Council Members, Members of the
Parliamentary Select Committee on Health, Development Partners, Representative of Ghana Health
Service and Ministry of Health. One scheme and one service provider were selected from each
region for the award. Special awards were also given to the President of Ghana Medical Association
and the Director General of the Ghana Health Service. The night was also used by management to
socialize with district schemes staff, service providers, development partners and other invited
guests.
WHO Country Representative, Dr. Daniel Kertesz, (left) presenting an
award to GMA President, Dr. Adom Winful.
3.9.4 Media engagement
Several media (print and electronic) were used to market NHIS to the public. Special jingles were
developed on the importance of NHIS and the need to register with the scheme, free maternal care
programme and fraud and abuse. Live Presenter Mention (LPM) was also developed on providers
and client responsibilities. The jingles and the LPM were aired on popular radio/FM stations in
Accra and other parts of the country.
Various directors, deputy directors and managers in NHIA were used in the communication
process. The strategy was to allow managers to disseminate information on their areas of expertise
through radio and television interviews thereby stepping up the level of ownership of issues. To
ensure closer monitoring of the media landscape, the NHIA commenced daily media content
analysis of issues affecting NHIS. The analysis is circulated to all directors for their input and
comments and for the necessary actions.
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2010 ANNUAL REPORT
WHO/UNDP EXCELLENCE AWARD
28
2010 ANNUAL REPORT
4.0 ACHIEVEMENTS
4.1 INCREASED COVERAGE
The major success story of NHIS is its high patronage by residents in Ghana. As at 31st December
2010, over 18 million Ghanaians had subscribed to the scheme out of which over 8 million
representing 34% of the population are active card bearers. The high patronage attests to the fact
that Ghanaians have embraced the NHIS as the preferred health care financing mechanism.
4.2 UNDP/WHO EXCELLENCE AWARD
Ghana received an award from the United Nations Development Programme and the World Health
Organization for showing leadership in health insurance implementation within the southern
countries. It was in recognition of Ghana’s leadership role in providing financial risk protection
against cost of health care services for its population, especially the poor and vulnerable in society.
Mr. Sylvester A. Mensah receiving the award in Geneva Switzerland
4.3 FINANCIAL AND CLINICAL AUDITS
The establishment of Clinical audit division and strengthening of the internal audit division in 2010
resulted in huge cost savings to NHIS. Clinical audit alone recovered a total of GH¢16.8 million
from service providers. The exercise also helped in ensuring quality service delivery to NHIS
members. Generally, the activities of the two divisions helped in reducing financial leakages and
strengthened internal controls at both the district schemes and service provider ends.
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2010 ANNUAL REPORT
4.4 REVIEW OF MEDICINES LIST
The NHIS Medicines List was developed in 2008 to serve as a guide to health providers in
delivering healthcare services to NHIS subscribers. The List contains medications in the various
therapeutic groupings used in the management of disease conditions covered under the benefit
package of the National Health Insurance Scheme, which forms over 95% of disease conditions in
Ghana.
Since its inception, the Medicines List has had two reviews with the last review in the last quarter
of 2010. The current List has five hundred and fifty two (552) formulations. In reviewing the
Medicines List, all anaesthetics (both local and general) and programme drugs were removed from
the List. This is because the anaesthetics form part of the tariffs paid for the services rendered while
programme drugs are those used in public health programmes of the Ministry of Health and as such
health providers are not to charge NHIS clients for such medicines.
However, although Sulfadoxine + Pyrimethamine tablet, 525 mg, is a Programme drug, it has been
maintained on the List due to its unavailability at some facilities across the country. This has been
done to prevent malaria in pregnancy and aid the country’s attainment of the Millennium
Development Goal 5 (which is to improve maternal health).
In addition, the following formulations were added to the List. They include:
o
Artemether Injection, 40 mg/mL
o
Artemether Injection, 80 mg/mL
o
Cetirizine softgel Capsule, 10 mg
o
Ferrous Gluconate Syrup
o
Zinc Tablet, 10 mg
o
Zinc Tablet, 20 mg
The Artemether injection formulations were added because of its importance in the treatment of
severe malaria conditions. Cetirizine softgel capsule was added for the benefit of the aged whilst
Ferrous Gluconate syrup was added to the therapeutic group of drugs affecting blood on the List.
Furthermore, the Zinc formulations were added for the treatment of diarrhoea in children as
stipulated in the Standard Treatment Guidelines.
4.5 ACCREDITATION OF HEALTH FACILITIES
In pursuant of NHIA mandate to give accreditation to service providers prior to providing services
to NHIS subscribers, a total of 915 health facilities were inspected in 2010, out of which 849
received formal accreditation. Out of a total number of 2,915 facilities inspected, 2,647 of them
have received formal accreditation since the inception of the exercise in 2009.
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2010 ANNUAL REPORT
4.6 IMPROVED REIMBURSEMENT TO PROVIDERS
Reimbursement to accredited health care providers improved tremendously during the year under
review. Funds were released to district Schemes for payment of claims on timely basis. NHIA
placed advertisers’ announcement in the dailies reminding providers to submit their claims for
prompt reimbursement and informing them of fund transfers to the various schemes with whom
they have signed service contract. Thus, the issue of delayed reimbursement resulting in withdrawal
of health care service to NHIS clients became a thing of the past.
4.7 GATE-KEEPER SYSTEM AND FREE MATERNAL CARE PROGRAMME
Non enforcement of the gatekeeper system and abuse of the free maternal care programme have
been identified as major contributors to escalating claims which currently accounts for 76.2% of
National Health Insurance Authority (NHIA) total expenditure. To address these challenges, two
stakeholders meetings were held in Koforidua and Kumasi in September and October 2010
respectively, to develop guidelines that are mutually acceptable to stakeholders. Participants at the
meetings included representatives from Ghana Health Service (GHS), Ministry of Health (MOH),
NHIA, Christian Health Association of Ghana (CHAG), Korle–Bu, Komfo Anokye and Tamale
Teaching Hospitals, Ghana Registered Nurses and Midwives Association and Association of
Community Pharmacies. The revised guidelines have been distributed for implementation.
