2011 ANNUAL REPORT
TABLE OF CONTENTS
TABLE OF CONTENTS ...... i LIST OF ACRONYMS ...... iv VISION, MISSION AND CORE VALUES ...... 1 PROFILE OF DIRECTORS ...... 6 CHAIRMAN’S ACKNOWLEDGEMENT ...... 8 REPORT OF CHIEF EXECUTIVE ...... 10 1.0 INTRODUCTION ...... 12 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 MEMBERSHIP AND ID CARD MANAGEMENT...... 15 3.1.1 Membership: Evolving methodology & trends ...... 15 3.1.2 Special registration exercise ...... 18 3.1.3 Free maternal health care (FMC) ...... 18 3.2.4 ID cards production and distribution...... 18 3.2 CLAIMS MANAGEMENT ...... 19 3.2.1 Out-patient utilization ...... 19 3.2.2 Inpatient utilization ...... 20 3.2.3 Claims payment trend ...... 20 3.3 SUSTAINABILITY AND COST CONTAINMENT ...... 21 3.4 ICT AND DATA MANAGEMENT ...... 22 3.5 PROVIDER ACCREDITATION AND QUALITY ASSURANCE ...... 22 3.6 ADMINISTRATION AND HUMAN RESOURCE ...... 24 3.7 PLANNING, MONITORING, EVALUATION, RESEARCH AND DEVELOPMENT ..... 24 3.8 PROJECTS AND PROCUREMENTS ...... 25 3.9 COMMUNICATION AND STAKEHOLDER ENGAGEMENT ...... 26 3.9.1 NHIS stakeholders’ forum ...... 26 3.9.2 Policy fair ...... 28 3.9.3 Public education on NHIS ...... 28 3.9.4 Publications...... 28 3.9.5 Media interaction ...... 28 3.9.6 Oxfam report ...... 30 3.9.7 Customer care ...... 30 4.0 ACHIEVEMENTS ...... 31 4.1 INCREASED COVERAGE ...... 31 4.2 HEAD OFFICE COMMISSIONING ...... 31 4.3 LINKING TREATMENT TO DIAGNOSIS ...... 32 4.4 COST SAVINGS INITIATIVES ...... 32 4.5 IMPROVED REIMBURSEMENT TO PROVIDERS ...... 33 4.6 STUDY VISIT BY OTHER COUNTRIES ...... 33 4.7 INCREASED DONOR SUPPORT ...... 34 5.0 CHALLENGES ...... 35 5.1 FINANCIAL SUSTAINABILITY OF THE SCHEME ...... 35 5.2 IDENTIFICATION OF THE POOR IN THE INFORMAL SECTOR ...... 35 5.3 ID CARD MANAGEMENT ...... 35 5.4 ICT ...... 35 ii 2011 ANNUAL REPORT
6.0 OUTLOOK FOR 2012 ...... 36 6.1 ENHANCE FINANCIAL SUSTAINABILITY OF THE NHIS...... 36 6.1.1 Defensive Strategy: ...... 36 6.1.2 Prudent fund management: ...... 36 6.1.3 Sourcing Strategy: ...... 36 6.2 INCREASE ACTIVE MEMBERSHIP TO 40% OF THE POPULATION ...... 37 6.3 STRENGTHEN THE NHIS ICT ...... 37 6.4 PROMOTE QUALITY IMPROVEMENT IN SERVICE PROVIDER FACILITIES ...... 37 6.5 STRENGTHEN CLAIMS MANAGEMENT ...... 37 6.6 IMPROVE ID CARD MANAGEMENT ...... 38 6.7 HUMAN RESOURCE CAPACITY AND ORGANISATIONAL REFORMS ...... 38 6.7.1 Attracting, developing and retaining relevant human resource ...... 38 6.8 COMMUNICATION AND MARKETING STRATEGIES...... 38 6.8.1 Internal and external communication ...... 38 7.0 CONCLUSION ...... 39 ANNEXES ...... 40 ANNEX 1: Financial Statement ...... 41 ANNEX 2: Minimum health care package under NHIS ...... 49 ANNEX 3: Unit heads and managers ...... 51 ANNEX 4: Regional Managers ...... 52 ANNEX 5: Directory of district mutual health insurance schemes ...... 53 ANNEX 6: Training programs organised in 2011 ...... 60
List of Figures
Figure 1: NHIS Value chain...... 14 Figure 2: Active membership as percent of population by region in 2011 ...... 15 Figure 3: Active NHIS Subscribers by Category 2011 ...... 17 Figure 4: Outpatient Utilization Trend ...... 19 Figure 5: Inpatient utilization trend from 2005 to 2011 ...... 20 Figure 6: Claims Payment Trend (GH¢ Millions) ...... 21
List of Tables
Table 1: Membership trends ...... 16 Table 2:Total number of members registered under the special registration exercise ...... 18 Table 3: Free maternal registration ...... 18 Table 4: ID Cards production and distribution by region ...... 19 Table 5: Accreditation results ...... 23 Table 6: Claims cumulative savings for 2010, 2011 ...... 32
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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 CPA Consolidated Premium Account CPC Claims Processing Centre DMHIS District Mutual Health Insurance Scheme DPs Development Partners DVLA Driver and Vehicle Licensing Authority G-DRG Ghana Diagnostic Related Grouping GH¢ Ghana Cedis GHS Ghana Health Services 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 PRO Public Relations Officer PPP Preferred Primary Provider PW Pregnant women R&D Research and Development SCAD Strategy and Corporate Affairs Division SSNIT Social Security and National Insurance Trust 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 : NO. 36-6 AVENUE, OPPOSITE AU SUITE
RIDGE INDUSTRIAL AREA, 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 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 (W&S) Mrs. Aimee Yuori Deputy Director, Legal (Council Secretary) Mrs. Freda M. Bartels Mensah Deputy Director, Procurement. (Goods) Mr. Vitus G. Kaleo-Bioh Deputy Director, ICT
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SSYYLLVVEESSTTEERR AA... MMEENNSSAAHH,,, CCHHIIEEFF EEXXEECCUUTTIIIVVEE,,, 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 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 25 years working experience in the Public Services, Private Sector, Banking and Academia. Mr. Mensah was elected Member of Parliament for Dadekotopon constituency in the Greater Accra Region in 1997.
Under his stewardship as Chief Executive of the National Health Insurance Authority since June 2009, the NHIA has experienced significant growth in membership and utilisation, manifesting increasing public confidence in the scheme. Mr. Mensah has introduced a raft of reforms and initiatives including the NHIA Call Centre, a modern Claims Processing Centre, Clinical Audit as an integral function of the Authority and piloted Capitation as an alternative provider payment mechanism. He has provided distinguished leadership and improved operational as well as financial efficiency of the scheme. Under his watch, Ghana’s NHIA has become a leading global model, attracting international recognition.
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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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.
Mr Acheampong has served as Temporary Advisor for WHO Guideline Panel on Pharmaceutical Pricing Policies.
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 was a Deputy Director of R&D and later appointed the first Director of Clinical Audit of NHIA in 2010.
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 2011 ANNUAL REPORT
Certified Accountants, UK (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: ACTING DIRECTOR, CLAIMS
Mr. Perry Nelson joined the NHIA in September 2009 as ICT Consultant and assumed his current role in June 2010. He has over 22 years working experience in the ICT industry and has played varied and critical roles in several major ICT projects across the USA, United Kingdom, Africa, and continental Europe. Perry has been ICT consultant to several blue chip companies such as IBM, Universal Music, Toyota Motor Company (for whom he spent over 7 years on several high profile projects), Bombardier, Lloyds TSB and Royal Bank of Scotland.
