NATIONAL HEALTH INSURANCE AUTHORITY 2009 ANNUAL REPORT

Y T I R O H T U A

E C N A R U S N I

H T L A E H

L A N O I T A N

ANNUAL REPORT 2009 1 Minister for Health (Hon. Dr. Benjamin Kunbuor)

2 TABLE OF CONTENTS

VISION AND MISSION STATEMENTS...... THE NATIONAL HEALTH INSURANCE COUNCIL (BOARD OF DIRECTORS) ...... MANAGEMENT TEAM ...... PROFILE OF DIRECTORS...... 2009 CHAIRMAN'S REPORT...... ANNUAL REPORT OF THE CHIEF EXECUTIVE ...... REPORT 2009 ANNUAL REPORT...... 1.0 SIGNIFICANT EVENTS AND INITIATIVES......

1.1 Introduction ...... Y

...... T 1.2 Appointment of new Council and Chief Executive I

1.3 Strategic seminar...... R

1.4 Audit...... O

1.5 Collaboration with stakeholders...... H 1.6 Press soiree ...... T 1.7 Legislative review...... U A 1.8 One -Time Premium Payment ...... 1.9. Revamping of Information Communications and Technology (ICT)...... E C N ...... 2.0 OPERATIONAL RESULTS A

2.1 Membership registration ...... R

2.1.1 Registration trends...... U 2.1.2 Registration by region ...... S N

2.1.3 Registration by categories...... I

2.2 ID card issuance...... H

2.3 Outpatient services utilization ...... T L 2.4 Inpatient services utilization (2009)...... A

2.5 Claims payment ...... E

2.6 Accreditation...... H

2.6.1 Collaboration...... L A

3.0 SOURCES OF FUNDING...... N O I

4.0 REGIONAL OFFICE OPERATIONS...... T 4.1 Key findings...... A N

5.0 DISTRICT SCHEME OPERATIONS...... 5.1 Key issues identified at district scheme level......

6.0 SPECIAL PROJECTS, PROGRAMMES AND INITIATIVES...... 6.1 Marketing of NHIS by celebrities, organizations and individuals......

7.0 WAY FORWARD......

8.0 CONCLUSION ......

NHIA FINANCIAL STATEMENT (UNAUDITED)...... MINIMUM HEALTH CARE PACKAGE UNDER NHIS...... DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES

3 Chief Executive, NHIA Sylvester A. Mensah

4 VISION AND MISSION STATEMENTS

2009 VISION ANNUAL REPORT To be a model of a sustainable and equitable social health insurance scheme in Africa and beyond.

Y T I R O H

MISSION T U A

To provide financial risk protection against the cost of basic/ standard quality healthcare for all residents in , and to delight our E subscribers and stakeholders with an enthusiastic, motivated, and C N

empathetic professional staff who share the values of honesty and A accountability in partnership with all stakeholders. R U S N I

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5 THE NATIONAL HEALTH INSURANCE COUNCIL (BOARD OF DIRECTORS)

st 2009 1. Hon. Doe Adjaho (1 Dep. Speaker of Parliament) - Chairman ANNUAL REPORT 2. Hon. Dr. Benjamin Kunbuor (Dep. Min. of Health) - Member

3. Mr. Sylvester A. Mensah - Chief Executive Y T I R 4. Dr. Elias Sory - Member O H T

5. Dr. Stephen Ayidiya - Member U A

E

6. Mr. Samuel Akwei - Member C N A

7. Mrs. Czarina Baeta Ribeiro - Member R U S

8. Dr. J. K. Kwakye-Maafo (Nana Ohemeng Awere V) - Member N I

H T

9. Dr. Steve Ahiawordor - Member L A E

10. Mr. Kwame Owusu-Bonsu - Member H

L A

11. Dr. Mercy Bannerman - Member N O I 12. Mrs. Nyamikeh Kyiamah - Member T A N 13. Mr. Kofi Asamoah - Member

6 COUNCIL SECRETARY: 2009 ANNUAL REPORT MRS. AIMEE YUORI

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H REGISTERED OFFICE: T U A

CDH HOUSE, RIDGE, E C N A R U S N

I AUDITORS:

H T

L ERNST AND YOUNG, CHARTERED A

E (ACCOUNTANTS) H

L A N O I T

A BANKERS: N GHANA COMMERCIAL BANK LTD ECOBANK GHANA LTD, AMONG OTHERS

7 MANAGEMENT TEAM

1. Mr. Sylvester A. Mensah - Chief Executive

2. Mr. Nathaniel Otoo - Director, Admin. & General Counsel 2009 ANNUAL 3. Dr. Nicholas A. Tweneboa - Director, Operations REPORT

4. Mr. O. B. Acheampong - Director, Research & Development

Y T 5. Dr. Gustav Cruickshank - Chief Internal Auditor I R O

6. Mr. Ben Kusi - Director, ICT H T U A 7. Mr. Ahmed Imoro - Ag. Director, Finance E C

8. Dr. Lydia Dsane-Selby - Ag. Director, Clinical Audit N A R U

9. Mr. Sam Buabasah - Ag. Director, Procurement & Projects S N I

10. Mr. Francis-Xavier Andoh- Adjei - Deputy Director, Operations H T L

11. Mr. Eric Ametor –Quarmyne - Deputy Dir. Strategy & Corp. Affairs A E H

12. Dr. Francis Asenso-Boadi - Deputy Director, Research & Development L A N

13. Mr. Rudolf Zimmermann - Deputy Director, Finance O I T A

14. Mr. Anthony Gingong - Deputy Director, Operations N

15. Mrs. Adelaide Bunatal - Deputy Director, Claims

16. Ms Mary Owusu - Deputy Director, Human Resource

17. Mr. Ben Yankah - Deputy Director, Actuary

8 PROFILE OF DIRECTORS

NATHANIEL OTOO, DIRECTOR, ADMINISTRATION AND 2009 GENERAL COUNSEL ANNUAL Mr. Otoo has 19 years work experience spanning both the public and REPORT 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

Y Projects Cordinator at Promasidor Ghana Limited. T I R

O A Lawyer by profession, Mr. Nathaniel Otoo completed his Professional H Law Studies in 1988 after obtaining a Bachelor's degree in law from the University of Ghana. He T

U also holds a Master of Arts Degree in International Relations from the International University of A

Japan, and has undertaken a Professional Training Course in Marketing and Management under E the auspices of the Carl Duisberg Gesellschaft of Germany. He has participated in various health C

N leadership courses. A R U S N I

H T

L DR NICHOLAS A. TWENEBOA, DIRECTOR, OPERATIONS. A

E With over thirty years working experience spanning several fields, H particularly in the practice of medicine and in management, Dr Nicholas L

A Tweneboa has over the years gained deep insight into the health sector,

N having worked in management capacity in several organizations and O

I hospitals in the public, private and quasi-public sub-sectors. He has T facilitated many workshops and undertaken consultancy services in A

N 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.

9 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 2009 developed and managed drug formularies. ANNUAL REPORT 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 Y

studied at Brown University where he obtained a Bachelor of Arts degree in Urban T I

Studies/Planning and Yale School of Management. R O H T U A AHMED IMORO, ACTING DIRECTOR, FINANCE E C

Mr. Ahmed Imoro joined the Controller and Accountant General N

Department in 1995 and was seconded to National Health Insurance A R

Authority as Principal Accountant in 2005. He was later appointed the U

substantive Deputy Director of Finance and has since 2006 been the S N I

Acting Director of Finance. H T

Mr. Ahmed Imoro has a Masters Degree in Business Administration L

(MBA- Finance) and a Bachelors degree in Business Administration A E (Accounting and Finance) from European University of Lefke. H

L A N O I

BEN KUSI, DIRECTOR, ICT T A N 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.