4.8 RISK ASSESSMENT
NHIS is confronted with various risks leading to high operational cost, which emanates partly from
weak controls and non standardization of the entire NHIS operations. To adequately identify and
control these risks, and to make the scheme more sustainable, an eleven-member Risk Assessment
Committee was constituted by NHIA to identify, assess, document and evaluate the various risks
associated with the entire operations of NHIS. The Committee identified 81 risk areas out of which
17% were high, 46% medium and 37% low. The recommendations made by the team are
vigorously enforced by management of NHIA.
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2010 ANNUAL REPORT
5.0 CHALLENGES
5.1 FINANCIAL SUSTAINABILITY OF THE SCHEME
Financial sustainability of the scheme remains a big challenge to management given the increasing
demand for health insurance and its consequent increase in health care service utilisation. It is
projected that without any additional sources of funding to the current sources, the NHIF risks of
dipping down by the close of year 2012. There is therefore the need to secure additional sources of
funding for the scheme while implementing cost containment strategies to minimise operational
cost.
5.2 IDENTIFICATION OF THE POOR IN THE INFORMAL SECTOR
The national health insurance scheme is a pro-poor programme that focuses much attention on
targeting the poor for exemption. The general perception, however, is that the poor are not
adequately covered by the scheme. The inadequate coverage could be attributed to the difficulty in
identifying them for exemption.
Management has initiated discussion with officials managing the LEAP programme on how best
NHIA and LEAP could collaborate in identifying as many poor as possible for health insurance
coverage. Other methods of targeting the poor for exemption may, however, have to be explored to
improve coverage of the poor.
5.3 ID CARD MANAGEMENT
ID card management is one key constraint facing the scheme. There are delays in members
obtaining their cards on time because there are delays along the entire ID card management chain,
comprising data entry, data batching, card production and distribution. Card distribution constraints
are occasioned by several factors including difficulty in locating places of residence particularly in
the urban centres, change of residence and double registration.
5.4 ICT
There are constraints with the ICT system which need to be addressed to make it more robust.
These include slowness of the system and frequent down time. These challenges, together with the
large numbers of subscribers and low numbers of scheme staff, mostly account for non regular use
of the system at the district scheme level.
5.5 CLAIMS MANAGEMENT
Several challenges have been identified with claims management within the NHIS. There have been
delays in the submission of claims by some service providers, which is frequently occasioned by
inadequate capacity within health facilities in the preparation of claims. The district scheme offices
also do not have adequate capacity to vet claims effectively.
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2010 ANNUAL REPORT
6.0 OUTLOOK FOR 2011
In 2011, steps will be taken to enhance the financial sustainability of the NHIS, strengthen the ICT
platform, promote continuous service improvement in service provider facilities, strengthen claims
management, improve ID card management, improve human resource capacity and organisational
reforms and take steps to improve the internal and external communication of the NHIS.
To achieve these corporate objectives, the strategies described in the sections below will be
pursued.
6.1 ENHANCE FINANCIAL SUSTAINABILITY OF THE NHIS
Three areas have been identified for addressing the sustainability issue:
6.1.1 Defensive Strategy:
Developing cost containment measures to minimise leakages. These will include:
i. Establishing and operationalizing a Consolidated Premium Account to centralise
premium payment into two designated accounts.
ii. Intensifying Clinical Audits in collaboration with provider groups.
iii. Introducing and piloting Capitation as an alternative payment mechanism.
iv. Collaborating with providers and subscribers to enforce the gatekeeper policy of the
Ministry of Health.
v. Linking treatment to diagnosis to improve rational use of medicines.
vi. Implementing uniform prescription forms to promote rational prescribing.
vii. Using mystery shopping to identify inefficiencies and abuse in the entire NHIS system
for redress.
It is also known that over 27% of the scheme’s medicines cost is attributable to anti-malarial
medicines. For example, in 2009 the scheme spent over GH¢ 51 million on anti-malarial medicines
alone. The NHIS will therefore liaise with the Global Fund/Malaria Control Program office in order
to benefit from the Affordable Medicines Facility – Malaria (AMFm) program. Savings from
AMFm is projected to be over 50% annually.
6.1.2 Prudent fund management:
Fund Management and Investment will be strengthened to ensure that NHIA funds are judiciously
managed to generate optimal returns on investments. One strategic investment initiative will be the
development and maintenance of an optimal asset allocation system, through tactical asset timing
and superior investment selection. This is because between 80% and 90% of the performance of the
portfolio is determined by the mix of investment assets held in the portfolio.
Additionally, the NHIS will develop a robust investment research team to continually review the
investment environment, economic policies and capital market expectations for optimal investment
decision making. NHIS will also identify and include in the portfolio, alternative investments with
very low or negatively correlated returns. This is aimed at diversifying away unsystematic risks, for
higher risk adjusted investment returns.
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2010 ANNUAL REPORT
6.1.3 Sourcing Strategy:
i.
Seeking additional funding through policy
The approach is to further diversify our sources of funds by securing additional stable sources of
funds by December 2011, and collaborate with stakeholders to increase the value derived from
these sources by December 2014. Sources to be considered include petro-chemical levy, ‘sin tax’,
DVLA, NHIL increase.
ii.
Review premiums
Since they were set in 2004, premiums have not been reviewed. With effect from 2011 premiums
would be reviewed annually to reflect changes in the domestic economy.
iii.