Mr. Perry Nelson earned his Bachelor of Science degree in Computer Science from the Kwame Nkrumah University of Science and Technology in 1980.
Perry has been instrumental in the successful set up of the Claims Processing Centre and the development of strategies and policies for Claims Management within the NHIS.
WINFRED AGBEIBOR: AG. DIRECTOR, STRATEGY & CORPORATE AFFAIRS
Winfred is a business planner and marketing communicator with over 13 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.
CHAIRMAN’S ACKNOWLEDGEMENT 2011 ANNUAL REPORT
In line with its enabling enactment, the NHIA presents its 2011 Annual Report.
Many of the achievements recorded in 2011 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 congratulate the management and staff of NHIS for their hard work which has contributed to this remarkable performance over the last three years. I deeply appreciate their dedication and commitment to the continued success of the organisation.
On behalf of the Council, I wish to express my gratitude to the Ministry of Health, our cherished service providers, subscribers, development partners and other stakeholders for their support and cooperation.
Thank you.
HON. DOE ADJAHO COUNCIL CHAIRMAN, NHIA
2011 ANNUAL REPORT
REPORT OF CHIEF EXECUTIVE
INTRODUCTION
The National Health Insurance Scheme (NHIS) was established by the National Health Insurance Act 2003, (Act 650) to provide financial access to quality basic health care for residents in Ghana. The scheme is currently operational in 145 districts and five satellite offices across the country. It has a total active membership of 8.2 million representing 33% of the population. During the year under review, 785 health facilities were accredited, bringing the total number of accredited health facilities to 3344.
SIGNIFICANT EVENTS AND ACHIEVEMENTS
The year 2011 witnessed a number of events and implementation of cost containment initiatives designed to contribute towards making the scheme sustainable. Key initiatives and achievements recorded include the following:
Operationalisation of Consolidated Premium Account (CPA)
The Consolidated Premium Account became operational in 2011. The main purpose of this initiative is to improve efficiency in premium collection at the scheme level. A remittance account was opened for the schemes into which premiums mobilised at the scheme level were lodged before being transferred to a central account. Special training sessions were organised for scheme and regional office staff on the CPA operating procedures and reporting systems. As at the close of the financial year, the total premium accrued was GH ¢27.7 million as against GH¢21.1million recorded in 2010 representing an increase of 31% in premium mobilisation.
Claims Processing Centre
A world-class ultra modern Claims Processing Centre (CPC) was established in 2010 to ease the burden of claims management at the district schemes. At the inception of the project, vetting of claims was limited to the three teaching hospitals, regional hospitals and some selected facilities. In 2011, the centre added on all claims from Volta Region and some selected health facilities in Greater Accra and Ashanti Regions. The operationalisation of CPC has contributed to a considerable reduction in claims turnaround time from an average of 90 days to 60 days.
Introduction of Capitation
NHIA had a successful negotiation for stakeholder acceptance of capitation as an additional provider payment mechanism. Major activities carried out included stakeholder meetings with providers, Parliamentarians and District Chief Executives in Ashanti Region, and community durbars to explain the policy and to get the buy in of the people and stakeholders. Also key to the capitation pilot process was the enrolment of subscribers to their Preferred Primary Providers (PPP) which commenced in the third quarter of year 2011. Capitation will be used to re-imburse providers for primary care out-patient services while Ghana Diagnostic Related Groupings (G-DRG) will continue to be used to re-imburse providers for inpatient and specialized services.
Commissioning of head office building
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NHIA Head Office Building was officially commissioned on 13th October 2011, by the President, His Excellency John Evans Atta Mills. The event was witnessed by a cross section of the public including Ministers of State, Members of Parliament, representatives of government agencies, development partners, donor agencies as well as NHIS subscribers and service providers. In an address at the ceremony, the President reiterated government’s commitment to ensuring that every Ghanaian has access to quality health care. He lauded the strategic initiatives adopted by the NHIA to ensure the sustainability of the scheme and pledged government’s continued support to achieve a sustainable health insurance system for the country.
NHIS stakeholders’ forum
As part of measures to strengthen collaboration with stakeholders, NHIA organised annual stakeholders’ forum as a means of promoting dialogue among its stakeholders. The forum was held at GIMPA in Accra from the 28th to the 29th June, 2011 on the theme “Building Stakeholder Consensus towards Quality and Sustainability”. The conference was aimed at soliciting views, addressing issues of concern to all NHIS stakeholders on the NHIA’s medium term Strategic Plan (2011 to 2014) and to update stakeholders on developments within the National Health Insurance Scheme and the Health Sector as a whole.
NHIS call centre
As part of efforts to give listening ears to NHIS subscribers and other stakeholders, management commenced the process of establishing a call centre. The centre will facilitate communication with stakeholders and try to address issues and challenges raised by them. Most of the preparatory work towards the launch including the signing of contractual agreement with service providers was completed and it is expected that the centre will be officially launched in the first quarter of 2012.
Outlook for 2012
Piloting of capitation in Ashanti Region will commence in January 2012. Management will therefore finalise the processes and modalities towards the project. Management will also commence nationwide PPP enrolment by the third quarter of 2012 as a step towards eventual rollout of capitation across the country. It is expected that the new policy will help contain cost and improve quality of care at provider sites.
It is envisaged that the legislative review process will be completed in 2012 to streamline the operations of the NHIS. Other key activities to be undertaken include the following:
1. Introduce a bespoke Enterprise Risk Management Framework that identifies and mitigates the natural propensity for institutional leakages, neglect and abuse. 2. Institute corporate-wide monitoring and evaluation framework that defines and measures success and determines what counts as achievement. 3. Establish staff Provident Fund. 4. Develop a Corporate-wide Performance Management System, 5. Conduct comprehensive ICT audit covering - implementation, operation, functionality, ownership, management and performance. 6. Add family planning to NHIS benefit package 7. Devote sufficient time and attention to ID card management and instant ID card issuance. 8. Conduct regular operational audit 9. Implement a fully functional and operational CPC with electronic claims processing 10. Submit to government a proposal for reviewing the sustainability of the scheme.
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Specific projects to be undertaken in 2012 are: • Complete the construction work on the 10 regional offices and furnish them with the needed equipments. • Commence the construction of NHIA Head Office Annex. • Commence the construction of the Official Duty Post/ residence. • Contract agencies for branding and communication activities in the areas of general communication and Capitation. • Implement processes to procure biometric and authentication system. • Commence the pilot of electronic claims management. • Consolidate all ongoing initiatives. • Secure parliamentary review of Act 650 of 2003.
CONCLUSION
I appreciate the team spirit and cordial working relationship with a technically efficient management team who have always kept their “eyes on the ball”. I salute all Directors, Deputy Directors, Managers and Officers of the authority and scheme and emphasize that I value your collective talents, co- operation and friendship.
I wish to thank all NHIS stakeholders for your continued support and commitment to building a sustainable health insurance scheme.
Thank you.
Sylvester A. Mensah Chief Executive
1.0 INTRODUCTION
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The National Health Insurance Authority (NHIA) is a statutory body mandated to secure the implementation of the National Health Insurance Scheme. The Authority is responsible for the registration, licensing and regulation of health insurance schemes in the country. It also plays the role of supervising the operations of District Mutual Health Insurance Schemes (DMHIS), granting accreditation to healthcare providers and monitoring 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 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.