10 DR LYDIA DSANE-SELBY, AG. DIRECTOR, CLINICAL AUDIT

A Medical Doctor by profession, Dr. Lydia Dsane-Selby worked as Medical Officer at Korle-Bu Teaching Hospital, Achimota Hospital and 2009 in the UK prior to taking appointment at the NHIA, ANNUAL REPORT 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 . She is an ICT Trained Microsoft Certified Professional.

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A DR. GUSTAV G.L. CRUICKSHANK, CHIEF INTERNAL AUDITOR R U

S Prior to his present appointment, Dr. Gustav G.L Cruickshank was a N

I lecturer in MBA, MSc and BSc degree programs in various institutions in

the UK. He also worked with organizations such as Arthur Andersen H

T representative office, Intercontinental Bank, LCBM (UK), Gabem Group L

A (UK), Zenith Aegis Ltd (UK and Ghana). He has over fifteen years E international experience in management consultancy, accounting, H

L finance, auditing and operations and strategic planning. A

N Dr. Gustav Cruickshank is a Chartered Accountant and has an MBA in Finance and PhD in Strategic O

I Management. He is a Fellow of the Association of Chartered Certified Accountants, UK (FCCA), T

A the Institute of Financial Accountants UK (FFA), the Institute of Business Consultancy UK (FIBC), a

N member of the Institute of Chartered Accountants, Ghana (ICAG) and the Institute of Internal Auditors (IIA).

11 SAM BUABASAH, AG. DIRECTOR, PROCUREMENT AND PROJECTS

Mr. Buabasah joined the NHIA in 2009. Prior to his present appointment, he worked with Volta Aluminum Company Limited (VALCO) as Assistant Procurement Manager and later as Materials and 2009 Distribution Manager at Coca Cola Bottling, Procurement Manager at ANNUAL British American Tobacco, Head of Procurement at Guinness Ghana REPORT Breweries and Group Head of Procurement at Ecobank E- Process

(Ecobank Group).

Mr. Sam Buabasah is a graduate from the University of Ghana Business School with a Bachelor of Y T Science Degree in Administration (Marketing Option). He also holds Diploma in Shipping I R

Management, Clearing & Forwarding and Expert Management. He is a member of the Chartered O

Institute of Purchasing and Supply (MCIPS) UK. H T U A

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12 CHAIRMAN'S REPORT

On June 15, 2009, the current Council, which is the governing body of the National Health Insurance Authority (NHIA), was sworn into office to steer the affairs of the NHIA and for that matter the National Health Insurance Scheme (NHIS). We therefore deem it appropriate to share 2009 with stakeholders the performance of the NHIA and the NHIS, especially as regards the situation ANNUAL we found it in when we assumed office, what we have done to date and where we intend to take REPORT the NHIS in the future.

The Council took office with some challenges. There were huge outstanding arrears of income to

be received from the Ministry of Finance and Economic Planning running into hundreds of Y

T millions of Ghana Cedis. So also were arrears of claims to be paid to accredited health service I

R providers.

O Also significant was fraud and abuse in the system. Some District Mutual Health Insurance H

T Scheme (DMHIS) officials and health service providers took advantage of the weak internal

U control measures in place and outsmarted the system, resulting in huge financial loss to the NHIS. A The situation naturally called for measures to make the NHIS more efficient and sustainable. The E

C following outlines some of the measures taken and other achievements in 2009: N

A INDEBTEDNESS R

U Our first task was to clear the claims arrears of 2008 in addition to settling claims submitted in S

N 2009. This bold step provided relief for our cherished health service providers to continue to I

provide healthcare services to our subscribers. H T L AUDIT A E

H To instill sanity in the operations of the DMHIS, intensive financial and clinical audits were

L embarked upon across the country. DMHIS officials who were found to have embezzled funds A

N were duly sanctioned. Some health service providers were also suspended from providing

O service to NHIS subscribers, for various lapses. I T

A LEGISLATIVE REVIEW N The current law on the NHIS has been found to have implementation challenges and partly accounts for most of the challenges facing the NHIS. A legislative review process was set in motion to correct some of the implementation bottlenecks in the system.

13 ENROLMENT

The year 2009 witnessed a remarkable improvement in enrolment following intensive public education embarked upon by the DMHIS across the country. Enrolment increased from 12.5million (about 55% coverage) in 2008 to about 14.5 million in 2009 representing about 62% of the population (using 2009 population estimate). The high patronage to the NHIS attests to the 2009 fact that Ghanaians have embraced the NHIS as the preferred health care financing mechanism. ANNUAL INVESTMENTS REPORT

The Council instituted measures to ensure that reserve funds were invested in profitable

ventures to yield maximum returns, and in accordance with the approved investment policy of Y T the NHIA. Investment income increased from 11.78% of total NHIS funding sources in 2008 to I 17% in 2009. R O H OUTLOOK FOR 2010 T U A It is the expectation of Council that a new law regulating the implementation of the NHIS would E come into being by the close of 2010. Additionally, Council would steer the operations of the C NHIA and provide a sense of direction for the NHIA / NHIS. A new Strategic Plan for 2010-2014 is N A

being developed. R U

The Council will continue to pursue aggressive programmes to reduce administrative costs and S N I improve efficiency through organizational restructuring. The ongoing clinical and financial audits would be sustained to minimize fraud and abuse in the system and make the NHIS sustainable. H T L A

ACKNOWLEDGEMENTS E H

I sincerely thank my colleague Council Members for their dedication and commitment to L A

ensuring that we succeed. On some weekends and other public holidays we have had to hold N O

meetings to deliberate on pressing issues affecting the work of the NHIA and the success of the I

NHIS. I am indebted to them for this high level of cooperation. I also congratulate the T A

management and staff of the NHIA and the DMHIS for their hard work which contributed to these N remarkable achievements during the year under review. I deeply appreciate their dedication and commitment to the continued success of the NHIS.

14 On behalf of the Council, I wish to express my gratitude to all stakeholders of the NHIS for their support and goodwill which have been invaluable to our work.

Thank you. 2009 ANNUAL REPORT

Y T I Hon. Doe Adjaho R Council Chairman, NHIA O H T U A

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H T L A E H

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15 REPORT OF THE CHIEF EXECUTIVE

INTRODUCTION

The National Health Insurance Scheme (NHIS) was established in 2003 to provide financial access to healthcare services. Currently, 145 District Mutual Health Insurance Schemes are operating 2009 across the country. Ten regional offices have been set up to supervise and monitor operations of ANNUAL the district schemes. REPORT

The scheme has a cumulative membership base of 14,511,777 representing 62% of the estimated st national population as of 31 December 2009. 1,930 health facilities had been accredited to Y

provide services to insured members. The total volume of claims for in-patient and out-patient T I

visits was 17,603,216 and GH¢308.15m had been paid in respect of claims. R O

NEW DEVELOPMENTS AND RESTRUCTURING H T

Events following my assumption of office as the Acting Chief Executive of the National Health U A Insurance Authority (NHIA) in mid June 2009 and leading up to the end of 2009 have been both E

challenging and encouraging. The new management team embarked on a transformation C programme to reposition the NHIA in order to sustain the operations of the scheme. Some of the N areas that went through restructuring include the following: A R U

Internal Audit S N I Towards the end of the year 2009, the Internal Audit Unit was restructured to re-position it to H

inject more efficiency into the financial operations of the scheme. A new Chief Internal Auditor T was appointed and an audit plan for the year 2010 was developed. The 2010 Audit Plan was L A programmed to cover all district schemes as well as divisions, departments and units within the E H

Authority. Also in the programme was regular conduct of investigations into matters of fraud, and the management and use of ICT and to ensure compliance with laws, regulations and directives L A

relevant to the operations of the NHIA. N O I

Claims Processing and Management Centre T A

To deal with competency gaps in claims management at the scheme level, NHIA initiated a process N for the setting up of a Claims Processing Centre to vet claims from Teaching and Regional Hospitals across the country.