Internally-driven fundraising activities
This activity would be treated as ad-hoc programs aimed at raising funds for specific purposes and
activities.
iv.
Support from development partners
The NHIS will continue to welcome support from Development Partners (DP). For example, the
Health Insurance Project (HIP) is expected to maintain support for the strengthening of the
purchasing policies and mechanism, and the integrated claims management systems.
6.2 STRENGTHEN THE NHIS ICT
6.2.1 ICT deployment
In 2011, it is expected that nationwide down time of ICT platform will not exceed 5%. A minimum
of 105 additional terminals will be provided to serve key service providers.
To improve service delivery to SSNIT contributors especially at the time of registration and
renewal, business rules between NHIS and SSNIT will be harmonised. Monthly meetings between
the two institutions will be re-introduced effective January 2011.
6.2.2 ICT governance
In view of the strategic role of ICT in the operations of the NHIS, an ICT steering committee
chaired by the Chief Executive will be set-up to help optimise the realisation of value from ICT
investments. At the Council level, a sub-committee on ICT will be set up to provide strategic
direction.
6.2.3 Data integrity
To enhance the integrity of the membership database, the NHIS will embark on a database cleaning
process by incorporating biometric features into its applications. In this regard, the NHIS will
continue discussions and collaboration with other institutions.
34
2010 ANNUAL REPORT
6.3 PROMOTE QUALITY IMPROVEMENT IN SERVICE PROVIDER FACILITIES
One of the key mandates of the NHIS is the assurance of quality within NHIS-accredited health
care service provider facilities. This notwithstanding, at the inception of the scheme, public, quasigovernment and mission health facilities were given blanket provisional accreditation, while private
health care facilities were required to apply for accreditation. Under this arrangement, the health
care facilities were not inspected before being given provisional accreditation.
Since 2009, however, a formal accreditation system has been instituted under which health care
facilities are inspected to ensure that they meet pre-determined criteria before being granted
accreditation. To date, over 2,600 providers have been formally accredited. PharmAccess of the
Netherlands has provided significant support to the accreditation programme of the NHIS.
To promote quality improvements in health care service provision, NHIS will continue with
accreditation and strengthen post-accreditation monitoring. A further 1,000 health care facilities
will be inspected in 2011.
6.4 STRENGTHEN CLAIMS MANAGEMENT
To ensure timely payment of claims to providers, NHIS will implement a claims management
system that is complete with a rules-based engine and workflow management software. To support
the migration to electronic processing, the current claims module used at the schemes will be
enhanced to make it more user-friendly. The pilot for this enhanced module has been completed in
three schemes in the Greater Accra Region and rollout to the other regions will be completed by
July 2011.
The NHIS intends to centralize claims at three zones. The first zonal CPC will become operational
in 2011. This initiative is expected to bring efficiency and effectiveness in the processing of claims.
6.5 IMPROVE ID CARD MANAGEMENT
NHIA will institute measures to improve the production and distribution of ID cards in order to
make the NHIS card the most respected and trusted local card. The internal processes will be
reviewed and streamlined to clearly define roles and responsibilities at all levels of the production
and distribution chain. A manual will be developed to serve as a guideline to improve the processes
involved in ID card management.
6.6 HUMAN RESOURCE CAPACITY AND ORGANISATIONAL REFORMS
The following activities shall be undertaken as part of capacity strengthening within the NHIS:
6.6.1 Attracting, developing and retaining relevant human resource
The NHIA will attract, develop and retain relevant human resource capacity by providing a positive
and engaging working environment. It will recognise, reward and reinforce the right behaviour and
attitudes. It will also involve and engage employees through communication and feedback
mechanisms in the daily administration of the scheme. NHIS will utilise robust and focused training
and career development programs to create a match between training needs, people opportunities
and corporate goals while conducting continuous monitoring, evaluation and measurement of
progress to remove de-satisfiers and reinforce what satisfies people.
35
2010 ANNUAL REPORT
NHIA will continue with the revision of the entire conditions of service for staff. New schemes
such as a provident fund will be included in line with best practice with the view to securing
financial security of staff. Other welfare packages, such as annual medical checkups and
counselling services, will be implemented to motivate staff.
6.6.2 Organizational reforms
The successful implementation of the strategies highlighted in the preceding sections calls for some
organisational reforms in structure and function. The case for an organisational review is further
strengthened by the proposed new law that makes the scheme unitary.
A new structure that allows for the creation of two Deputy Chief Executives (DCEs) is proposed.
The creation of two DCEs calls for a thinning of the total number of directorates currently within
the NHIS. In this regard, the NHIS intends to reduce the total number of divisions to nine by the
end of 2011.
To make up for any gap that would be created by the above arrangements, and to strengthen staff
quality and capacity at the district/scheme level, District Director (DD) positions will be created in
all 145 districts across the country by the end of 2011.
6.6.3 Ghana Health Insurance Institute
The National Health Insurance Scheme has been acclaimed worldwide for showing leadership in
social health insurance implementation within the South-South regions, culminating in an
international award in 2010. The design of the scheme is an innovation and several other innovative
systems have been developed and implemented within the NHIS. These include the accreditation
system, institutionalised clinical audits, the Ghana Diagnosis Related Groupings, the NHIS
Medicines List, the Claims Processing Centre and a nationwide ICT platform. Members of staff
within the scheme have also had the opportunity of exposure to best practices and to present papers
around the world.
Thus the NHIS has experiences worth sharing with Africa and the world at large. There are
therefore plans to develop a Ghana Health Insurance Institute for in-country capacity building and
for sharing ideas and experiences with practitioners in Africa and beyond.
As a first step, a committee will be set up to develop a proposal that outlines the roadmap for the
establishment of the institute.
