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 i 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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LIST OF ACRONYMS
1TP One-Time Premium Act 650 National Health Insurance Act, 2003 (Act 650) AMFm Affordable Medicine Facility – Malaria CHAG Christian Health Association of Ghana CPC Claims Processing Centre DCEs Deputy Chief Executive DMHIS District Mutual Health Insurance Scheme DVLA Driver and Vehicle Licensing Authority G-DRG Ghana Diagnostic Related Grouping GH¢ Ghana Cedis GHS Ghana Health Services GMA Ghana Medical Association HIP Health Insurance Project ICT Information Communication Technology IPD In-Patient Department LEAP Livelihood Empowerment Against Poverty LPM Live Presenter Mention M&E Monitoring & Evaluation MDAs Ministries, Departments and Agencies MDGs Millennium Development Goals MOH Ministry of Health NGOs Non Governmental Organisations NHIA National Health Insurance Authority NHIL National Health Insurance Levy NHIS National Health Insurance Scheme OPD Out Patient Department PDAs Personal Digital Assistance PRMs Provider Relationship Managers PRO Public Relations Officer PW Pregnant women RAC Risk Assessment Committee R&D Research and Development SCAD Strategy and Corporate Affairs Division SSNIT Social Security and National Insurance Trust UNDP United Nations Development Programme WHO World Health Organization
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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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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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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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EXECUTIVE MANAGEMENT
Mr. Sylvester A. Mensah Chief Executive Mr. Nathaniel Otoo Director, Admin. & General Counsel Dr. Nicholas A. Tweneboa Director, Operations Mr. O. B. Acheampong Director, Research & Development Dr. Gustav Cruickshank Chief Internal Auditor Mr. Ben Kusi Director, ICT Mr. Ahmed Imoro Ag. Director, Finance Dr. Lydia Dsane-Selby Ag. Director, Clinical Audit Mr. Perry Nelson Ag. Director, Claims Mr. Winfred Agbeibor Ag. Director Strategy & Corporate Affairs Mr. Francis-Xavier Andoh-Adjei Deputy Director, Strategy Mr. Eric Ametor-Quarmyne Deputy Director, Corporate Affairs Dr. Francis Mensah Asenso-Boadi Deputy Director, Research & Development Mr. Rudolf Zimmermann Deputy Director, Finance Mr. Anthony Gingong Deputy Director, Operations Mrs. Adelaide Bunatal Deputy Director, Claims Ms. Mary Owusu Deputy Director, Human Resource Mr. Ben Yankah Deputy Director, Actuary Mr. Sam Buabasah Deputy Director, Procurement & Projects Mrs. Aimee Yuori Deputy Director, Legal (Council Secretary)
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SSYYLLVVEESSTTEERR AA.. MMEENNSSAAHH,,, CCHHIIEEFF EEXXEECCUUTTIIVVEE,,, NNHHIIAA...
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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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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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 (MBA- Finance) 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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(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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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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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
10 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. Deploying the CPC to its full capacity with the introduction of all software and equipment. 2. Addressing the low claims management capacity outside the CPC operation/ coverage. 3. Strengthening the poor gatekeeper system. 4. Enforcing the MOH’s Medicine prescribing levels. 5. 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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The following projects would be undertaken:
1) Complete and relocate into the new Head Office Premises. 2) Re-locate data centre from STL to NHIA head quarters premises. 3) Develop & maintain Data Recovery Site within STL for at least 12 months. 4) Construct ten (10) new regional offices. 5) 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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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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Figure 1: NHIS Value chain
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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. To mobilise 100% of the required funds by the end of 2014. 2. To increase efficiency in the financial operations of the scheme. 3. To increase active membership to 60% of the population by 2014. 4. To increase coverage of the vulnerable including the poor and the indigent to 70% by 2014. 5. To provide support to increase access to quality basic health care services in all districts. 6. To strengthen governance systems and improve human resource capacity. 7. 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
15 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 2008 2009 2010
Old 1,348,160 2,521,372 6,643,371 9,914,256 10,638,119 N/A
New N/A N/A N/A N/A 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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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 2010 Region New Members Renewals Active Members Ashanti 606,349 978,748 1,585,097 Brong Ahafo 323,092 691,462 1,014,554 Central 303,592 189,125 492,717 Eastern 316,861 613,482 930,343 Greater Accra 492,443 469,012 961,455 Northern 349,899 421,436 771,335 Upper East 238,935 278,932 517,867 Upper West 158,911 202,154 361,065 Volta 263,050 318,255 581,305 Western 466,458 481,518 947,976 Ghana 3,519,590 4,644,124 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% 30% 28% 23% 25%
20%
10%
0% Ashanti Brong Central Eastern Greater Northern Upper Upper Volta Western Ahafo Accra East West
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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) Under 18 years 31.8% 47.7%
Pregnant women 8.6% SSNIT pensioners 70 years & 0.4% above SSNIT Indigents 5.4% contributors 1.4% 4.7%
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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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. Regional breakdown of members registered during the exercise is shown in table 3 below.