16 Procurement and Projects

Procurement and Projects division was created in October 2009 to speed up our operations and enhance service delivery to our internal stakeholders. Apart from the procurement of goods and services for the Authority and the schemes, the division is handling the construction of the head 2009 office building, which is near completion. The division has also initiated the process towards the ANNUAL construction of ten (10) regional offices in the regional capitals to strengthen regional REPORT administration of the Authority.

Strategy & Corporate Affairs

Y The Corporate Affairs unit was renamed Strategy and Corporate Affairs Division and upgraded to T I a Division to provide strategic direction to the operations of NHIS/NHIA and also to address the R

O communication gaps between the Authority and stakeholders. The division is also tasked to

H effectively market NHIS to the general public. T U

A Human Resources

E

C In November 2009, the Human Resource Department was created within the Administration

N and Legal Directorate and a substantive Director recruited to head the department. The A

R department is tasked to provide support for the recruitment of talents both within the NHIA and

U the schemes and to strategically manage and develop the human resource required for the S effective running of the NHIS. The Human Resource Department worked to beef up the human N I resource capacity both at the NHIA and the schemes. H T

L One-Time Premium Payment A E The government has stated its commitment to assuring unhindered financial access to H

L healthcare for residents of the country through a One-Time Premium Payment. A roadmap

A towards the implementation of the One-Time Premium has been developed in anticipation of N the passage of the new bill into law. O I T Outlook A N Government's intention of introducing One-Time Premium Payment would require financial discipline, optimal use of resources, and possible additional funding sources. To make the Scheme more efficient and sustainable, NHIA will rigorously pursue the following cost containment Strategies in 2010:

Pilot Capitation Payment system for primary level healthcare.

Operationalise the Central Claims Processing Unit.

17 * Intensify clinical and financial audits both at scheme and provider level. * Introduce a uniform NHIS Prescription Form with unique prescriber identification number. 2009 * Enforce prescribing levels as stipulated in the Essential Medicines List (EML) of the ANNUAL Ministry of Health (MOH). REPORT

Strengthen the Gatekeeper System. * Y T

Introduce a centralized consolidated premium account. I

* R O

Strengthen collaboration with stakeholders. H

* T

Other projects and initiatives to be pursued include the following: U A

E

Completion of the new NHIA Head Office complex to accommodate staff. C

* N A

Collaborate with the Ministry of Employment and Social R

* U Welfare on implementation of Livelihood Empowerment Against Poverty S

(LEAP) program. N I

H

Review the Ghana Diagnostic Related Groupings (G-DRGs) and its impact on T * L NHIS in terms of sustainability and quality of care. A E H

Link treatment to diagnosis in the common ICT platform. L

* A Develop tools for rational use of medicines (prescription analysis, N O

* I

indicators for rational use of medicines). T A

Support DMHIS to increase coverage to 70% of Ghana's population N * by Dec 31, 2010 (current population figures).

Promote uniform procedures within districts through training and effective * ID card distribution.

Promote quality of care through accreditation of at least 2,000 facilities and * monitoring of facilities. * Strengthen the relationship between the Authority and the provider community.

18 CONCLUSION

As we begin a new phase in the development of the Scheme, it is imperative that every stakeholder demonstrates enough commitment and passion needed to re-craft the image of the 2009 scheme. The ongoing reforms in NHIS call for strategic thinking, benchmarking best practices, ANNUAL team work and excellent working relations, efficient use of resources, sacrifice and REPORT 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

Y residents in Ghana with highly motivated professionals who value customer intimacy and T I delight. R

O I would like to thank all stakeholders of NHIS for their continued support and understanding over H T the years. I welcome your views on how best we can grow together to greater heights. U

A Thank you.

E C N A R U S N I

H

T Sylvester A. Mensah L (Chief Executive) A E H

L A N O I T A N

19 2009 ANNUAL REPORT

1.0 SIGNIFICANT EVENTS AND INITIATIVES 1.1 Introduction 2009 The National Health Insurance Authority (NHIA) is a statutory body mandated to secure the ANNUAL implementation of the National Health Insurance Policy. The NHIA is responsible for the REPORT registration, licensing and regulation of health insurance schemes in the country. It also has the

role of supervising the operations of schemes, grant accreditation to healthcare providers and to Y T I

monitor their performance for efficient and quality service delivery. It is responsible for R O

managing the National Health Insurance Fund and devising mechanisms to ensure that indigents H T are adequately catered for under the NHIS. U A

E C

1.2 Appointment of new Council and Chief Executive N

A R

The year 2009 saw the appointment of a new Council to govern the NHIA. The composition of the U S

Council includes representatives from the Ministries of Health, Finance, and Local Government, N I

Ghana Health Service, Trades Union Congress, Consumers, National Insurance Commission, H T Pharmaceutical Society of Ghana, Society of Private Medical and Dental Practitioners, Social L A

Security and National Insurance Trust, and the Ghana Bar Association. In June 2009, a new Chief E H

Executive, Mr. Sylvester Mensah, was appointed to steer affairs of the NHIA. L A N O

1.3 Strategic seminar I T A

During the year under review, NHIA organized its maiden Strategic Seminar at from 27th N - 30th August, 2009 under the theme 'Delivering on the NHIS Promise'. The aim of the seminar was to offer opportunity for divisional directors and their core staff to make inputs into a new strategic direction of NHIA. The seminar was replicated in all NHIA regional branches across the country.

20 2009 ANNUAL REPORT

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S The then Deputy Minister for Health delivering a speach at the seminar at Sogakope. N I

H 1.4 Audit T L During the year under review, NHIA intensified financial and clinical audit at the schemes and A E accredited service provider sites. The primary goal of the exercise was to minimize financial H

L leakages through errors, abuse and fraud in claims administration in order to enhance the A

N financial sustainability of the scheme. The exercise resulted in the suspension, interdiction and O

I dismissal of some scheme officials who were found to have embezzled scheme funds. The T

A accreditation of some health facilities were also suspended for fraud and abuse of the system. N 1.5 Collaboration with stakeholders

Stakeholder engagement took a central part of NHIA operations with the view to building stronger cooperation, collaboration and partnership. In September 2009, a two - day National Stakeholders meeting jointly hosted by NHIA and the Ministry of Health was held at . The primary objective of the meeting was to share information and ideas on key policy and operational issues pertaining to the implementation of the NHIS. Key issues discussed include claims administration, legislative review, registration of indigents into the NHIS, and challenges with the ICT system. Other meetings held in 2009 include review meetings with accredited service providers to deliberate on reimbursement and quality issues and Inter Agency Steering

21 Committee meetings to discuss the Health Insurance Project (World Bank sponsored projects under NHIS).

2009 ANNUAL REPORT

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A group photograph of participants at NHIS A section of participants at the T meeting. U A Stakeholder meeting at College of Physicians E

& Surgeons. C

N 1.6 Press soiree A R U

In December 2009, NHIA organized a press soiree for both the print and electronic media. The S N

Authority used the occasion to brief the press on its operations and to allow for questions and I

clarification of issues. The Chief Executive of NHIA used the platform to thank the press for their H T

support and cooperation and asked for closer collaboration in the coming year. L A E

1.7 Legislative review H

L

The existing legal regime for the implementation of the NHIS is fraught with numerous A challenges that affect the smooth implementation of the scheme. The most notable challenges N O are the fragmentation of schemes into 145 autonomous schemes and the governance problems I T

associated with the structure of the scheme. The mandates and lines of authority have not been A adequately defined for NHIA, Scheme Boards of Directors and District Assemblies leading to N conflicting directives. To ensure efficiency and smooth implementation of the NHIS, a legislative review process was commenced in 2009. Stakeholder consultations were carried out across the country to solicit public input in the review process. The output of the consultations has been the development of a legislative proposal which has been translated into a draft bill.