6.7 Communication and marketing strategies
6.7.1 Internal and external communication
The communication strategy takes cognisance of the need to be proactive in educational,
sensitisation and general information activities. It differentiates between internal and external
communications. Internal communications would be targeted at staff and council, while external
communications would be targeted at the general public and the international community.
36
2010 ANNUAL REPORT
Through monitoring and evaluation of the activities of the various divisions, there will be timely
internal communications to draw attention to shortfalls. Standards will be developed for this.
All types of media, from drama and information services vans at the community level to new media
such as mobile telephony and the internet, will be engaged.
Specifically, the following will be done:
i. Preparation and submission of monthly snapshot reports to the Ministry of Health,
Parliamentary Select Committee on Health (PARSCOM/Health) and to the NHIA Council
ii. Quarterly presentations/interaction with parent Ministry, Ministry of Information and other
relevant MDAs
iii. Quarterly press interactions
iv. Semi-annual staff durbars
v. Semi-annual interaction with the Press
vi. Annual interaction with stakeholders – providers and members, separately.
6.7.2 Communication with service providers
To improve communication between the scheme and service providers, management will develop
direct communication relationships with them. To retain technical links with providers, M&E
Manager for Claims/Provider Services and M&E Manager for Membership will be appointed in all
10 regional offices in 2011. These managers will serve as the main contact and information bank
through which other divisions will relate to providers, subscribers and other stakeholders.
A call centre will also be established to facilitate communication with subscribers and other
stakeholders and to resolve issues and challenges promptly. Public Relations Officers in the district
schemes will be empowered to play active roles in the mainstream communication and public
education at the district and regional levels.
As part of measures to position the NHIS website as a key communication medium and to facilitate
quicker update on the initiatives envisaged for 2011 and beyond, management will re-engineer the
NHIS website to match up to the task and to give the NHIS a reputable global image.
As part of its international marketing strategy, the NHIS will do some publications in international
journals, attend conferences and workshops to share experiences with the global community.
Management will also, continuously engage staff through staff durbars, one-on-one interactions and
get-togethers. Opportunities will also be created to receive feedback on policies, programmes and
decisions.
37
2010 ANNUAL REPORT
7.0 CONCLUSION
Over the past six years, particularly the last one-and-half years, the NHIA has seen significant
improvement in its operational results culminating in the attainment of an international award from
UNDP/WHO in November 2010. There was significant reduction in claims re-imbursement period
from over 90 days to 60 days on average. Other achievements include increase in membership
enrolment and increase in number of accredited facilities to improve physical access to healthcare.
These achievements have been recorded in the midst of numerous challenges, giving testimony to
the effectiveness of prudent strategies adopted by management.
To consolidate the gains made so far, management is determined to meet the aspirations of
Ghanaians by introducing far reaching innovations that will ensure an efficient and responsive
scheme.
38
2010 ANNUAL REPORT
ANNEXES
39
2010 ANNUAL REPORT
ANNEX 1: Financial Statement
NHIA FINANCIAL STATEMENT (UNAUDITED)
NATIONAL HEALTH INSURANCE AUTHORITY (NHIA)
INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR ENDED
31 DECEMBER, 2010
2010
2009
GH ¢
401,848,524.08
58,708,664.99
GH ¢
329,459,128.92
75,638,686.50
308,784.37
2,412,772.32
460,865,973.44
407,510,587.74
Subsidies and Claims
397,610,425.00
359,956,868.90
Administrative &
Logistical
23,300,837.11
8,346,070.31
Support to Partner
Institutions
65,080,841.83
41,870,416.36
Operational &
Administrative Expenses
22,133,809.61
16,883,796.75
508,125,913.55
427,057,152.32
(47,259,940.11)
(19,546,564.58)
Levies
Investment Income
Other Income
Deficit Transferred to
Accumulated Fund
NATIONAL HEALTH INSURANCE AUTHORITY (NHIA)
ACCUMULATED FUND FOR THE YEAR ENDED
31ST DECEMBER, 2010
2010
GH ¢
Balance b/f
443,263,968.13
Prior Year Adjustment
2009
GH ¢
462,495,574.80
314,957.91
Deficit Transferred from
Income & Expenditure
(47,259,940.11)
(19,546,564.58)
Accumulated Fund For
the year
396,004,028.02
443,263,968.13
40
2010 ANNUAL REPORT
NATIONAL HEALTH INSURANCE AUTHORITY (NHIA)
BALANCE SHEET AS AT THE YEAR ENDED
31ST DECEMBER, 2010
Fixed Asset
Property, Plant and
Equipment
Investments
2010
GH ¢
2009
GH ¢
48,011,901.46
284,487,882.28
35,943,972.47
437,818,825.16
332,499,783.74
473,762,797.63
15,902,358.94
179,207,690.75
1,330,417.37
37,528,128.94
63,612,196.55
906,445.95
13,508,602.25
5,715,260.29
Total Current Assets
209,949,069.31
107,762,031.73
Total Assets
542,448,853.05
581,524,829.36
Funds & Liabilities
Accumulated Fund
396,004,028.02
443,263,968.13
Current Liability
Claims Payable
114,459,682.43
110,261,804.23
23,973,822.18
23,417,000.00
8,011,320.42
4,582,057.00
Total Current Liabilities
146,444,825.03
138,260,861.23
Total Fund and
Liabilities
542,448,853.05
581,524,829.36
Current Assets
Interest Receivable
NHIL Receivable
Other Receivable
Bank and cash
Accured Support to
Partner Institutions
Other Accounts Payables
41
2010 ANNUAL REPORT
NATIONAL HEALTH INSURANCE AUTHORITY (NHIA)
CASH FLOW STATEMENT FOR THE YEAR ENDED 31ST DECEMBER, 2010
Cashflow from Operating
Activities
Deficit
Add Depreciation
Increase in Receivables
Increase Payables
Decrease in Premium
Deposits
2010
2009
GH ¢
GH ¢
(47,259,940.11)
9,286,605.74
(94,393,695.62)
(32,518,697.37)
449,813.94
55,883,103.27
8,183,963.80
133,179,199.24
-
964,394.25
Net inflow from operating
activities
(124,183,066.19)
157,957,813.33
Decrease in Fixed
Deposits (Short Term)
153,330,942.88
(158,287,910.97)
Investing Activities
Property, Plant &
Equipment Acquisition
(21,354,534.73)
(21,801,885.34)
Net Decrease in Cash &
Cash Equivalent
7,793,341.96
(22,131,982.98)
Cash & Cash Equivalent as
at 01/01/10
5,715,260.29
27,847,243.27
Net Cash & Cash
Equivalent as at 31/12/09
13,508,602.25
5,715,260.29
42
2010 ANNUAL REPORT
ANNEX 2: Minimum health care package under NHIS
1. Out-Patient Services
A) Consultation including reviews. These include both general and specialist
consultations.