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Figure 1: NHIS Value chain
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2.0 CORPORATE GOALS AND OBJECTIVES
2.1 CORPORATE GOALS
The 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 2011-2014
The NHIS has developed a strategic plan to provide direction for the period 2011-2014 to enable management focus on its core mandate. The plan envisages achieving 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 2011 are derived from the corporate objectives outlined above. This section presents the key activities undertaken within the year.
3.1 MEMBERSHIP AND ID CARD MANAGEMENT 3.1.1 Membership: Evolving methodology & trends
The NHIS has made significant progress towards extending health insurance coverage to residents of Ghana. Since the NHIS became operational, data on membership has predominantly been reported by way of cumulative membership i.e. the sum of all those who have ever registered to the scheme whether or not they have renewed their membership. Active membership reports were also based on manual reports from the schemes. 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.
The challenges identified with the old methodology of calculating active membership 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.
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Clearly, due to these challenges and the availability of substantial data on the ICT membership database, the NHIA has departed from the old manual methodology of calculating active membership. The new approach is based on the sum of the number of new members registered for a given year and the number of renewals made in that year. To further improve the quality of the data, the ICT platform was used in the extraction of the number of new members registered and the number of subscribers who renewed their membership during the given year. 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 from 2010.
The total active membership of the scheme increased from 8.16 million in 2010 to 8.23 million in 2011 showing an increase of 0.8% over the 2010 figure and representing 33% of the population. Table 1 presents NHIS membership trend from 2005 to 2011. Figure 2 also presents the percentage coverage of active membership on regional basis for 2011.
Table 1: Membership trends
Year 2005 2006 2007 2008 2009 2010 2011 Registered 1,348,16 Members 3,867,862 8,184,294 12,518,560 14,511,777 18,031,366 21,392,402 0 (Cumulative) Active 1,348,16 membership 2,521,372 6,643,371 9,914,256 10,638,119 14,157,708 17,518,744 0 (Old Methodology) Active membership n/a n/a n/a n/a n/a 8,163,714 8,227,823* (New Methodology) *Figure is provisional
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. If the old methodology were applied the active membership would have been about 17.5 million as at 31st December 2011.
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Figure 2: Active membership as percent of population by region in 2011
60.0%
50.9% 50.0% 45.9% 45.3%
37.8% 40.0% 36.0% 32.2% 29.0% 30.0% 24.6% 25.6% 25.5% Percentages Percentages 20.0%
10.0%
0.0% AS BA CR ER GA NR UE UW VR WR Regions
Figure 3 shows the distribution of active members as at December 2011 by category. Children under 18 years constitute 49.7% of NHIS active members followed by the informal sector 36.4% with the SSNIT Pensioners being the least 0.3%. See figure 3 for details.
Figure 3: Active NHIS Subscribers by Category 2011 SSNIT Contributors 4.5% SSNIT Pensioners 0.3% Informal Sector 36.4%
Under 18 years 49.7% Indigents (18-69) 4.2% 70 years and above 4.9%
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3.1.2 Special registration exercise
Special registration exercises were carried out across the country to increase membership enrolment. During the year under review, a total of 629,640 new members were enrolled through special registration exercises. This shows an increase of 128% as compared to number enrolled in 2012. Brong Ahafo Region recorded the highest number of enrolees while the Northern Region registered the least number of enrolees as indicated in Table 2.
Table 2: Total number of members registered under the special registration exercise REGION 2010 2011 % change ASHANTI 6,830 13,202 93.3 BRONG AHAFO 23,192 159,657 588.4 CENTRAL 31,882 29,963 (6.0) EASTERN 4,993 52,922 959.9 GT. ACCRA 39,048 117,972 202.1 NORTHERN 11,031 4,993 (54.7) UPPER EAST 47,216 6,683 (85.8) UPPER WEST 8,296 33,817 307.6 VOLTA 80,152 140,300 75.0 WESTERN 23,660 70,131 196.4 TOTAL (NATIONAL) 276,300 629,640 127.9
3.1.3 Free maternal health care (FMC)
The free maternal care programme was introduced in July 2008 to contribute to meeting the 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. The table below shows the new registrations under the FMC since inception.
Table 3 Free maternal registration Year New Members Registered 2008 421,234 2009 383,216 2010 504,609 2011 485,460
3.2.4 ID cards production and distribution
A total of 3,258,545 NHIS ID cards were printed, out of which 3,249,998 were distributed to NHIS subscribers. There was a remarkable improvement in ID card distribution with national average distribution rate of 84.6%. Ashanti Region recorded the highest rate (93.2%) while Volta Region had the lowest rate (75.6%). The improvement recorded in Ashanti Region may be attributed to the ID cards management piloting that took place in the region in 2011. Table 4 provides regional details.
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Table 4: ID Cards production and distribution by region ID card Backlog Brought ID Cards ID Cards REGION distribution Forward Produced Distributed rate % ASHANTI 137,854 619,247 705,272 93.2 BRONG AHAFO 50,975 296,919 291,721 83.9 CENTRAL 64,127 264,914 273,500 83.1 EASTERN 47,298 374,314 366,267 86.9 GT. ACCRA 56,887 512,735 445,614 78.2 NORTHERN 51,026 238,349 254,466 87.9 UPPER EAST 25,884 211,727 203,784 85.8 UPPER WEST 36,488 120,678 127,233 81.0 VOLTA 66,825 313,320 287,327 75.6 WESTERN 44,751 306,342 294,814 84.0 TOTAL (NATIONAL) 582,115 3,258,545 3,249,998 84.6
3.2 CLAIMS MANAGEMENT 3.2.1 Out-patient utilization
Outpatient utilization of healthcare services increased over forty-fold from 0.6 million in 2005 through 16.9 million in 2010 to 25.5 million in 2011. Figure 4 presents outpatient utilization trend from 2005 to 2011.
Figure 4: Outpatient Utilization Trend
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3.2.2 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 previous years instead of outpatient • Providers are changing their behaviour due to effective clinical audit
In 2011, however, inpatient utilisation doubled, from 724,440 to 1,451,596. Figure 5 presents Inpatient utilization trend from 2005 to 2011.
Figure 5: Inpatient utilization trend from 2005 to 2011 1,600,000 1,451,596 1,400,000
1,200,000
973,524 1,000,000
800,000 724,440 627,795 600,000 Number of admissions 400,000 303,930
200,000 135,221 28,906 - 2005 2006 2007 2008 2009 2010 2011 Years
3.2.3 Claims payment trend
There has been a significant increase in claims payment from GH¢7.60 million in 2005 to GH¢ 549.77 million in 2011. Figure 6 shows the trend in claims payment from 2005 to 2011.
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Figure 6: Claims Payment Trend (GH¢ Millions)
600.00 549.77
500.00
397.71 400.00 362.64
300.00
200.00 183.01 Amount (GH¢ Million)
100.00 79.26 35.48 7.60 0.00 2005 2006 2007 2008 2009 2010 2011 Year Data Source: Unaudited Financial Statements (2010/2011)
NOTE: Claims figures for 2010 and 2011 were quoted from unaudited financial statements of NHIA. The claims payments for 2008 and 2009 reflect figures from published audited accounts. The claims figures in the 2010 annual report for 2008 and 2009 were quoted from unaudited financial statements.
3.3 SUSTAINABILITY AND COST CONTAINMENT
Sustainability and cost containment measures continued to engage attention of management during the year under review. As such, Clinical Audit Division conducted clinical audit in 218 accredited health facilities to assure provision of quality health care services and to minimize financial leakages resulting from provider-side moral hazards. The Internal audit division also audited 100 schemes and all the 10 regional offices across the country. Additionally, the Consolidated Premium Account (CPA) was established and all schemes directed to deposit their premium into the account.