1.8 One -Time Premium Payment

Government is determined to implement a universal health insurance scheme for the benefit of all residents in Ghana. The new policy direction will guarantee access to free health care in accredited healthcare institutions. One-Time Premium Payment for the informal sector members is a key feature of the universal health insurance scheme. Actuarial work on the

22 sustainability of the One-Time Premium policy has been carried out and the results show that the new policy is feasible. A roadmap towards the implementation of a One-Time Premium has been developed. A nationwide survey to seek the views of the general public was commissioned by NHIA and conducted by independent researchers from GIMPA and University of Ghana Business School. What remains to be done is the policy document detailing out the various One-Time 2009 amounts to be paid by subscribers and the additional sources of funding required. ANNUAL REPORT 1.9. Revamping of Information Communications and Technology (ICT)

Y Year 2009 witnessed the revamping of the nationwide ICT platform with the engagement of an T I ICT Consultant to work with the ICT Division. R

O One significant achievement was the installation of new and more effective antivirus software H

T ESET at NHIA, schemes and provider site and improved response time on NHIA application by re- U

A engineering the bandwidth allocation to users without implementing the 100% increase in

E bandwidth which was initially proposed. C

N

A Another significant milestone was the implementation of email messaging (outlook) and toll free R telephone using voice-over-IP technology. The technology has enhanced communication U

S between NHIA and district schemes across the country. This is envisaged to save the organization N I a minimum of approximately GH¢36,000 per annum. H T

L Additionally, schemes' MIS Officers and Regional ICT Coordinators were re-trained to fully A

E support the use of the NHIS ICT platform at district schemes and provider sites. There is also H ongoing ICT improvement such as re-training of Data Centre Staff, re-engineering of claims and L

A membership module to address the data integrity challenges. N O

I The new NHIS ID card introduced barely two years ago allows subscribers to access healthcare T

A everywhere across the country. As at the end of December 2009, about 5million subscribers have N been issued with the new cards.

A sample of the new card is shown on the next page.

23 2009 ANNUAL REPORT

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24 Although there were remarkable achievements in 2009, the following ICT challenges confront the scheme:

Poor data integrity. * Limited membership authentication at service provider sites. * Manual vetting of claims . 2009 * ANNUAL Strategies to address the aforementioned challenges include: REPORT Re-engineering the membership application to include biometric solution to deal * with data integrity issues.

Y Ongoing modification to the claims module to make it more user friendly to

T *

I encourage electronic claims vetting instead of the manual vetting. R

O Encourage electronic claims submission by providers through the claims module.

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25 2.0 OPERATIONAL RESULTS 2.1 Membership registration 2.1.1 Registration trends

As at December 31, 2009 a total of 14,511,777 subscribers representing 62% of the estimated population had registered with the Scheme, as against 2008 coverage of 55% for the same 2009 period. The general trend shows continuous increase in membership over the five-year period ANNUAL from 2005 to 2009 (See table 1 and Chart 1 for details). REPORT

Table 1: Registration trend per category (aggregated from 2005-2009)

2005 2006 2007 2008 2009 Y T I

NO. CATEGORIES NUMBER (%) NUMBER (%) NUMBER (%) NUMBER (%) NUMBER (%) R O H 1. INFORMAL ADULT 309,880 22.99 1,099,516 28.43 2.482,827 30.34 3,725965 29.76 4,266,051 29.40 T U 2. SSNIT A CONTRIBUTORS 135,417 10.04 332,010 8.58 618,175 7.55 798,573 6.38 884,666 6.10 E

3. SSNIT C PENSIONERS 13,838 0.01 29,560 0.76 48,926 0.60 65,653 0.52 76,974 0.53 N A

4. CHILDREN AGED R BELOW 18 YEARS 739,292 54.84 1,989,565 51.44 4,222,786 51.60 6,324,487 50.52 7,175,085 49.44 U S

5. ADULTS AGED 70 N I

YEARS AND H ABOVE 126,495 9.38 345,050 8.92 651,280 7.96 881,725 7.04 967,401 6.67 T L A

6. INDIGENTS 23,238 1.72 72,161 1.87 160,300 1.96 300,923 2.40 337,150 2.32 E H

7. PREGNANT L

WOMEN ------421,234 3.36 804,450 5.54 A N O TOTAL(NATION A L ) 1,348,160 6.31 3,867,862 17.68 8,184,294 36.56 12,518,560 54.66 14,511,777 61.97 I T A N

26 Chart 1: Membership registration trend

REGISTRATION TREND16

2009 16,000,000 14,511,777 ANNUAL 14,000,000 12,518,560 REPORT 12,000,000 10,000,000 8,184,294 8,000,000 6,000,000

3,867,862 4,000,000 Y 1,348,160 2,000,000 T I 0 R 2005 2006 2007 2008 2009

O Year H T U A

E

C 2.1.2 Registration by Region N

A had the highest penetration rate of 89.92% followed by Brong R , 77.49%. had the least penetration rate of 40.31%. U

S With the exception of Greater Accra Region, all the other regions had registered more N

I than 50% of the population in their respective regions (see details in Chart 2).

H

T Chart 2: % Coverage by region as at December 31, 2009 L A E H

L

A % COVERAGE BY REGION N O

I 90.00 T 80.00 A

N 70.00

E 60.00 G

A 50.00 R E V 40.00 O C

% 30.00

20.00

10.00

0.00 ASHANTI BRONG CENTRA L EASTER N GT. ACCR A NORTHER N UPPER UPPER VOLTA WETERN AHAFO EAST WEST Series1 70.77 77.49 62.90 69.31 40.31 66.89 65.38 89.92 54.97 53.18

27 2.1.3 Registration by categories

Chart 3 shows the distribution of registered members as at 31st December 2009. Children under 18 years constituted the largest category of registered members (49.4%) followed by the informal sector (29.4%). SSNIT contributors and pensioners represented 6.1% and 0.5% 2009 ANNUAL respectively of the total registered members. (See Chart 3 for details). REPORT Chart 3: Distribution of cumulated registered members by category

Y T I R O H T U A

E C N A R

PREGNANT U

INDIGENTS, WOMEN, 804,450 S 337,150 (2.3%) (5.5%) INFORMAL ADULT, N

4,266,051 (29.4%) I

ADULTS AGED 70 YEARS AND ABOVE, 967,401 H (6.75) T L A E H

L

SSNIT A

CONTRIBUTORS N CHILDREN AGED 884,666 (6.1%) BELOW 18 YEARS SSNIT O 7, 175, 085 (49.4%) PENSIONERS, I 76,974 (0.5%) T A N

28 2.2 ID card issuance The total number of subscribers with valid ID cards as at December 31, 2009 was 12,534,128, representing 86.37 % of the total registered members. This represents a growth rate of 13.28% over 2008. The general trend for the past three years however shows a gradual decline in the percentage of ID cards issued as against total registered members. Details are as shown in table 2009 2 and Chart 4. ANNUAL REPORT Table 2: Aggregated ID cards issued (from 2005-2009)

ID CARDS ISSUED

Y TOTAL T

I YEAR REGISTERED (TR) INFORMAL EXAMPLE TOTAL % TR R

O 2005 1,348160 136,727 353,185 489,912 36.34 H T 2006 3,867,862 695,852 1.726,254 2,422,106 62.62 U A 2007 8,184,294 2,119,634 5,155,801 7,275,435 88.90 E C

N 2008 12,518,560 3,300,381 7,764,200 11,064,581 88.39 A

R 2009 14,511777 3,795,918 8,738,210 12,534,128 86.37 U S N I

H T L

A Chart 4: Trends in ID cards issuance E H

L A

N Trends in ID cards issuance O I

T 14000000 s d A

r 12000000 a c N 10000000 D I

8000000 f o 6000000 r e

b 4000000

m 2000000 u

N 0 1 2 3 4 5 Year 2005 2006 2007 2008 2009

ID cards issued 489,912 2,422,10 7,275,43 11,064,5 12,534,1

29 2.3 Outpatient services utilization

Chart 5 presents OPD service utilization trends for the five year period (2005- 2009). Utilization increased from 597,859 in 2005 to 2,434,008 in 2006 showing 2009 an increase of 307%. The utilization rates increased by 91%, 101% and 56% in ANNUAL REPORT 2006, 2007 and 2008 respectively to reach 14,573,902 in 2009.