B) Requested investigations including laboratory investigation, x-rays and ultrasound
scanning for general and specialist out-patient services.
C) Medication, namely, prescription drugs on National Health Insurance Drugs List,
traditional medicines approved by the Food and Drugs Board and prescribed by
accredited medical and traditional practitioners.
D) HIV/AIDS symptomatic treatment for opportunistic infection.
E) Out-patient/Day Surgery Operations including hernia repairs, incision and drainage,
haemorrhoidectomy.
F) Out-patient Physiotherapy.
2. In-Patient Services
A) General and Specialist in-patient care
B) Requested investigations including laboratory investigations, x-rays and ultrasound
scanning for in-patient care.
C) Medication; namely, prescription drugs on National Health Insurance Drugs List,
traditional medicines approved by the Food and Drugs Board and prescribed by
accredited medical and traditional medicine practitioners, blood and blood products.
D) Cervical and Breast Cancer Treatment
E) Surgical Operations
F) In-patient Physiotherapy
G) Accommodation in general ward
H) Feeding (where available)
3. Oral Health Services
A) Pain Relief which includes incision and drainage, tooth extraction and temporary
relief.
B) Dental Restoration which includes, Simple Amalgam Fillings and Temporary
Dressing.
4. Eye Care services
A) Refraction
B) Visual Fields
C) A-Scan
D) Keratometry
E) Cataract Removal
F) Eye lid Surgery
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2010 ANNUAL REPORT
5. Maternity Care
A) Antenatal Care
B) Deliveries; namely, normal and assisted
C) Caesarian Section
D) Postnatal care
6. Emergencies
A) All emergencies shall be covered. These refer to crisis health situation that demand
urgent intervention and include:
B) Medical emergencies
C) Surgical emergencies including brain surgery due to accidents.
D) Paediatric emergencies
E) Obstetric and Gynaecological emergencies including caesarian sections
F) Road Traffic Accidents
G) Industrial and workplace accidents
H) Dialysis for acute renal failure
EXCLUSION LIST
The following health care services are excluded:
A) Rehabilitation other than physiotherapy
B) Appliances and prostheses including optical aid, hearing aids, orthopedic aids,
dentures
C) Cosmetic surgeries and aesthetic treatment
D) HIV retroviral drugs
E) Assisted Reproduction e.g. Artificial insemination and gynaecological hormone
replacement therapy
F) Echocardiography
G) Photography
H) Angiography
I) Orthoptics
J) Dialysis for chronic renal failure
K) Heart and Brain surgery other than those resulting from accidents.
L) Cancer treatment other than cervical and breast cancer
M) Organ transplanting
N) All drugs that are not listed in the NHIS Drug list
O) Diagnosis and treatment abroad
P) Medical examinations for purposes of visa applications, educational, institutional,
driving license
Q) VIP ward (Accommodation)
R) Mortuary Services
44
2010 ANNUAL REPORT
ANNEX 3: Unit heads and managers
UNIT HEADS AND MANAGERS
#
1
2
3
NAME
Amadu Ali
Collins Danso Akuamoah
Daniel K. Amekudzi
4 Diana Oye Ahene (Ms.)
5 Abena Agyeiwaa Amoako (Dr.)
6 Edward Buckman
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Francis Sampana Zuure
George Omaboe
George Asamoah Baah
George G. Amoo
Iddrisu Hudu
Isaac Marful Dapaah
Ismail Osei
Maxwell Addico
Constance Addo-Quaye Adjetey
(Mrs)
Nicholas Afram Osei
Nii Anang Adjetey (Dr.)
Prince Debrah
Rebecca Akatue (Mrs.)
Stella Adu-Amankwa (Mrs.)
Stephen N. Bewong
Thomas Adoboe
Vivian Addo-Cobbiah (Mrs.)