Escalating claims cost has been a major threat to the sustainability of the scheme. During the year under review, the Claims Processing Center took up the processing of all claims from Volta Region and some selected facilities in Greater Accra and Ashanti Regions. NHIA also collaborated with MOH to get the prices of ACTs reduced contributing to decline in claims cost under the AMFm program. Prior to this collaborative effort, AMFm antimalarial constituted 20% of claim costs. After the intervention, it reduced to about 16%. Additionally, preparatory work towards the piloting of capitation in Ashanti Region as an additional provider payment mechanised continued. Major activities carried out included stakeholder meetings with providers, Parliamentarians and District Chief Executives in Ashanti Regions, and community durbars to explain the policy and to get their buy in. Enrolment of subscribers to their Preferred Primary Providers was completed to pave way for the commencement of the pilot in January 2012.
2011 ANNUAL REPORT
MP for Old Tafo, Dr. Anthony Osei Akoto contributing to the discussion at the stakeholders meeting on capitation in Kumasi
3.4 ICT AND DATA MANAGEMENT
As part of measures to strengthen ICT system and improve data integrity of the scheme, a proposal on biometric solution was submitted to Council for approval. ID card production time was reduced from three months to two weeks to relieve NHIS clients the challenge of waiting for long period for their cards. The re-location of data centre at the NHIA head office was completed and data is being managed by NHIA staff while maintaining a temporary data recovery site at the vendor site. Additionally, a software was developed for the implementation of capitation payment mechanism. The software was tested and rolled out in all public, Christian Health Association of Ghana (CHAG) and some selected private health facilities in Ashanti Region.
3.5 PROVIDER ACCREDITATION AND QUALITY ASSURANCE
The National Health Insurance Scheme Act, 2003 (Act 650) mandates 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 and the third batch carried out in 2010. Three batches of inspections were also carried out in 2011 during which 827 facilities were inspected out of which 795 were accredited. This brought the total accredited health facilities to 3344 as at the end of 2011 (see table 5 for details)
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Table 5: Accreditation results
NHIA ACCREDITATION- 2009-2011
SUMMARY OF ACCREDITED FACILITIES INDIVIDUAL INDIVIDUAL ACCREDITED ACCREDITED ACCREDITED ACCREDITED FACILITIES BY FACILITIES FACILITIES FACILITIES FACILITIES FACILITIES TYPE PER REGION FOR 2011 FROM 2009 TO FOR 2011 FROM 2009 2011 TO 2011
CHEMICAL SHOPS 47 222 ASHANTI 138 564 BRONG CHPS ZONE 261 960 AHAFO 72 336 CLINICS 86 272 CENTRAL 73 287 DENTAL CLINIC 1 7 EASTERN 70 415 DIAGNOSTIC GREATER CENTRES 13 37 ACCRA 99 380 EYE CLINIC 2 11 NORTHERN 45 311 HEALTH CENTRES 188 853 UPPER EAST 32 186 LABORATORIES 27 87 UPPER WEST 28 164 MATERNITY HOMES 29 215 VOLTA 112 287 PHARMACIES 62 297 WESTERN 126 414 PHYSIOTHERAPY 1 1 TOTAL 795 3344 POLYCLINICS 1 12 PRIMARY HOSPITALS 53 307 INDIVIDUAL ACCREDITED ACCREDITED FACILITIES FACILITIES FACILITIES BY GRADE SECONDARY FOR 2011 FROM 2009 HOSPITAL 1 11 TO 2011 TERTIARY HOSPITAL 0 1 GRADE A+ 2 8 ULTRASOUND 23 51 GRADE A 18 91 TOTAL 795 3344 GRADE B 189 689 GRADE C 356 1400 INDIVIDUAL ACCREDITED ACCREDITED FACILITIES FACILITIES FACILITIES BY FOR 2011 FROM 2009 TO OWNERSHIP 2011 GRADE D 218 1090 GOVERNMENT 436 1804 PROVISIONAL 12 66 MISSION 35 202 TOTAL 795 3344 QUASI-GOV'T 4 23 PRIVATE 320 1315 TOTAL 795 3344
3.5.1 Post accreditation monitoring
In August 2011, the NHIA developed Post Accreditation Monitoring Tools with the help of a team of experts from all the Health Professional Groups including Doctors, Nurses, Pharmacists, Midwives and Biomedical Scientists. The tools would be used to monitor providers with the view of ensuring that quality standards are maintained in all accredited health facilities.
23 2011 ANNUAL REPORT
3.6 ADMINISTRATION AND HUMAN RESOURCE
In order to improve staff efficiency, morale and welfare, management prepared and circulated a salary grading scale document among staff, rationalized and harmonized all staff salaries and distributed revised conditions of service and disciplinary code to all staff. Employees also benefited from training and capacity building programmes both locally and abroad. In all, 58 different training programmes were organised for a total of 1,146 participants (see annex 6). Proposal for the establishment of staff provident fund was approved by Council for implementation in 2012.
In response to the logistical needs of the organization, NHIA provided security at all Regional Offices of the Authority, installed GPS equipment on NHIS vehicles to track their movement, enforced guidelines for transporting people and ensured compliance with maintenance & certification schedule for all vehicles.
3.7 PLANNING, MONITORING, EVALUATION, RESEARCH AND DEVELOPMENT
The ten-member Technical Committee formed by NHIA management in September 2010 to develop the NHIA Medium Term Strategic Plan 2011-2014 continued its work. The document was finally approved by Council and would be circulated among all staff in the first quarter of 2012.
Weekly management meetings were held throughout the year to review activities and plan for ensuing weeks. As a way of measuring performance and charting the way forward, a management retreat was held to review the Authority’s performance during the year. Each Divisional Director made a
presentation and self-measurement of performance relating to 2010 performance contract.
Deputy Minister of Health Hon. Rojo Mettle-Nunoo addressing staff at the management retreat 2011 ANNUAL REPORT
Group photograph of NHIA Management staff after the 2011 management retreat at Sogakope
Besides routine monitoring and supervision by the regional office staff, the Operations Division embarked on support visits in nine regions, covering an average of five schemes and five provider sites. Also in line with NHIA mandate of monitoring private health insurance schemes, periodic monitoring activities were conducted in all licensed private health insurance schemes in the country.
During the year under review, investigations were conducted into membership registration on the Free Maternal Care Programme and availability of SP for Intermittent Preventive Treatment of Malaria in pregnant women. The new prescription forms were designed and piloted in ten facilities in Greater Accra Region. The NHIS medicines list was also reviewed.
3.8 PROJECTS AND PROCUREMENTS
The Head Office building was completed and duly commissioned by His Excellency, Prof. John Evans Atta Mills, the President of the Republic of Ghana. Construction of all 10 regional offices was at various stages of completion while processes for the award of contract for the construction of Chief Executive’s Duty Post had been initiated. Five (5) out of the ten (10) satellite offices had been completed and were in use. Three station wagon vehicles & four pick-up trucks were added to the fleet of vehicles.
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3.9 COMMUNICATION AND STAKEHOLDER ENGAGEMENT
As a measure to improve communication and strengthen collaboration with key stakeholders of NHIA, management carried out the following stakeholder engagement activities:
3.9.1 NHIS stakeholders’ forum
In line with its objective of strengthening collaboration with stakeholders, NHIA organised annual stakeholders’ forum from the 28th to the 29th June, 2011 at GIMPA in Accra. It was on the theme “Building Stakeholder Consensus towards Quality and Sustainability”. The forum was attended by the Minister of Health, Director General of Ghana Health Service, the Chairman of National Development Planning Commission, the NHIA Council members, members of Parliamentary Select Committees on Health and Finance, Development Partners, Christian Health Association of Ghana (CHAG), service providers (both private and public) NHIA management team, all managers at head office, regional managers and some scheme staff.