Y T I

Chart 5: Outpatient services utilization (2005 - 2009) R O H T U A

E 16,000,000 14,573,902 C N

14,000,000 A R

12,000,000 U S N I

10,000,000 9,339,296 N O H I T T A 8,000,000 L Z I A L I T E

U 6,000,000 4,648,119 H

L

4,000,000 A 2,434,008 N

2,000,000 O 597, 859 I T A

2005 2006 2007 2008 2009 N YEAR

30 2.4 Inpatient services utilization (2009)

Inpatient utilization increased from 28,906 in 2005 to 135,221 in 2006 showing an increase of 368%. It increased further from 303,930 in 2007 to 627,795 in 2008 depicting an increase of 2009 107%. In 2009, utilization had reached 846,311 (refer to Chart 6). ANNUAL Chart 6: Inpatient services utilization (2005 - 2009) REPORT

Y T I 900,000 846,311 R O 800,000 H T

U 700,000 627,795 A

E

N 600,000 O C I T A N

Z 500,000 I A L I T R

U 400,000 U 303,930 S

N 300,000 I

H 200,000 135,221 T L

A 100,000

E 28,906 H

L

A 2005 2006 2007 2008 2009 N YEAR O I T A N

31 2.5 Claims payment

Claims payment is the major cost driver accounting for over 85% of NHIA expenditure in 2009. Total disbursements (subsidies and reinsurance) for claims payment increased from GH¢ 7.60 million in 2005 to GH¢35.48 million in 2006 showing an increase of 367%. The payments increased from GH¢79.26 million in 2007 to GH¢ 198.11 million in 2008 and increased to 2009 ANNUAL GH¢308.15 in 2009. Chart 7 shows claims disbursement trends from 2005 to 2009. REPORT

Chart 7: Disbursements for claims payment (2005-2009) Y T I R O H T U

350 A 308.15 E

300 C N A )

¢ 250 R H G

198.11 U N S O

I 200 L N L I I

M (

150 H T N T U L O

79.26 A

M 100 A E H 50 35.48 7.60 L A N 2005 2006 2007 2008 2009 O I

Reinsurance Subsidies T A N 2.6 Accreditation

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 all, 1,930 service providers were accredited in 2009. Table 3 summarizes the accreditation results.

32 Table 3. Accreditation results

SUMMARY OF INSPECTED FACILITIES- 1ST AND 2ND BATCHES 2009 ANNUAL FACILITIES BY TYPES 1ST 2ND TOTAL FACILITIES BY LEVEL 1ST 2ND TOTAL REPORT CHPS ZONE 74 366 440 GRADE A+ 2 5 7 MATERNITY HOMES 130 61 191 GRADE A 21 34 55 HEALTH CENTRE 74 350 424 GRADE B 86 267 353 EYE CLINIC 0 3 3 GRADE C 140 535 675

Y CLINICS 94 137 231 GRADE D 277 330 607 T

I POLYCLINICS 0 9 9 PROVISIONAL 48 52 100

R PRIMARY HOSPITALS 62 163 225 GRADE R(FAIL) 44 89 133

O SECONDARY HOSPITAL 4 3 7 TOTAL 618 1312 1930 H TERTIARY HOSPITAL 0 1 1 T

U PHARMACIES 80 102 182 A

CHEMICAL SHOPS 55 74 129 FACILITIES BY REGIONS 1ST 2ND TOTAL

E LABORATORIES 28 22 50 ASHANTI 153 285 438 C ULTRASOUND 17 7 24 BRONG ANAFO 61 106 167 N DIAGNOSTIC CENTRES 0 14 14 CENTRAL 113 86 119 A

R TOTAL 618 1313 1930 EASTERN 86 207 293

U GREATER ACCRA 67 138 205 S FACILITY BY OWNERSHIP 1ST 2ND TOTAL NORTHERN 27 161 188 N I

GOVERNMENT 168 769 937 UPPER EAST 39 79 118

H MISSION 13 106 119 UPPER WEST 1 36 37 T

L PRIVATE 436 427 863 VOLTA 25 97 122

A QUASI GOVERNMENT 1 10 11 WESTERN 46 117 163 E TOTAL 618 1312 1,930 TOTAL 618 1312 1930 H

L A N

O 2.6.1 Collaboration I T

A NHIA is collaborating with PharmAccess, a Dutch Non Governmental Organization (NGO) in N 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.

33 3.0 SOURCES OF FUNDING

The major source of funding for the NHIS is the National Health Insurance Levy (NHIL) which accounted for approximately 61.5% and 61.0% of the total income of NHIS in 2008 and 2009 respectively. Premium income from the informal sector was approximately 5.1% of total income in 2008. The proportion of premium income dropped to 3.8% in 2009. Charts 8 & 9 present the proportion of income from various sources in 2008 and 2009.

st 2009 Chart 8: NHIS total inflow as at 31 December, 2008 ANNUAL REPORT

Sector Budget Insurance Premium Other Income Support 5.00% 0.01% SSNIT Contribution 4.76% 16.87% Y T I

Investment income R 11.78% O H T U A

E C N A Health Insurance Levy R

61.49% U S N I

H T

Source: Draft Financial Statements for the year ended 31/12/2008 L Chart 9: NHIS total inflow as at 31st December, 2009 A E H

L A N Sector Budget Insurance Premium O

Support 3.8% Other Income I 0.2% 2.3% T SSNIT Contribution Investment income 15.6% A

17.0% N

Health Insurance Levy 61.0%

Source: Draft Financial Statements for the year ended 31/12/2009

34 4.0 REGIONAL OFFICE OPERATIONS

Regional Offices were established in 2007 by NHIA to supervise and monitor the operations of District Mutual Health Insurance Schemes (DMHIS) and their accredited service providers. Regional offices are required to report regularly to the Head Office on their activities for 2009 management decision making. ANNUAL REPORT

Y T I R O H T U A

E C N A R U S N I

H T

L Monitoring team in en route to Kokrobutan (island community) in the Afram

A Plains District to monitor health facilities. E H

L 4.1 Key findings A

N Below were some of the key findings from the regional monitoring activities: O I

T Wrong application of tariffs by some service providers.

A * Insured clients being compelled by service providers to come for two reviews even

N * though they were found to be doing well on the first review. In some health facilities, reviews seemed to be automatic as almost every folder had two reviews. Some health facilities charged Ante natal tariff for several conditions like malaria and * waist pains in pregnant women instead of charging general OPD tariff. Some providers filed for claims on behalf of clients who never used their facility. * Poly pharmacy and irrational drug prescription. * Some providers referred patients to independent laboratories and still charged all inclusive tariffs. Collection of illegal fees by some service providers, which defeats the purpose of * introducing the NHIS.