24 Washington Komla Darke
25 William Sabi
DIVISION
Claims
Strategy & Corporate Affairs
Admin & Gen. Counsel
Admin. / CE's Secretariat
Operations
ICT
Internal Audit
Internal Audit
Finance
Clinical Audit
Claims
ICT
Clinical Audit
Internal Audit
Clinical Audit
Claims
Strategy & Corporate Affairs
Internal Audit
Operations
Strategy & Corporate Affairs
Claims
ICT
Operations
Finance
Operations
POSITION
Claims Manager
Strategy Manager
HR Manager -Talent &
Recruitment
Personal Assistant to CE
Provider Relations Manager
Information Systems
Manager
Audit Senior
Audit Manager
Finance Manager
Clinical Audit Manager
Claims Manager
ICT Applications Manager
Clinical Nurse
I.T. Auditor
Pharmacist
Senior Claims Manager
Communications Manager
Audit Manager
Operations Manager
Publications Manager
Business Systems Manager
IT Infrastructure Manager
Accreditation & Quality
Manager
Fund Manager
Operations Manager
45
2010 ANNUAL REPORT
ANNEX 4: Regional Managers
#
1
2
3
4
5
6
7
8
9
10
NAME
Afrifa Yamoah Ponko
Foster Agyei-Korang
Francis Asante Mensah
James Mettle
John Bosco Zury
Lawrence Amartey
Nester Akototse
Rashid Tanko
Roger Aposs
Windham Emil Afram
REGION
Ashanti
Brong Ahafo
Western
Central
Upper West
Greater Accra
Volta
Northern
Upper East
Eastern
46
2010 ANNUAL REPORT
ANNEX 5: Directory of district mutual health insurance schemes
Name of Region
Name of scheme
Address/location
Telephone number
Adansi North
Box 21, Fomena Ashanti
0302-216970 EXT 5510/6510
Adansi South
Box 1, New Adubiase
0302-216970 EXT 5511/6511
Afigya Sekyere
Box 1, Agona Ashanti
0302-216970 EXT 5512/6512
Ahafo - Ano North
Box 39, Tepa - Ashanti
Box 9, Mankranso Ashanti
0302-216970 EXT 5513/6513
0302-216970 EXT
5514/6514
0302-216970 EXT 5515/6515
Amansie East
Box 7 Jacobu
Box 350, Bekwai Ashanti
Amansie West
Box 1, Manso Nkwanta
0302-216970 EXT 5517/6517
Asante Akim North
Box 214, Konongo
0302-216970 EXT 5518/5518
Asante Akim South
Box 12, Juaso
0302-216970 EXT 5519/6519
Asokwa Sub - Metro
Box 1916, Kumasi
Box 17, Nkawie Ashanti
0302-216970 EXT 5520/6520
Ahafo - Ano South
Amansie Central
Ashanti
Atwima Nwabiagya
Atwima Mponoa
0302-216970 EXT 5516/6516
0302-216970 EXT 5521/6521
0302-216970 EXT 5522/6522
Box Kj- 508,Kejetia Kumasi
0302-216970 EXT 5523/6523
Box 24, Kuntanase
0302-216970 EXT 5524/6524
Ejisu – Juaben
Box 144, Ejisu
0302-216970 EXT 5525/6525
Ejura Sekyeredumase
Box 9, Ejura
0302-216970 EXT 5526/6526
Kwabre
Box 8, Mamponteng
0302-216970 EXT 5527/6527
Manhyia Sub - Metro
Pmb, Adum - Kumasi
0302-216970 EXT 5528/6528
Bantama Sub - Metro
Bosomtwe - AtwimaKwanwoma
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2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region
Ashanti
Brong Ahafo
Name of scheme
Address/location
Telephone number
Obuasi Municipal
Box 32,Obuasi
0302-216970 EXT 5529/6529
Offinsoman
Box 281, Offinso
Box 360, Mampong Ash
0302-216970 EXT 5530/6530
Box 302, Effiduase
0302-216970 EXT 5532/6532
Subin Sub - Metro
Box Kj - 509, Kejetia Kumasi
0302-216970 EXT 5533/6533
Asunafo North
Box 237, Goaso
0302-216970 EXT 5534/6534
Asunafo South
Box 14, Kukuom
0302-216970 EXT 5535/6534
Asutifi
Box 23, Hwidiem
0302-216970 EXT 5536/6536
Atebubu
Box 125, Atebubu
0302-216970 EXT 5537/6537
Berekum
Box 21, Berekum
0302-216970 EXT 5538/6538
Dormaa
Box 94, D - Ahenkro
0302-216970 EXT 5539/6539
Jaman North
Box 62, Sampa
0302-216970 EXT 5540/6540
Jaman South
Box 56, Drobo
0302-216970 EXT 5541/6541
Kintampo North
Box 130, Kintampo
0302-216970 EXT 5542/6542
Kintampo South
Box 50, Jema
0302-216970 EXT 5543/6543
Nkoranza District
Box 169, Nkoranza
0302-216970 EXT 5544/6544
Pru
Box 115, Yeji
0302-216970 EXT 5545/6545
Sene
Box 11, Kwame Danso
Sunyani Municipal
Box 2640, Sunyani
0302-216970 EXT 5546/6546
0302-216970 EXT
5547/6547
Tain
Box 2, Nsawkaw
0302-216970 EXT 5548/6548
Sekyere West
Sekyere East –
Effiduase
0302-216970 EXT 5532/6531
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2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region
Brong Ahafo
Central
Eastern
Name of scheme
Address/location
Telephone number
Tano North
Box 24, D/Nkwanta
0302-216970 EXT 5549/6549
Tano South
Box 179, Bechem
0302-216970 EXT 5550/6550
Techiman Municipal
Box 522, Techiman
0302-216970 EXT 5551/6552
Wenchi
Abura-AsebuKwamankese
Box 75, Wenchi
0302-216970 EXT 5552/6552
C/O District Assembly