Chief Executive of NHIA answering questions at the function
The conference was aimed at soliciting views on the implementation process of NHIS. Management took the opportunity to present the NHIA draft strategic plan to stakeholders and solicited their comments to refine the document and to update stakeholders on developments within the National Health Insurance Authority. Broad areas covered during the forum included the NHIA strategic plan, Operations of the NHIA and NHIS, Sustainability of the NHIS among others. 2011 ANNUAL REPORT
World Bank Country Director, Dr. Daniel Kertesz contributing to the discussions at the meeting
Chairman of Parliamentary Select Committee on Health, Hon Mohammed Muntakah delivering a speech at the forum.
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3.9.2 Policy fair
NHIA participated in a five-day National Policy Fair held in Accra and regional fairs in the Volta, Ashanti, and Northern Regions. The purpose of the fair was to afford all Ministries, Departments and Agencies, (MDAs) as well as the Metropolitan, Municipal and District Assemblies, (MMDAs) the opportunity to showcase government policies, programmes and activities they are executing and to enable the general public have direct contact with officials of those MDAs and MMDAs. The National Health Insurance Authority mounted an exhibition to update the public on status of implementation of the scheme.
3.9.3 Public education on NHIS
A number of activities were undertaken to provide more information and education to help people to better understand the operations of the scheme. To this end, a thirteen-week media campaign was initiated with the aim of educating providers, clients as well as the general public about the activities of the NHIA and also to help them appreciate the roles they need to play to enhance their service experience and to help sustain the NHIS.
3.9.4 Publications
The semi-annual NHIA corporate magazine 2011 was produced and distributed to all staff and key stakeholders. Four NHIS brochures namely- a Guide to Registering and Accessing NHIS, Frequently Asked Questions (FAQ) about the capitation, handbills on NHIS accreditation and Clinical Audit were produced. 50,000 capitation brochures on Frequently Asked Questions were printed and distributed for use in the education campaign in the Ashanti region. The Capitation Enrolment Regulations produced by the Technical Sub-committee was also printed for distribution to providers and other stakeholders.
3.9.5 Media interaction
Media interaction was organised with the heads of Media houses and other Senior Journalists in August 2011.
28 2011 ANNUAL REPORT
Chief Executive of NHIA addressing the press at NHIA Auditorium
The interaction afforded the Authority the opportunity to provide the personalities with first hand information about the operations of the NHIS and to build cordial working relationship with the press. Participants took the opportunity to ask questions and to seek further clarification on issues.
A cross section of the press at the meeting 2011 ANNUAL REPORT
3.9.6 Oxfam report
In March 2011, a group of NGOs led by Oxfam of the UK and its three Ghanaian counterparts ISODEC, Essential Services Platform of Ghana and Alliance for Reproductive Rights, launched a research document titled “Achieving a Shared Goal: Free Universal Healthcare in Ghana” in which they made some cynical statements about Ghana’s National Health Insurance Scheme. The report generated debate in the media on the credibility of membership data.
Management responded by addressing the issues raised in the report. NHIA’s response was widely circulated in both print and electronic media with more than seven credible agencies publishing it on their website. NHIA also placed publication in four print media exclusively on disclaimers received from two renowned health experts whose names were cited in the Oxfam report.
3.9.7 Customer care
NHIA is very keen on addressing clients’ concerns. A Client Relations Unit was therefore set up under the Strategy and Corporate Affairs Division to ensure that clients concerns are given adequate attention. Subscribers made complaints in person at the head office (walk-ins), or via telephone calls and emails. These were subsequently documented manually and electronically. Client Relations Officers addressed complaints and provided support to subscribers for their renewals, registrations and acquisition of overdue NHIS ID cards. They also educated subscribers on the benefits package, Medicines List, Tariffs and Free Maternal Care policy amongst others.
Registration related complaints accounted for the highest number of complaints followed by provider issues.
30 2011 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 2011 over 8 million subscribers representing 33% of the population were active card bearing members of the scheme. The high patronage attests to the fact that Ghanaians have embraced the NHIS as the preferred health care financing mechanism.
4.2 HEAD OFFICE COMMISSIONING
NHIA Ultra Modern Head Office Building was officially commissioned on 13th October, 2011, by the President, His Excellency John Evans Atta Mills. The event was witnessed by a cross section of the public including Ministers of state, Members of Parliament, representatives of government agencies as well as NHIS subscribers and service providers. Donor agencies such as DANIDA, the World Bank and the World Health Organization were also represented.
H.E. Prof. John Evans Atta Mills, President of the Republic of Ghana, delivering the keynote address
In an address, the President lauded the strategic initiatives adopted by the NHIA to secure the sustainability of the scheme and pledged government’s continued support to achieve a sustainable Health insurance system for the country. A photo exhibition was mounted to showcase progress made since the inception of the NHIS. 2011 ANNUAL REPORT
The Chief Executive, NHIA presenting NHIS educational materials to H.E. Prof. John Evans Atta Mills President of the Republic of Ghana at the function.
4.3 LINKING TREATMENT TO DIAGNOSIS
NHIA completed the necessary processes for linking treatment to diagnosis as part of measures to minimise abuse and fraud in the system. This will be incorporated into the new claims module to facilitate electronic claims processing and inject efficiency into claims management and payment system. The project also seeks to ensure rational drug use and to contain cost.
4.4 COST SAVINGS INITIATIVES
The establishment of a Clinical Audit Division and strengthening of the Internal Audit Division in 2010 had resulted in huge cost savings to NHIS. During the year under consideration, Clinical audit alone recovered a total of GH¢2.7million from 203 service providers audited. The exercise was also expected to help in ensuring quality service delivery to NHIS members. Through effective and efficient claims processing, the CPC is able to make an appreciable cost savings by an average of 15% of claims submitted. Claims cumulative savings in 2010 and 2011 was GH¢17.3million. In 2011, a total of GH¢10million was saved representing 11% of claims submitted by service providers (Please refer to table 6 for details).
Table 6: Claims cumulative savings for 2010, 2011 NUMBER OF VALUE OF % YEAR CLAIMS CLAIMS VETTED AMOUNT ↓ADJUSTED SUBMITTED (GH¢) ADJUSTED (GH¢) 2010 1,114,743 40,298,894.86 7,216,684.61 18% 2011 3,555,092 91,592,579.24 10,109,048.08 11% COST SAVINGS: 17,325,732.69 2011 ANNUAL REPORT
Generally, the activities of the three divisions helped in reducing financial leakages and strengthened internal controls at both the district schemes and service provider ends.
4.5 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 had 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.
4.6 STUDY VISIT BY OTHER COUNTRIES
Ghana’s NHIS continues to serve as a model to many countries in Africa and beyond who aspire to embark on similar health policy goal of improving financial access to quality health care. This is testified by the number of countries who visited the scheme to understudy its operations for possible adoption in their respective countries.
Chief Executive of NHIA in a chat with Dr. Monwabisi Gantsh, the Chief Executive of Registrar of the South Africa Council for Medical Schemes(CMS)
Countries and organisations that undertook study visits included the Democratic Republic of Congo, Bangladesh, South Africa and United Nations, among others. There are also negotiations to invite staff of NHIA to some countries in Africa to assist in the initial set up of health insurance schemes. It is expected that the knowledge sharing and interaction will help reduce financial barrier to access health care in Africa and other countries in the developing world.