35 5.0 DISTRICT SCHEME OPERATIONS

The National Health Insurance Act, 2003 (Act 650) allows the establishment of autonomous District Mutual Health Insurance Schemes (DMHIS) as companies limited by guarantee. Currently, there are 145 DMHIS duly licensed by NHIA to operate in the country. Table 4 shows the distribution of DMHIS by regions. 2009 ANNUAL Table 4: Number of DMHIS by Region REPORT

Region No. of schemes Y T Ashanti 24 I R O Brong Anafo 19 H T

Central 13 U A

Eastern 17 E C

Gt. Accra 10 N A

Northern 18 R U

Upper East 6 S N I

Upper West 8 H T Volta 15 L A E

Western 15 H

L

Total 145 A N O I T

5.1 Key issues identified at district scheme level A * Majority of schemes lack permanent office accommodation. They operate N from rented premises; generally not conducive for office duties. * Low staff capacity. * Some districts such as East Gonja, Tolon/Kumbungu, West Mamprusi, West Gonja, /Tatali, Nanumba North and South in the and North in the Eastern Region need out-board motors to access their overseas communities. Schemes encounter difficulties in identifying and registering indigents based on * the means test provided in the National Health Insurance Regulations, 2004 (LI 1809).

36 6.0 SPECIAL PROJECTS, PROGRAMMES AND INITIATIVES

The Authority either sponsored or took part in activities and programmes of the following organizations and communities:

National Health Fair organized by Ministry of Health in Accra in August 2009 (Exhibition). 2009 * ANNUAL * Commonwealth Pharmacists Association meeting in Accra in August 2009 (Financial REPORT Support and Exhibition). Establishment of National Platform for Disaster Risk Reduction and Climate Change Risk * Management under NADMO (Financial support).

Y T

I Launching of Assin Development Fund (Financial support).

R *

O Apiredeman Health Outreach Programme in December 2009 to mark Odwira Festival

H * (Financial support, public education and registration). T

U Okyeman Health Outreach Programme at Kyebi in October 2009 (Education). A * E

C Provision of Hotel Accommodation in Accra for 32 member International Healthare

N * Volunteers from the United States on a health outreach programme in Ghana in August

A 2009. R U

S 6.1 Marketing of NHIS by celebrities, organizations and individuals N I During the year under review, a number of external organizations and individuals effectively H

T marketed Ghana's NHIS through registration of the needy, conducting research and study tour. L They included: A E

H Ongoing programme by one of Ghana's leading female international singer Rebecca

L * Acheampong (Becca) to register ten thousand needy children under NHIS. A

N Registration of needy people by Members of Parliament (MPs) in their constituencies. O

I *

T Study tour by Cameroonian Health Delegation to study NHIS in Ghana. A * N * Research into NHIS by local and foreign students and organizations.

7.0 WAY FORWARD

Management of NHIA is committed to the implementation of One-Time Premium Payment Policy in 2010. To this end, ample time and effort would be devoted to making all the necessary preparations towards the take off of the new policy. The following are some of the planned activities:

Development of a policy document on the One-Time Premium Payment in collaboration * with the Ministry of Health and Ghana Health Service.

37 Re-engineering of NHIS membership database by capturing biometric * data on subscribers to enhance data integrity. * Stakeholder engagement to get their buy-in. * Sustained public education on the One-Time Premium. * Pursuance of cost containment strategies to make the scheme sustainable. * Improve customer care to sustain public interest in the scheme 2009 8.0 CONCLUSION ANNUAL REPORT The introduction of NHIS barely five years ago has brought improved access to quality health

care to Ghanaians especially the poor and vulnerable. The sustainability of the scheme is Y T

therefore critical since NHIS is one of the most important social policies that affect every citizen. I R Management of NHIA is determined to improve service delivery and introduce far reaching O innovations to make the schemes meet the needs and aspirations of Ghanaians. With H T determination of government and commitment of staff, the scheme will continue to meet its U A

goal of increasing financial access to healthcare for all residents in Ghana. E C N A R U S N I

H T L A E H

L A N O I T A N

38 NHIA FINANCIAL STATEMENT (UNAUDITED)

NATIONAL HEALTH INSURANCE AUTHORITY (NHIA) INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR ENDED 2009 31 DECEMBER, 2009 ANNUAL REPORT

Y T I R O H T U A

E C N A R U S N I

H T L A E H

L NATIONAL HEALTH INSURANCE AUTHORITY (NHIA) A ACCUMULATED FUND FOR THE YEAR ENDED N 31ST DECEMBER, 2009 O I T A N

39 NATIONAL HEALTH INSURANCE AUTHORITY (NHIA) BALANCE SHEET AS AT THE YEAR ENDED 31ST DECEMBER, 2009 2009 ANNUAL 2009 2008 REPORT Fixed Asset GH¢ GH ¢ Property, Plant and Equipment 44,317,195.96 22,965,124.56

Investments 437,185,486.33 284,372,329.29 Y T

481,502,682.29 307,337,453.85 I Current Assets R Accounts Receivables 83,696,905.36 139,325,622.89 O H

Rent Prepaid 206,727.79 255,133.23 T

Insurance prepaid 3,570.46 4,875.22 U A

Bank and cash 5,591,991.47 37,175,892.02 Total Current Assets 89,499,195.08 176,761,503.36 E C

Total Assets 571,001,877.38 484,098,957.21 N A R U

Funds & Liabilities S

Accumulated Fund 462,909,453.28 481,492,422.57 N I

H

Current Liability T Accounts Payable 107,640,294.10 2,559,814.64 L A

Premium Deposits 452,130.00 46,720.00 E H

Total Current Liabilities 108,092,424.10 2,606,534.64 Total Fund and Liabilities 571,001,877.38 484,098,957.21 L A N O I T A N

40 NATIONAL HEALTH INSURANCE AUTHORITY (NHIA) CASH FLOW STATEMENT FOR THE YEAR ENDED 31ST DECEMBER,

2009 ANNUAL 2009 2008 REPORT Cashflow from operating Activities GH¢ GH ¢ Deficit (18,582,969.29) 114,662,934.61 Add Depreciation 449,813.94 198,839.78

Y Decrease in Receivables 55,628,717.53 (19,378,333.89) T I Decrease in Prepaid Rent 48,385.44 (141,513.23) R Decrease in Prepaid Insurance 1,304.76 (4,875.22) O

H Increase in Payables 105,080,479.46 (7,483,662.36)

T Increase in Premium Deposits 405,410.00 46,720.00 U Net inflow from operating activities 143,031,141.83 87,900,109.69 A

E

C Increase in Fixed Deposits (Short Term) (152,813,157.04) (116,507,890.33) N A

R Investing Activities

U Property, Plant & Equipment Acuisition (21,801,885.34) (18,848,555.34) S N I Net Decrease in Cash & Cash Equivalent (31,583,900.56) (47,456,335.98) H

T Cash & Cash Equivalent as at 01/01/09 37,175,892.02 84,632,228.00 L Net Cash & Cash Equipment as at 31/12/09 5,591,991.47 37,175,892.02 A E H

L A N O I T A N

41 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. 2009 C) Medication, namely, prescription drugs on National Health Insurance Drugs List, ANNUAL traditional medicines approved by the Food and Drugs Board and prescribed by REPORT 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. Y T F) Out-patient Physiotherapy. I R

2. In-Patient Services O H

A) General and Specialist in-patient care T

B) Requested investigations including laboratory investigations, x-rays and U A

ultrasound scanning for in-patient care.