0302-216970 EXT 5615/6615
Agona
Box 595, Swedru
0302-216970 EXT 5616/6616
Ajumako Enyan
Asikuma Odoben
Brakwa
Box 1, Ajumako
0302-216970 EXT 5617/6617
Box 36, B, Asie
0302-216970 EXT 5618/6618
Assin North
Box 102, Foso
Box 18,NsuaemKyekyeware
0302-216970 EXT 5619/6619
Box 1, Winneba
0302-216970 EXT 5621/6621
Oguaman – Capecoast
C/O District Assembly
0302-216970 EXT 5622/6622
Gomoaman
Komenda-EdinaEguafo-Abirem
Box Ap 162, Apam
Box 29,
Elimina0243167295
0302-216970 EXT 5623/6623
Mfantsiman
Twifo Hemang Lower
Denkyira
Box 28, Saltpond
0302-216970 EXT 5625/6625
Box 182, Twifo - Praso
0302-216970 EXT 5626/6626
Upper Denkyira
Box 89, Dunkwa - Offin 0302-216970 EXT 5627/6627
Afram Plains
Box 43, Donkorkrom
0302-216970 EXT 5598/6598
Akuapem North
Box 154, Nsawam
0302-216970 EXT 5599/6599
Akuapem South
Box Nw 602, Nsawam
0302-216970 EXT 5600/6600
Assin South
Awutu - Effutu –
Senya
0302-216970 EXT 5620/6620
0302-216970 EXT 5624/6624
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2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region
Eastern
Greater Accra
Name of scheme
Address/location
Telephone number
Asuogyaman
Box Ab 457, Akosombo
0302-216970 EXT 5601/6601
Atiwa
Box 14, Kwabeng
0302-216970 EXT 5602/6602
Birim North
Box 1, New - Abirem
0302-216970 EXT 5603/6603
Birim South
Box 939, Akim Oda
0302-216970 EXT 5604/6604
East Akim
Box Ky 174, Kibi
0302-216970 EXT 5605/6605
Fanteakwa
Box 113, Begoro
0302-216970 EXT 5606/6606
Kwaebibirem
0302-216970 EXT 5607/6607
Manya Krobo
Box 114, Kade
Box 266, Odumasi
Krobo
New Juaben
Boxkf518, Koforidua
0302-216970 EXT 5609/6609
Okwawuman South
Box 26, Mpraeso
0302-216970 EXT 5610/6610
Okwawuman West
Box 770, Nkawkaw
0302-216970 EXT 5611/6611
Suhum Kraboa Coalta
Box Su 260, Suhum
0302-216970 EXT 5612/6612
Yilo Krobo
Box 102, Somanya
0302-216970 EXT 5613/6613
West Akim
Box 136, Asamankese
0302-216970 EXT 5614/6614
Ablekuma
Box 228, Abossey Okai
0302-216970 EXT 5485/6485
Ashiedu Keteke
Box Gt 2152, Accra
0302-216970 EXT 5486/6486
Ayawaso
Box 473, Nima
0302-216970 EXT 5487/6487
Dagme East
Box Af 179, Ada - Foah
0302-216970 EXT 5500/6500
Dagme West
Box Dd 195, Dodowa
0302-216970 EXT 5501/6501
Ga District
Box 1, Amasaman
0302-216970 EXT 5502/6502
0302-216970 EXT 5608/6608
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2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region
Greater Accra
Name of scheme
Address/location
Telephone number
Kpeshie
Box Os 1979, Osu
0302-216970 EXT 5503/6503
Okaikoi
Box 101, Sakum - Estate 0302-216970 EXT 5488/6488
Osu- Klottey
Box Ad 133, Adabraka
0302-216970 EXT 5489/6489
Tema
Box 301, Tema
0302-216970 EXT 5505/6505
Bole
Box 72, Bole
0302-216970 EXT 5553/6553
Bunkpurugu
Box 11, Nakpanduri
0302-216970 EXT 5554/6554
Central Gonja
0302-216970 EXT 5556/6556
East Gonja
Box 9, Salaga
0302-216970 EXT 6555/7555
East Mamprusi
Box 41,Gambaga
0302-216970 EXT 5557/6557
Gushegu
Box 1, Gushegu
0302-216970 EXT 5558/6558
Karaga
Northern
0302-216970 EXT 5559/6559
Nanumba
Box 1, Bimbilla
0302-216970 EXT 5560/6560
Nanumba South
Box 1, Wulensi
0302-216970 EXT 6561/7561
Saboba/Cherekponi
Box 42, Saboba
0302-216970 EXT 5562/6561
Savelugu/ Nanton
B0x 1, Savelugu
0302-216970 EXT 5562/6563
Sawla-Tuna-Kalba
0302-216970 EXT 5643/6643
Tamale
0302-216970 EXT 5564/6543
Tolon/Kumbungu
Box 2531, Tamale
0302-216970 EXT 5565/6565
West Gonja
Box Dm 97, Damongo
0302-216970 EXT 6566/7566
West Mamprusi
Box 6, Walewale
0302-216970 EXT 5567/6567
Yendi
B0x 1, Yendi
0302-216970 EXT 5568/6568
Zabzugu/Tatale
Box 1, Zabzugu
0302-216970 EXT 5569/6569
51
2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region
Upper East
Upper West
Volta
Name of scheme
Address/location
Telephone number
Bawku Municipal
Box 1, Bawku
0302-216970 EXT 5570/6570
Bawku West
Box 1, Zebella
0302-216970 EXT 5571/6571
Bolga
0302-216970 EXT 5572/6572
Bongo
Box 1, Bongo
0302-216970 EXT 5573/6573
Builsa
Box 3, Sandema
0302-216970 EXT 5574/6574
Kasena-Nankana
Box 94, Navrongo
0302-216970 EXT 5575/6575
Jirapa
Box 1, Jirapa
0302-216970 EXT 5576/6576
Lawra
Box 23, Lawra
0302-216970 EXT 5577/6577
Nadowli
Box 40, Nadowli
0302-216970 EXT 5578/6578
Sissala East
Box 107, Tumu
0302-216970 EXT 5579/6579
Sissala West
C/O Box 107, Tumu
0302-216970 EXT 5580/6580
Wa Municipal
Box 587, Wa
0302-216970 EXT 5581/6581
Wa West
C/O Box 587, Wa