2011 ANNUAL REPORT
NHIA management in a group photograph with a delegation from United Nations University, Kuala Lumpur
4.7 INCREASED DONOR SUPPORT
There is growing financial and technical support to Ghana’s NHIS by the international community as a result of the confidence and interest they have in the system. During the year under consideration, the Danish Government through DANIDA provided US$32,000 and GH¢79,000 financial assistance for the training of all Public Relations Officers of District Schemes and M & E Officers (at the regional offices and selected staff at head office) respectively. DANIDA also agreed to provide technical assistance by engaging Strategic Planning, Monitoring and Evaluation Advisor to the NHIA for a period of two years. The selection and interview of candidates was completed and the successful applicant is expected to commence work in January 2012. Additionally, NHIA obtained a grant of US$ 44,000 from the Joint Learning Network to undertake a study visit to Health Insurance Schemes in India.
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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. Other challenges identified include demand and supply side moral hazards, non adherence to the gatekeeper system and efficiency challenges.
5.2 IDENTIFICATION OF THE POOR IN THE INFORMAL SECTOR
The national health insurance scheme is a pro-poor programme that focuses 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 is therefore collaborating with officials managing the LEAP programme to identify as many poor people as possible for health insurance coverage. Other methods of targeting the poor for exemption are also being 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, arising from 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. Even though there has been considerable improvement in ID card distribution in Ashanti Region following a successful piloting programme in the region, the intervention is yet to be rolled out across the country.
5.4 ICT
There are constraints with the ICT system which need to be addressed. They 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.
35 2011 ANNUAL REPORT
6.0 OUTLOOK FOR 2012
In 2012, steps will be taken to increase coverage, 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: Various cost containment measures will be rigorously pursued to minimise leakages. These will include: i. Strengthening the operationalisation of the Consolidated Premium Account by intensifying monitoring at the scheme level. ii. Intensifying Clinical Audits in collaboration with provider groups. iii. Piloting Capitation in Ashanti Region as an alternative payment mechanism. Management will also commence nationwide rollout of Preferred Primary Care Provider enrolment as an initial step towards nationwide rollout of capitation. iv. Collaborating with providers and subscribers to enforce the gatekeeper policy of the Ministry of Health. v. Operationalising linking treatment to diagnosis to improve rational use of medicines. vi. Implementing uniform prescription forms to promote rational prescribing. vii. Intensifying mystery shopping to identify inefficiencies and abuse in the entire NHIS system for redress.
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, NHIA will identify additional high yield and relatively safe investment opportunities, do risk profiling of banks/institutions to minimize investment risk, develop Fund Management Procedural Manual and report Investment Performance periodically.
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, and collaborate with stakeholders to increase the value derived from these sources. Sources to be considered include petro-chemical levy, ‘sin tax’, DVLA, NHIL increase.
36 2011 ANNUAL REPORT 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). Ongoing collaboration and discussions with DANIDA for both financial and technical assistance will continue. Additionally, the Health Insurance Project (HIP) supported by the World Bank is expected to maintain support for the strengthening of the purchasing policies and mechanism, and the integrated claims management systems.
6.2 INCREASE ACTIVE MEMBERSHIP TO 40% OF THE POPULATION
NHIA will intensify membership mobilization in order to increase active membership to 40% by the end of the year 2012. Specific activities planned to meet the set target will be to support special registration exercise, train scheme and regional staff on the process of implementation of 1TP, and monitor adherence to standards. Other activities to increase coverage are to support the registration of indigents, LEAP beneficiaries, inmates of psychiatric hospitals, leprosaria and orphanages.
6.3 STRENGTHEN THE NHIS ICT
As part of measures to improve the performance of ICT platform, management will upgrade the data centre, increase the capacity of the WAN (bandwidth) and set up systems in the new regional and satellite offices.
To enhance the integrity of the membership database, the NHIS will embark on a database cleaning process by incorporating biometric features into its applications. Biometric registration will commence by the 4th quarter of 2012. As a step towards ensuring accountability in premium mobilisation, NHIA will install mobile registration, payment and authentication system. NHIA will set up e-claims solution alongside the introduction of instant ID (smart card) with biometric data.
6.4 PROMOTE QUALITY IMPROVEMENT IN SERVICE PROVIDER FACILITIES
To further improve the quality of services accessed by members in the national health insurance system, a training programme will be conducted for Accreditation Surveyors on the application of reviewed accreditation tools and to sensitize Regional Office staff and Scheme Managers on the accreditation process. The post accreditation tools developed in 2011 will be used to monitor providers to ensure that standards are maintained. A further 500 health care facilities will be inspected in 2012.
6.5 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. Activities of high impact identified in the claims management process in 2012 will include operationalising the claims processing software, rolling out of e-claims submission nationwide, implementing national claims register and the setting up of the second CPC in the Northern Region. To improve claims management
37 2011 ANNUAL REPORT process at the scheme and provider level, NHIA will conduct claims processing and submission training for providers and schemes and implement an M&E system for quality control.
6.6 IMPROVE ID CARD MANAGEMENT
In 2011, management piloted a new ID card distribution system in Ashanti region and the outcome of the intervention showed improvement in ID card distribution in the region. In 2012, the pilot will be rolled out in the three northern regions. The internal processes in ID card management 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.
6.7 HUMAN RESOURCE CAPACITY AND ORGANISATIONAL REFORMS
6.7.1 Attracting, developing and retaining relevant human resource
The NHIA will continue to 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.
Other initiatives to be undertaken include implementation of job evaluation report and setting up of the Provident Fund. Management will also develop job rotation plan, succession plan and obtain approval to right-size staff levels at Schemes. Management will further rationalize staff placement and compensation, improve conditions of service and staff retention and develop proposal for staff recognition. Staff satisfaction survey will be conducted periodically to assess staff concerns for redress.
6.8 COMMUNICATION AND MARKETING STRATEGIES
6.8.1 Internal and external communication
Strenuous efforts will be made to improve communication with both internal and external publics of the scheme. Management will therefore use a combination of communication tools and methods to effectively market the scheme. 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:
a. Preparation and submission of monthly snapshot reports to the Ministry of Health, Parliamentary Select Committee on Health (PARSCOM/Health) and to the NHIA Council b. Quarterly presentations/interaction with parent Ministry, Ministry of Information and other relevant MDAs c. Quarterly press interactions d. Semi-annual staff durbars e. Semi-annual interaction with the Press f. NHIS Stakeholder meeting in the third quarter.
38 2011 ANNUAL REPORT
g. Advertise in the national dailies claims payments made in favor of service providers h. Facilitate interviews, radio discussions and talk shows to promote capitation pilot in Ashanti Region i. Facilitate the conduct of public education including community durbars in all districts j. Round table meetings to discuss major policies of the scheme
The call centre will also be launched 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 2012 and beyond, management will re-engineer the NHIS website to match up to the task and to give the NHIS a reputable global image. NHIS will do some publications in international journals, attend conferences and workshops to share experiences with the global community.
Management will 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.