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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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
Total (National) 3,950,502 3,450,822 499,680
20 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 16,000,000
14,000,000
12,000,000
10,000,000 9,339,296
8,000,000
6,000,000 4,648,119 4,000,000 2,434,008 2,000,000 597,859 0 2005 2006 2007 2008 2009 2010
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.
21 2010 ANNUAL REPORT
Figure 5: Inpatient Utilization Trend 1,000,000 973,524
900,000
800,000 724,440 700,000 627,795 600,000
500,000
400,000 303,930 300,000
200,000 135,221 100,000 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
50.00 35.48 7.60 0.00 2005 2006 2007 2008 2009 2010 22 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.
23 2010 ANNUAL REPORT
Table 5: Accreditation results SUMMARY OF NHIA ACCREDITED FACILITIES AS AT DECEMBER 2010 FACILITIES 1ST 2ND 3RD FACILITIES 1ST 2ND 3RD BY TYPES BATCH BATCH BATCH TOTAL BY GRADE BATCH BATCH BATCH TOTAL CHEMICAL SHOPS 50 69 60 178 GRADE A+ 2 4 0 6 CHPS ZONE 74 343 308 714 GRADE A 21 35 19 75 CLINICS 82 107 58 255 GRADE B 86 267 151 507 DENTAL CLINIC 0 0 2 3 GRADE C 139 536 380 1066 DIAGNOSTIC CENTRES 0 13 6 19 GRADE D 278 330 279 887 EYE CLINIC 0 3 3 6 PROVISIONAL 48 52 20 106 HEALTH CENTRES 73 347 242 658 TOTAL 574 1224 849 2647 LABORATORIES 22 21 15 59 MATERNITY HOMES 120 58 22 198 PHARMACIES 76 94 65 238 FACILITIES BY 1ST 2ND 3RD POLYCLINICS 1 9 2 12 REGIONS BATCH BATCH BATCH TOTAL PRIMARY HOSPITALS 58 150 54 267 ASHANTI 138 268 50 456 BRONG PYHSIOTHERAPY 0 0 0 0 AHAFO 45 99 138 282 SECONDARY HOSPITAL 4 3 2 9 CENTRAL 107 82 28 217 TERTIARY HOSPITAL 0 1 0 1 EASTERN 86 181 91 358 GREATER ULTRASOUND 14 6 10 30 ACCRA 64 126 98 288 TOTAL 574 1224 849 2647 NORTHERN 27 161 83 271 UPPER EAST 38 77 40 155 FACILITY BY 1ST 2ND 3RD OWNERSHIP BATCH BATCH BATCH TOTAL UPPER WEST 1 31 102 134 GOVERNMENT 167 741 564 1460 VOLTA 22 89 83 194 MISSION 11 106 29 149 WESTERN 46 110 136 292 PRIVATE 395 367 250 1022 TOTAL 574 1224 849 2647 QUASI GOVERNMENT 1 10 6 16 TOTAL 574 1224 849 2,647
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.
24 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.
25 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 Participants at NHIA stand Directors at the fair
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.
27 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.
29 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.
30 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.
31 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.
32 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.