0302-216970 EXT 5582/6582
Wa East
C/O Box 587, Wa
0302-216970 EXT 5583/6583
Adaklu Anyigbe
Box Ap 47, Kpetoe
0302-216970 EXT 5644/6644
Akatsi
Box 55, Akatsi
0302-216970 EXT 5584/6584
Ho
Box 47, Ho
0302-216970 EXT 5585/6585
Hohoe
Box 126, Hohoe
0302-216970 EXT 5586/6586
Jasikan
Box 20, Jasikan
Box 50, KadjebiAkan
0302-216970 EXT 5587/6587
Kadjebi
0302-216970 EXT 5588/6588
52
2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region
Volta
Name of scheme
Address/location
Telephone number
Keta
Box Kw, 231
0302-216970 EXT 5589/6589
Ketu
Box De 189, Denu
0302-216970 EXT 5590/6590
Kpando
Box 45, Kpando
0302-216970 EXT 5591/6591
Krachi East
Box11, Damba
0302-216970 EXT 5592/6592
Krachi West
Box 42, Krachie
0302-216970 EXT 5593/6593
Nkwanta
Box 1, Nkwanta
0302-216970 EXT 5594/6594
South Dayi
Box 3, Kpeve
0302-216970 EXT 5595/6595
North Tongu
South Tongu
Box 19, Adidome
Box 46, Sogakope
0302-216970 EXT 5596/6596
0302-216970 EXT 5597/6597
Ahantaman
Box 10, Agona - Ahanta
0302-216970 EXT 5630/6630
Amenfiman
Pmb, Asankragua
0302-216970 EXT 5631/6631
Aowin- Suaman
Box 32, Enchi
0302-216970 EXT 5632/6632
Bia
Western
0302-216970 EXT 5636/6636
Bibiani-Anhwiaso
Box 49, Bibiani
0302-216970 EXT 5633/6633
Jomoro
Box 176, Half - Assini
0302-216970 EXT 5634/6634
Juaboso
Box 1, Juaboso
0302-216970 EXT 5635/6635
Mpohor Wassa East
Box 1008, Daboase
0302-216970 EXT 5637/6637
Nzema East
Box 25, Axim
0302-216970 EXT 5638/6638
Sefwi Wiawso
Box 183, S/Wiaso
0302-216970 EXT 5640/6640
Sekondi
Box Ax 43, Takoradi
0302-216970 EXT 5639/6639
Shama
Box 5, Shama
0302-216970 EXT 5629/6629
Takoradi
Box Ax 43, Takoradi
0302-216970 EXT 6641/7641
Wassa Amenfi East
Box 10, Wasa Akropong
0302-216970 EXT 5628/6628
Wassa West
Box 1, Tarkwa
0302-216970 EXT 5642/6642
53
2010 ANNUAL REPORT
ANNEX 6: Training programs organised in 2010
PROGRAM
NUFFIC
FUNDED
TRAINING
1.
2.
3.
4.
5.
6.
7.
8.
9.
ICT Training All 10 Regions
Introduction to HR Principles
Job Description & constructive Feedback
Performance Appraisal
Fraud Detection & Controls
Knowledge of the Ghanaian Health System
Leadership & Management
Change Management
Master of Public Health (Amsterdam)
Sub Total
OTHER
LOCAL
TRAINING
10. Basic Auditing for Internal Auditors
11. Hardware & Networking Training
12. Public Sector IFRS
13. Making Change Fun & Successful
14. Forensic Auditing
15. Planning Management
16. Training Selection of Consultant Services
and Stores Management
17. Managing HR Records: Files & Records
Generated by HR Function
18. Training Selection of Consultants’ Services
19. Computer Based Auditing Management
20. Training on Stores Inventory Management
21. Fraud Detection. Prevention & Controls
22. Efficiency & Effectiveness in Government
Expenditure
Sub Total
EXTERNAL
TRAINING
23. Result-Based Management: Performance
Indicators
24. Public Procurement Management
25. Financial & Budgetary Management of
Projects & Organizations
26. Improving the Quality of Health Services
27. ITIL
28. Strengthening Human Resource for Health
29. Public –Private Investment Partnerships:
Innovations & Efficiency in Health
Systems
30. Health Insurance (Quality, Provider
Management, ICT & Contracting
31. Health Insurance Portability &
Accountability
32. White Collar Crime
33. Procurement Auditing
34. Conflict Prevention
NO.
95
5
6
16
6
12
16
5
1
158
3
6
2
23
2
2
6
2
3
2
2
1
2
6
1
61
1
1
1
3
2
1
2
2
1
2
1
1
54
2010 ANNUAL REPORT
35. Company Secretary & Corporate Advisors
Course
36. Combating Corruption & Developing
Organizational Integrity
37. Advanced Audit Skills
38. International Ministerial Conference on
Health System Financing
39. First Global Symposium on Health
Research
40. Capitalizing on the Strategic Shift &
Elevation of the Human Resource
Component
41. Strategic Planning, Budgeting &
Forecasting Training Workshop
42. 2nd Financial Management Conference
Optimizing Public & Private Sector
Financial Performance
43. Strategic Skills Development for Africa
Conference
44. Joint Learning for Universal Coverage
Workshop on Provider Payment Systems
45. Financial Access to Healthcare for the Poor
46. Strategic HR Africa Forum Kenya
47. African Healthcare Management
Conference
48. Financial Modeling & Reporting
49. Health Sector Reform & Sustainable
Financing
Sub Total
GRAND TOTAL
1
2
1
1
2
2
1
2
2
1
2
2
1
2
3
2
1
45
266
55