7.0 CONCLUSION
The introduction of NHIS since 2003 has been a big relief to many Ghanaians who would have otherwise been denied access to basic health care service due to financial challenges. This has been made possible through committed and dedicated staff at both NHIA and the scheme level.,
Notwithstanding the challenges facing the schemes, Ghana’s NHIS serves as a beacon of hope and a model to many countries who want to embark on health system reforms. This is amply demonstrated in many countries and international organizations visiting the scheme in 20l1. Also, the enormous support provided by development partners in the implementation of the scheme is refreshing. Indeed, the numerous strategies and cost containment measures instituted by the leadership in 2009 are yielding positive results and thus provide hope of a sustainable scheme.
In the years ahead, management is determined to consolidate the gains made and introduce more innovative initiatives to enable the scheme achieve its strategic intent of building a scheme that stands out as a model in Africa and beyond, providing affordable, accessible and quality health care services for all residents in Ghana.
39 2011 ANNUAL REPORT
ANNEXES
40 2011 ANNUAL REPORT
ANNEX 1: Financial Statement NHIA FINANCIAL STATEMENT (UNAUDITED)
NATIONAL HEALTH INSURANCE AUTHORITY REVENUE AND EXPENDITURE ACCOUNT For The Year Ended 31st December 2011
REVENUE Note 2011 2010
NHIL Levies 2 449.96 314.84 SSNIT Contribution 107.61 87.01 Investment Income 31.87 58.80 Premium 27.66 - Sundry Income 0.57 0.31 617.67 460.96 RECURRENT EXPENDITURE
Claims Incurred to Service Providers 549.77 397.71 Support to Partner Institutions 3 48.28 76.19 Social Intervention Program 92.08 - Admin. & Logistical Support to Schemes 19.55 11.53 NHIA Operational Expenses 4 31.37 22.34 I.D. Card Production 9.62 11.84 Depreciation 5 13.40 11.72 764.07 531.33
Excess of Recurrent Expenditure over Revenue (146.40) (70.37)
BALANCE SHEET 41 2011 ANNUAL REPORT
As at Year Ended 31st December 2011
Notes 2011 2010
NON-CURRENT ASSETS Property, Plant & Equipments 5 40.63 46.33
INVESTMENTS 6 152.36 284.49
CURRENT ASSETS NHI Levies Receivables 229.44 176.71 Interest Receivable 9.30 15.71 Claims Prepayment – Capitation 2.12 - Other Receivables 7 4.76 1.15 Cash & Bank 8 50.31 13.55
Total Current Assets 295.93 207.12
TOTAL ASSETS 488.92 537.94
ACCUMULATED FUNDS & LIABILITIES
Liabilities Claims Payable 121.74 114.56 Payable to Partner Institutions & others 9 26.53 41.32 Bank Loans 105.00 -
Total Liabilities 253.27 155.88
Accumulated Funds 382.06 452.43 Excess Expenditure over Income (146.41) (70.37)
Net Accumulated Funds 235.65 382.06
TOTAL ACCUMULATED FUND & 488.92 537.94 LIABILITIES
CASHFLOW STATEMENT
42 2011 ANNUAL REPORT
For The Year Ended 31st December, 2011 Notes GH¢’ million GH¢’ million
Cashflow from Operating Activities
Excess Expenditure over Income (146.41)
Adjusting for Non-cash item
Provision for Depreciation 13.40
Increase in Accounts Receivable (49.93)
Increase in Prepayment (2.12)
Increase in Claims Payable 7.18
Decrease in Other Payables (14.79) (46.26)
(192.67)
Cashflow from Investing Activities
Proceeds from Disinvestments 132.13
Purchase of Fixed Assets (7.70) 124.43
Cashflow from Financing Activities
Bank Loans 105.00
Changes in Cash & Cash Equivalent 36.76
Analysis of Changes in Cash & Cash Equivalent During the Year Balance as at Jan-1, 2011 13.55
Changes in Cash & Cash Equivalent 36.76
Balance as at Dec-31, 2011 50.31
Analysis of Cash & Cash Equivalence As Shown in the Balance Sheet Cash 0.01
Bank 50.30
50.31
NOTES FORMING PART OF THE ACCOUNTS
43 2011 ANNUAL REPORT
NOTE 1 - ACCOUNTING POLICIES
1.1 Basis of Preparation
The principal accounting policies applied in preparation of these accounts are set out below:
The Financial statements have been prepared on a historical cost basis. The statements are also prepared in accordance with Ghana Accounting Standards issued by the Ghana National Accounting Standards Board (GNASB), companies codes 1963 (Act 179), and in compliance to National Health Insurance Act 650.
The accounting policies have been applied consistently throughout the period.
1.2 Revenue
Revenue is recognized to the extent that it is probable that the economic benefits will flow to the Authority and can be reliably measured. Revenue is measured at the fair value of the consideration received or fair estimate of the amount receivable.
The main revenue for the Authority are the following; the 2.5% national health insurance levy, 2.5% social security contribution, income from investment and premium from subscribers.
1.3 Investments
Investment in fixed deposits is valued at cost plus interest reinvested. Investment in any other financial instrument is valued at market price.
Interest earned on investment are accrued and recognized as revenue in the account.
1.4 Accounts Receivable
Accounts receivable are carried at anticipated realizable value. However receivable accruing from NHI levy is stated at full value per the collection reports issued by the Ghana Revenue Authority.
1.5 Foreign Currencies
Transactions in foreign currencies during the year are translated into Ghana cedis at prevailing rates at the time of the transactions. Monetary assets and liabilities denominated in foreign currencies at the balance sheet date are translated into Ghana cedis at the rates of exchange ruling on that date. The differences resulting from the translation are dealt with in the income statement in the period in which they arise.
1.6 Property, Plant & Equipment
44 2011 ANNUAL REPORT
Property, plant and equipment are stated at cost less accumulated depreciation. The cost of an asset comprises its purchase price any direct attributable costs of bringing the assets to working condition for its intended use.
Expenditure on its repairs and maintenance are charged to the income statement.
1.7 Depreciation
Property, plant and equipment are depreciated from the date of purchase on straight line basis at fixed annual rates over the estimated useful life as follows;
• Land & Buildings -5% • Nationwide ICT Infrastructure -25% • Computers & Accessories -25% • Office Equipments -20% • Furniture & Fittings -25% • Motor Vehicle -20%
At the end of each reporting period, the Authority checks whether there is any indication that any of its tangible assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss, if so, its amount.
If there has been any impairment loss, the asset is written down to its recoverable amount, with the loss charged to the statement of performance.
1.8 Expenditure
Expenditure on support to schemes and partner institutions are recognized when the Authority has paid or has obligation to transfer funds to the schemes and other beneficiary institutions. Other operating expenses are recognized when, and to the extent that, the goods and services have been received.