C) Medication; namely, prescription drugs on National Health Insurance Drugs List, E traditional medicines approved by the Food and Drugs Board and prescribed by C accredited medical and traditional medicine practitioners, blood and blood N A

products. R

D) Cervical and Breast Cancer Treatment U E) Surgical Operations S N

F) In-patient Physiotherapy I

G) Accommodation in general ward H

H) Feeding (where available) T L A E H

3. Oral Health Services A) Pain Relief which includes, incision and drainage, tooth extraction and temporary L relief. A B) Dental Restoration which includes, Simple Amalgam Fillings and Temporary N O Dressing. I T A

4. Eye Care services N A) Refraction B) Visual Fields C) A-Scan D) Keratometry E) Cataract Removal F) Eye lid Surgery

5. Maternity Care

A) Antenatal Care B) Deliveries; namely, normal and assisted C) Caesarian Section D) Postnatal care

42 6. Emergencies

2009 All emergencies shall be covered. These refer to crisis health situation that demand ANNUAL urgent intervention and include: REPORT A) Medical emergencies B) Surgical emergencies including brain surgery due to accidents. C) Paediatric emergencies

D) Obstetric and Gynaecological emergencies including caesarian sections Y E) Road Traffic Accidents T I F) Industrial and workplace accidents R G) Dialysis for acute renal failure O H T U A

E C N A R U S N I

H T L A E H

L A N O I T A N

43 EXCLUSION LIST

The following health care services are excluded: 2009 ANNUAL REPORT A) Rehabilitation other than physiotherapy B) Appliances and prostheses including optical aid, hearing aids, orthopedic

aids, dentures C) Cosmetic surgeries and aesthetic treatment Y T D) HIV retroviral drugs I E) Assisted Reproduction e.g. Artificial insemination and gynaecological R O hormone replacement therapy H

F) Echocardiography T

G) Photography U A

H) Angiography I) Orthoptics E C J) Dialysis for chronic renal failure N

K) Heart and Brain surgery other than those resulting from accidents. A

L) Cancer treatment other than cervical and breast cancer R

M) Organ transplanting U N) All drugs that are not listed in the NHIS Drug list S N I

O) Diagnosis and treatment abroad

P) Medical examinations for purposes of visa applications, educational, H T

institutional, driving license L

Q) VIP ward (Accommodation) A R) Mortuary Services E H

L A N O I T A N

44 DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES 2009 NAME OF ANNUAL REGION NAME OF SCHEME ADDRESS/LOCATION TELEPHONE NUMBER REPORT Adansi North Box 21, Ashanti 0302-216970 EXT 5510/6510

Adansi South Box 1, New Adubiase 0302-216970 EXT 5511/6511

Y

T Afigya Sekyere Box 1, Agona Ashanti 0302-216970 EXT 5512/6512 I R Ahafo - Ano North Box 39, Tepa - Ashanti 0302-216970 EXT 5513/6513 O

H Box 9, -

T Ahafo - Ano South Ashanti 0302-216970 EXT 5514/6514 U A

Amansie Central Box 7 0302-216970 EXT 5515/6515 E

C Box 350, -

N Amansie East Ashanti 0302-216970 EXT 5516/6516 A

R Amansie West Box 1, Manso 0302-216970 EXT 5517/6517 U S Asante Akim North Box 214, Konongo 0302-216970 EXT 5518/5518 N I

H ASHANTI Asante Akim South Box 12, 0302-216970 EXT 5519/6519 T L

A Asokwa Sub - Metro Box 1916, 0302-216970 EXT 5520/6520 E H Atwima Nwabiagya Box 17, - Ashanti 0302-216970 EXT 5521/6521 L

A Box Kj- 508,Kejetia -

N Atwima Mponoa Kumasi 0302-216970 EXT 5523/6523

O Bosomtwe - Atwima- I

T Kwanwoma Box 24, 0302-216970 EXT 5524/6524 A

N – Box 144, Ejisu 0302-216970 EXT 5525/6525

Ejura Sekyeredumase Box 9, 0302-216970 EXT 5526/6526

Kwabre Box 8, 0302-216970 EXT 5527/6527

Manhyia Sub - Metro Pmb, Adum - Kumasi 0302-216970 EXT 5528/6528

Obuasi Municipal Box 32, 0302-216970 EXT 5529/6529

Offinsoman Box 281, 0302-216970 EXT 5530/6530

45 DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES NAME OF REGION NAME OF SCHEME ADDRESS/LOCATION TELEPHONE NUMBER 2009 ANNUAL Sekyere West Box 360, - Ash 0302-216970 EXT 5532/6531 REPORT ASHANTI Sekyere East – Box 302, Effiduase 0302-216970 EXT 5532/6532 Box Kj - 509, Kejetia - Subin Sub - Metro Kumasi 0302-216970 EXT 5533/6533 Y T Asunafo North Box 237, 0302-216970 EXT 5534/6534 I R O 0302-216970 EXT 5535/6534

Asunafo South Box 14, Kukuom H T

Asutifi Box 23, 0302-216970 EXT 5536/6536 U A Box 125, Atebubu 0302-216970 EXT 5537/6537 E C

Berekum Box 21, 0302-216970 EXT 5538/6538 N A

Dormaa Box 94, D - Ahenkro 0302-216970 EXT 5539/6539 R U

Jaman North Box 62, Sampa 0302-216970 EXT 5540/6540 S N I Jaman South Box 56, Drobo 0302-216970 EXT 5541/6541 H T

Kintampo North Box 130, Kintampo 0302-216970 EXT 5542/6542 L A BRONG AHAFO Kintampo South Box 50, Jema 0302-216970 EXT 5543/6543 E H

Nkoranza District Box 169, 0302-216970 EXT 5544/6544 L A

Pru Box 115, 0302-216970 EXT 5545/6545 N O I

Sene Box 11, Kwame Danso 0302-216970 EXT 5546/6546 T A

Sunyani Municipal Box 2640, 0302-216970 EXT 5547/6547 N

Tain Box 2, 0302-216970 EXT 5548/6548

Tano North Box 24, D/Nkwanta 0302-216970 EXT 5549/6549

Tano South Box 179, 0302-216970 EXT 5550/6550

Techiman Municipal Box 522, 0302-216970 EXT 5551/6552

Wenchi Box 75, 0302-216970 EXT 5552/6552

46 DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES

NAME OF 2009 REGION NAME OF SCHEME ADDRESS/LOCATION TELEPHONE NUMBER ANNUAL Abura-Asebu- REPORT Kwamankese C/O District Assembly 0302-216970 EXT 5615/6615

Agona Box 595, Swedru 0302-216970 EXT 5616/6616

Y Ajumako Enyan Box 1, Ajumako 0302-216970 EXT 5617/6617 T

I Asikuma Odoben

R Brakwa Box 36, B, Asie 0302-216970 EXT 5618/6618 O

H Assin North Box 102, Foso 0302-216970 EXT 5619/6619 T Box 18,Nsuaem- U Assin South A Kyekyeware 0302-216970 EXT 5620/6620

E

C Awutu - Effutu – Senya Box 1, 0302-216970 EXT 5621/6621 N

A Oguaman – Capecoast C/O District Assembly 0302-216970 EXT 5622/6622 R

U Gomoaman Box Ap 162, 0302-216970 EXT 5623/6623 S Komenda-Edina-Eguafo- Box 29, N

I Elimina0243167295 0302-216970 EXT 5624/6624

Abirem

H CENTRAL

T Mfantsiman Box 28, 0302-216970 EXT 5625/6625 L Twifo Hemang Lower A

E Denkyira Box 182, Twifo - Praso 0302-216970 EXT 5626/6626 H

L Upper Denkyira Box 89, Dunkwa - Offin 0302-216970 EXT 5627/6627 A Afram Plains Box 43, 0302-216970 EXT 5598/6598 N O I Akuapem North Box 154, 0302-216970 EXT 5599/6599 T A Akuapem South Box Nw 602, Nsawam 0302-216970 EXT 5600/6600 N