33 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, quasi- government 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 ¢ GH ¢ Levies 401,848,524.08 329,459,128.92 Investment Income 58,708,664.99 75,638,686.50 Other Income 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
Deficit Transferred to Accumulated Fund (47,259,940.11) (19,546,564.58)
NATIONAL HEALTH INSURANCE AUTHORITY (NHIA) ACCUMULATED FUND FOR THE YEAR ENDED 31ST DECEMBER, 2010 2010 2009 GH ¢ GH ¢ Balance b/f 443,263,968.13 462,495,574.80
Prior Year Adjustment 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 2010 2009 Fixed Asset GH ¢ GH ¢ Property, Plant and Equipment 48,011,901.46 35,943,972.47 Investments 284,487,882.28 437,818,825.16 332,499,783.74 473,762,797.63 Current Assets Interest Receivable 15,902,358.94 37,528,128.94 NHIL Receivable 179,207,690.75 63,612,196.55 Other Receivable 1,330,417.37 906,445.95 Bank and cash 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 Accured Support to Partner Institutions 23,973,822.18 23,417,000.00
Other Accounts Payables 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
41 2010 ANNUAL REPORT
NATIONAL HEALTH INSURANCE AUTHORITY (NHIA) CASH FLOW STATEMENT FOR THE YEAR ENDED 31ST DECEMBER, 2010 2010 2009 Cashflow from Operating Activities GH ¢ GH ¢ Deficit (47,259,940.11) (32,518,697.37) Add Depreciation 9,286,605.74 449,813.94 Increase in Receivables (94,393,695.62) 55,883,103.27 Increase Payables 8,183,963.80 133,179,199.24 Decrease in Premium Deposits - 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
43 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
# NAME DIVISION POSITION 1 Amadu Ali Claims Claims Manager 2 Collins Danso Akuamoah Strategy & Corporate Affairs Strategy Manager 3 Daniel K. Amekudzi Admin & Gen. Counsel HR Manager -Talent & Recruitment 4 Diana Oye Ahene (Ms.) Admin. / CE's Secretariat Personal Assistant to CE 5 Abena Agyeiwaa Amoako (Dr.) Operations Provider Relations Manager 6 Edward Buckman ICT Information Systems Manager 7 Francis Sampana Zuure Internal Audit Audit Senior 8 George Omaboe Internal Audit Audit Manager 9 George Asamoah Baah Finance Finance Manager 10 George G. Amoo Clinical Audit Clinical Audit Manager 11 Iddrisu Hudu Claims Claims Manager 12 Isaac Marful Dapaah ICT ICT Applications Manager 13 Ismail Osei Clinical Audit Clinical Nurse 14 Maxwell Addico Internal Audit I.T. Auditor 15 Constance Addo-Quaye Adjetey Clinical Audit Pharmacist (Mrs) 16 Nicholas Afram Osei Claims Senior Claims Manager 17 Nii Anang Adjetey (Dr.) Strategy & Corporate Affairs Communications Manager 18 Prince Debrah Internal Audit Audit Manager 19 Rebecca Akatue (Mrs.) Operations Operations Manager 20 Stella Adu-Amankwa (Mrs.) Strategy & Corporate Affairs Publications Manager 21 Stephen N. Bewong Claims Business Systems Manager 22 Thomas Adoboe ICT IT Infrastructure Manager 23 Vivian Addo-Cobbiah (Mrs.) Operations Accreditation & Quality Manager 24 Washington Komla Darke Finance Fund Manager 25 William Sabi Operations Operations Manager
45 2010 ANNUAL REPORT
ANNEX 4: Regional Managers
# NAME REGION 1 Afrifa Yamoah Ponko Ashanti 2 Foster Agyei-Korang Brong Ahafo 3 Francis Asante Mensah Western 4 James Mettle Central 5 John Bosco Zury Upper West 6 Lawrence Amartey Greater Accra 7 Nester Akototse Volta 8 Rashid Tanko Northern 9 Roger Aposs Upper East 10 Windham Emil Afram 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 0302-216970 EXT 5513/6513 Box 9, Mankranso - 0302-216970 EXT Ahafo - Ano South Ashanti 5514/6514
Amansie Central Box 7 Jacobu 0302-216970 EXT 5515/6515 Box 350, Bekwai - Amansie East Ashanti 0302-216970 EXT 5516/6516
Amansie West Box 1, Manso Nkwanta 0302-216970 EXT 5517/6517
Asante Akim North Box 214, Konongo 0302-216970 EXT 5518/5518 Ashanti Asante Akim South Box 12, Juaso 0302-216970 EXT 5519/6519
Asokwa Sub - Metro Box 1916, Kumasi 0302-216970 EXT 5520/6520 Box 17, Nkawie - Atwima Nwabiagya Ashanti 0302-216970 EXT 5521/6521
Atwima Mponoa 0302-216970 EXT 5522/6522 Box Kj- 508,Kejetia - Bantama Sub - Metro Kumasi 0302-216970 EXT 5523/6523 Bosomtwe - Atwima- Kwanwoma 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
47 2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region Name of scheme Address/location Telephone number
Obuasi Municipal Box 32,Obuasi 0302-216970 EXT 5529/6529
Offinsoman Box 281, Offinso 0302-216970 EXT 5530/6530 Box 360, Mampong - Ashanti Sekyere West Ash 0302-216970 EXT 5532/6531 Sekyere East – Effiduase Box 302, Effiduase 0302-216970 EXT 5532/6532 Box Kj - 509, Kejetia - Subin Sub - Metro 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
Brong Ahafo 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 0302-216970 EXT 5546/6546 0302-216970 EXT Sunyani Municipal Box 2640, Sunyani 5547/6547
Tain Box 2, Nsawkaw 0302-216970 EXT 5548/6548
48 2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region 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 Brong Ahafo Techiman Municipal Box 522, Techiman 0302-216970 EXT 5551/6552
Wenchi Box 75, Wenchi 0302-216970 EXT 5552/6552 Abura-Asebu- Kwamankese C/O District Assembly 0302-216970 EXT 5615/6615
Agona Box 595, Swedru 0302-216970 EXT 5616/6616
Ajumako Enyan Box 1, Ajumako 0302-216970 EXT 5617/6617 Asikuma Odoben Brakwa Box 36, B, Asie 0302-216970 EXT 5618/6618
Assin North Box 102, Foso 0302-216970 EXT 5619/6619 Box 18,Nsuaem- Assin South Kyekyeware 0302-216970 EXT 5620/6620 Central Awutu - Effutu – Senya Box 1, Winneba 0302-216970 EXT 5621/6621
Oguaman – Capecoast C/O District Assembly 0302-216970 EXT 5622/6622
Gomoaman Box Ap 162, Apam 0302-216970 EXT 5623/6623 Komenda-Edina- Box 29, Eguafo-Abirem Elimina0243167295 0302-216970 EXT 5624/6624
Mfantsiman Box 28, Saltpond 0302-216970 EXT 5625/6625 Twifo Hemang Lower Denkyira 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
Eastern Akuapem North Box 154, Nsawam 0302-216970 EXT 5599/6599
Akuapem South Box Nw 602, Nsawam 0302-216970 EXT 5600/6600
49 2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region 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 Box 114, Kade 0302-216970 EXT 5607/6607 Eastern Box 266, Odumasi Manya Krobo Krobo 0302-216970 EXT 5608/6608
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 Greater Accra 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
50 2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES
Name of Region 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 Greater Accra 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 0302-216970 EXT 5559/6559 Nanumba Box 1, Bimbilla 0302-216970 EXT 5560/6560 Nanumba South Box 1, Wulensi 0302-216970 EXT 6561/7561 Northern 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 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 Upper East 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 Upper West 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 Volta Hohoe Box 126, Hohoe 0302-216970 EXT 5586/6586 Jasikan Box 20, Jasikan 0302-216970 EXT 5587/6587 Box 50, Kadjebi- Kadjebi Akan 0302-216970 EXT 5588/6588
52 2010 ANNUAL REPORT
DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES Name of Region 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 Volta 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 Box 19, Adidome 0302-216970 EXT 5596/6596 South Tongu Box 46, Sogakope 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 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 Western 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 NO.
NUFFIC 1. ICT Training All 10 Regions 95 FUNDED 2. Introduction to HR Principles 5 TRAINING 3. Job Description & constructive Feedback 6 4. Performance Appraisal 16 5. Fraud Detection & Controls 6 6. Knowledge of the Ghanaian Health System 12 7. Leadership & Management 8. Change Management 16 9. Master of Public Health (Amsterdam) 5 1 Sub Total 158 OTHER 10. Basic Auditing for Internal Auditors 3 LOCAL 11. Hardware & Networking Training 6 TRAINING 12. Public Sector IFRS 2 13. Making Change Fun & Successful 23 14. Forensic Auditing 2 2 15. Planning Management
16. Training Selection of Consultant Services 6 and Stores Management 17. Managing HR Records: Files & Records 2 Generated by HR Function 18. Training Selection of Consultants’ Services 3 19. Computer Based Auditing Management 2 20. Training on Stores Inventory Management 2 21. Fraud Detection. Prevention & Controls 1 22. Efficiency & Effectiveness in Government 2 Expenditure 6 1
61 Sub Total EXTERNAL 23. Result-Based Management: Performance 1 TRAINING Indicators 24. Public Procurement Management 1 25. Financial & Budgetary Management of 1 Projects & Organizations 26. Improving the Quality of Health Services 3 27. ITIL 2 28. Strengthening Human Resource for Health 1 29. Public –Private Investment Partnerships: 2 Innovations & Efficiency in Health Systems 30. Health Insurance (Quality, Provider 2 Management, ICT & Contracting 31. Health Insurance Portability & 1 Accountability 32. White Collar Crime 2 33. Procurement Auditing 1 34. Conflict Prevention 1
54 2010 ANNUAL REPORT
35. Company Secretary & Corporate Advisors 1 Course 36. Combating Corruption & Developing 2 Organizational Integrity 1 37. Advanced Audit Skills 1 38. International Ministerial Conference on Health System Financing 2 39. First Global Symposium on Health Research 2 40. Capitalizing on the Strategic Shift & Elevation of the Human Resource 1 Component 41. Strategic Planning, Budgeting & 2 Forecasting Training Workshop 42. 2nd Financial Management Conference Optimizing Public & Private Sector 2 Financial Performance 43. Strategic Skills Development for Africa 1 Conference 44. Joint Learning for Universal Coverage 2 Workshop on Provider Payment Systems 45. Financial Access to Healthcare for the Poor 2 46. Strategic HR Africa Forum Kenya 1 47. African Healthcare Management 2 Conference 3 48. Financial Modeling & Reporting 2 49. Health Sector Reform & Sustainable 1 Financing
Sub Total 45
GRAND TOTAL 266
55