Asuogyaman Box Ab 457, 0302-216970 EXT 5601/6601 EASTERN Atiwa Box 14, 0302-216970 EXT 5602/6602

Birim North Box 1, New - Abirem 0302-216970 EXT 5603/6603

Birim South Box 939, 0302-216970 EXT 5604/6604

East Akim Box Ky 174, Kibi 0302-216970 EXT 5605/6605

Fanteakwa Box 113, 0302-216970 EXT 5606/6606

47 DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES

NAME OF REGION NAME OF SCHEME ADDRESS/LOCATION TELEPHONE NUMBER 2009 ANNUAL Kwaebibirem Box 114, Kade 0302-216970 EXT 5607/6607 REPORT Manya Krobo Box 266, Odumasi Krobo 0302-216970 EXT 5608/6608

New Juaben Boxkf518, 0302-216970 EXT 5609/6609 Y T EASTERN Okwawuman South Box 26, 0302-216970 EXT 5610/6610 I R

Okwawuman West Box 770, 0302-216970 EXT 5611/6611 O H

Suhum Kraboa Coalta Box Su 260, Suhum 0302-216970 EXT 5612/6612 T U A Yilo Krobo Box 102, 0302-216970 EXT 5613/6613 E West Akim Box 136, 0302-216970 EXT 5614/6614 C N

Box 228, Abossey Okai A

Ablekuma 0302-216970 EXT 5485/6485 R U

Ashiedu Keteke Box Gt 2152, Accra 0302-216970 EXT 5486/6486 S N I Ayawaso Box 473, Nima 0302-216970 EXT 5487/6487 H T

Dagme East Box Af 179, Ada - Foah 0302-216970 EXT 5500/6500 L A

GREATER Dagme West Box Dd 195, 0302-216970 EXT 5501/6501 E H

ACCRA Ga District Box 1, 0302-216970 EXT 5502/6502 L A

Kpeshie Box Os 1979, Osu 0302-216970 EXT 5503/6503 N O I

Okaikoi Box 101, Sakum - Estate 0302-216970 EXT 5488/6488 T A

Osu- Klottey Box Ad 133, Adabraka 0302-216970 EXT 5489/6489 N

Tema Box 301, 0302-216970 EXT 5505/6505

Bole Box 72, Bole 0302-216970 EXT 5553/6553

Bunkpurugu Box 11, Nakpanduri 0302-216970 EXT 5554/6554 NORTHERN Central Gonja 0302-216970 EXT 5556/6556

East Gonja Box 9, 0302-216970 EXT 6555/7555

48 DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES

NAME OF 2009 REGION ANNUAL NAME OF SCHEME ADDRESS/LOCATION TELEPHONE NUMBER REPORT East Mamprusi Box 41, 0302-216970 EXT 5557/6557 Box 1, Gushegu 0302-216970 EXT 5558/6558

Karaga 0302-216970 EXT 5559/6559 Y

T Nanumba Box 1, 0302-216970 EXT 5560/6560 I

R Nanumba South Box 1, 0302-216970 EXT 6561/7561 O

H /Cherekponi Box 42, Saboba 0302-216970 EXT 5562/6561 T

U / Nanton B0x 1, Savelugu 0302-216970 EXT 5562/6563 A

NORTHERN Sawla-Tuna-Kalba 0302-216970 EXT 5643/6643 E

C Tamale 0302-216970 EXT 5564/6543 N

A Tolon/Kumbungu Box 2531, Tamale 0302-216970 EXT 5565/6565 R

U West Gonja Box Dm 97, 0302-216970 EXT 6566/7566 S

N West Mamprusi Box 6, 0302-216970 EXT 5567/6567 I

H B0x 1, Yendi 0302-216970 EXT 5568/6568 T L Zabzugu/Tatale Box 1, Zabzugu 0302-216970 EXT 5569/6569 A

E Municipal Box 1, Bawku 0302-216970 EXT 5570/6570 H

L Bawku West Box 1, Zebella 0302-216970 EXT 5571/6571 A

N Bolga 0302-216970 EXT 5572/6572 O

I Bongo Box 1, Bongo 0302-216970 EXT 5573/6573

T UPPER EAST A Builsa Box 3, 0302-216970 EXT 5574/6574 N Kasena-Nankana Box 94, 0302-216970 EXT 5575/6575

Jirapa Box 1, Jirapa 0302-216970 EXT 5576/6576

Lawra Box 23, 0302-216970 EXT 5577/6577

UPPER WEST 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

49 DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES

NAME OF REGION NAME OF SCHEME TELEPHONE NUMBER 2009 ADDRESS/LOCATION ANNUAL Wa Municipal Box 587, Wa 0302-216970 EXT 5581/6581 REPORT UPPER WEST Wa West C/O Box 587, Wa 0302-216970 EXT 5582/6582

Wa East C/O Box 587, Wa 0302-216970 EXT 5583/6583 Y

Adaklu Anyigbe Box Ap 47, Kpetoe 0302-216970 EXT 5644/6644 T I

Akatsi Box 55, 0302-216970 EXT 5584/6584 R O

Ho Box 47, Ho 0302-216970 EXT 5585/6585 H VOLTA T

Hohoe Box 126, 0302-216970 EXT 5586/6586 U A Box 20, Jasikan 0302-216970 EXT 5587/6587 E

Kadjebi Box 50, -Akan 0302-216970 EXT 5588/6588 C N

Keta Box Kw, 231 0302-216970 EXT 5589/6589 A R

Ketu Box De 189, 0302-216970 EXT 5590/6590 U S

Kpando Box 45, 0302-216970 EXT 5591/6591 N I

Krachi East Box11, Damba 0302-216970 EXT 5592/6592 H T Krachi West Box 42, Krachie 0302-216970 EXT 5593/6593 L A Nkwanta Box 1, Nkwanta 0302-216970 EXT 5594/6594 E H

South Dayi Box 3, 0302-216970 EXT 5595/6595 L A

North Tongu Box 19, 0302-216970 EXT 5596/6596 N O South Tongu Box 46, Sogakope 0302-216970 EXT 5597/6597 I T

Ahantaman Box 10, Agona - Ahanta 0302-216970 EXT 5630/6630 A N Amenfiman Pmb, 0302-216970 EXT 5631/6631

Aowin- Suaman Box 32, 0302-216970 EXT 5632/6632 Bia 0302-216970 EXT 5636/6636 WESTERN -Anhwiaso Box 49, Bibiani 0302-216970 EXT 5633/6633 Jomoro Box 176, Half - Assini 0302-216970 EXT 5634/6634 Box 1, Juaboso 0302-216970 EXT 5635/6635 Wassa East Box 1008, 0302-216970 EXT 5637/6637

50 DIRECTORY OF DISTRICT MUTUAL HEALTH INSURANCE SCHEMES 2009 NAME OF ANNUAL REGION NAME OF SCHEME ADDRESS/LOCATION TELEPHONE NUMBER REPORT Nzema East Box 25, 0302-216970 EXT 5638/6638 Sefwi Box 183, S/Wiaso 0302-216970 EXT 5640/6640 Sekondi Box Ax 43, Takoradi 0302-216970 EXT 5639/6639

Y

T Shama Box 5, Shama 0302-216970 EXT 5629/6629 I

R WESTERN Takoradi Box Ax 43, Takoradi 0302-216970 EXT 6641/7641 O

H Wassa Amenfi East Box 10, Wasa 0302-216970 EXT 5628/6628 T

U Wassa West Box 1, 0302-216970 EXT 5642/6642 A

E C N A R U S N I

H T L A E H

L A N O I T A N

51