1.9 Taxation
The Authority is not liable to corporation tax. Expenditure is shown inclusive of irrecoverable VAT. The
NOTE 2 - NHIA LEVIES
45 2011 ANNUAL REPORT
GH¢ ’million GH¢’million 2011 2010
CEPS 282.56 182.73 VAT 167.40 132.11 449.96 314.84
NOTE 3 - SUPPORT TO PARTNER INSTITUTIONS GH¢ ’million GH¢’million 2011 2010
Primary Health & Preventive Care 33.67 47.90 District Health Projects 7.85 7.76 Health Service Investments 6.75 20.53 48.25 76.19
NOTES 4 - NHIA OPERATING EXPENDITURE
GH¢ ’million GH¢’million 2011 2010
Staff Emolument & Allowances 9.84 6.81 Other Allowances 0.44 0.24 Staff Training 1.45 0.75 Council Fees & Allowances 1.10 0.46 Allowances- Health Select Cttee 0.77 0.27 Maintenance 0.20 0.16 Utilities 0.47 0.32 Printing, Publication & Stationery 5.47 0.28 Monitoring & Evaluation 0.32 0.14 Travelling Allowances 1.26 1.36 Audit Fees -accrued .274 0.35 0.29 Consultancy & Technical Assistance 0.25 0.86 Financial Charges 0.36 1.64 Publicity & Business Promotion 0.84 0.82 Data Center Management & Maintenance 5.66 6.07 Vehicle Running Cost 0.37 0.31 Conferences & Meetings 0.34 0.38 Tariff & Review of Drug List 1.00 0.01 General Expenses 0.67 0.58 Rent 0.21 0.54 31.37 22.29
NOTES – 5 PROPERTIES, PLANT & EQUIPMENT
46 2011 ANNUAL REPORT
Nation Office Computers Office Office Furniture Total wide Land & & Access Equipment Vehicles And ICT Buildings Fittings
Cost Balance b/d 43.05 11.98 0.40 0.79 1.02 1.88 59.12 Additions 1.80 3.18 2.32 0.04 0.22 0.14 7.70 Balance c/d 44.85 15.16 2.72 0.83 1.24 2.02 66.82
Depreciation Balance b/d 10.76 - 0.36 0.28 0.56 0.83 12.79 Charge 11.21 0.57 0.69 0.16 0.25 0.52 13.40 Balance c/d 21.93 0.57 1.05 0.44 0.81 1.34 26.19
Net – 31/12/11 22.92 14.59 1.78 0.55 0.64 0.68 40.63
Net – 31/12/10 32.29 11.98 0.04 0.51 0.46 1.05 46.33
NOTES -6 INVESTMENTS GH¢’ million GH ¢million 2011 2010
Access Bank 10.00 - Agricultural Development Bank 5.34 - Bank of Africa 6.44 48.92 CAL Merchant Bank 16.04 17.15 CDH Securities 2.00 2.00 Ecobank Ghana 8.45 14.81 Fidelity Bank 10.70 13.06 First Atlantic Merchant Bank 4.39 8.52 HFC Bank - 1.13 Intercontinental Bank 13.72 27.28 Merchant Bank 5.00 9.48 National Investment Bank 22.02 15.00 Prudential Bank 4.29 4.29 Unibank Ghana Limited 7.13 6.23 Unique Trust Bank 7.36 6.40 Zenith Bank 29.47 53.00 Promissory Notes - 57.21 TOTAL 152.35 284.48
NOTES -7 OTHER RECEIVABLE
47 2011 ANNUAL REPORT
GH¢’ million GH¢’million 2011 2010 Prepayments 1.42 0.22 Staff Car Loan 0.54 0.60 Interest Debtors 0.21 0.21 Health Insurance Project 1.08 - Ministry of Finance- Fees on Syndicated Loan 1.31 - Sundry Receivable 0.20 0.04 4.76 1.07
NOTES- 8 BANK & CASH GH¢’million GH¢’million 2011 2010 BANKS Bank of Ghana - 0.81 Ghana Commercial Bank 28.13 (6.51) Ecobank Ghana 4.32 1.45 Merchant Bank 0.68 0.68 Bank of Africa 2.96 7.96 Intercontinental Bank - 5.00 HFC Bank 0.08 0.01 Stanbic Bank 4.09 4.10 Energy Bank 5.00 - Agricultural Dev. Bank 1.29 - Access Bank 3.69 - CAL Bank 0.03 0.03 50.30 13.53 CASH 0.01 0.02
Total 50.31 13.55
NOTES- 9 ACCOUNTS PAYABLE GH¢’million GH¢’million 2011 2010
Ministry of Health- Primary Health Care 14.77 20.65 Ministry of Health – Health Service Investment 3.00 10.02 Parliamentarians – District Health Project 1.10 1.64 SSNIT 0.41 0.73 Ghana Revenue Authority 0.06 0.11 Premium Deposit 1.33 1.21 STL 0.81 3.86 Accrued Expenses 3.27 1.68 Sundry Payables 1.78 1.42 26.53 41.32
48 2011 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
5. Maternity Care A) Antenatal Care B) Deliveries; namely, normal and assisted
49 2011 ANNUAL REPORT
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
50 2011 ANNUAL REPORT
ANNEX 3: Unit heads and managers
UNIT HEADS AND MANAGERS
# NAME DIVISION POSITION 1 Amadu Ali Claims Claims Manager Strategy & Corporate Planning and Programming 2 Collins Danso Akuamoah Affairs 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 Iddrisu Hudu Claims Claims Manager 11 Isaac Marful Dapaah ICT ICT Applications Manager 12 Ismail Osei Clinical Audit Clinical Nurse 13 Maxwell Addico Internal Audit I.T. Auditor 14 Constance Addo-Quaye (Mrs) Clinical Audit Pharmacist 15 Nicholas Afram Osei Claims Senior Claims Manager 16 Nii Anang Adjetey (Dr.) Strategy & Corporate Communications Manager Affairs 17 Prince Debrah Internal Audit Audit Manager 18 Rebecca Akatue (Mrs.) Operations Operations Manager 19 Stella Adu-Amankwa (Mrs.) Strategy & Corporate Publications Manager Affairs 20 Stephen N. Bewong Claims Business Systems Manager 21 Thomas Adoboe ICT IT Infrastructure Manager 22 Vivian Addo-Cobbiah (Mrs.) Operations Accreditation & Quality Manager 23 Gloria Lamptey (Mrs) Procurement & Projects Procurement Manager 24 Washington Komla Darke Finance Fund Manager 25 Raphael Segkpeb Admin &General Counsel Admin Manager 26 Sarfo-Kantanka Appiah Claims Pharmacist 27 Marguerita Tailor Plange Strategy & Corporate Ag. Client Relations Affairs Manager 28 Joseph Annor ICT Ag. Business System Manager
51 2011 ANNUAL REPORT
ANNEX 4: Regional Managers
# NAME REGION 1 Emmanuel Baah Danquah 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
52 2011 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
53 2011 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
54 2011 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
55 2011 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
56 2011 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
57 2011 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
58 2011 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
59 2011 ANNUAL REPORT
ANNEX 6: Training programs organised in 2011 PROGRAM NO.
NUFFIC 1. Training of Trainers 10 FUNDED 2. Leadership & Management Program 27 TRAINING 3. Customer Care Training 37 4. Performance Management Workshop 60
Sub Total 134 OTHER A. LOCAL 5. Creating An Effective Public Relations Strategy 6 TRAINING 6. Managing Discipline in an Organization 4 7. WAN & LAN Training 2 8. Refresher Training for Accreditation Supervisor 5 2 9. Professional Front Desk Executive
10. Pharmacoeconomics: Evidence, Money & Selection of Medicines 7 11. Marketing & Management Development Professor Collin Gilligan in Ghana 19th-23rd June 3 12. Data Management & Analysis 4 13. Seminar: Occupational & Personal Pension Scheme (General) Regulations, 2011 1 14. Procurement Training 1 15. Insurance Training 1 16. Customized Training In M & E For Staff Of NHIA 30
17. Annual Report Writing & Understanding Financial 2 Statements 7 18. ICT Security Training 19. Best Practices In file Managements 4 20. Best Practice in Asset & Property Management 4 21. Data 1 22. CCTV Control Room Operations and Officers Course 1 23. Enterprise Risk Management 29 24. Internal Control & Auditing 2
Sub Total 116 B.
25. Clinical Audit Workshop 84 26. Workshop on Procurement 23 27. Workshop on Consolidated Premium Account for Greater Accra Region 27 28. Workshop on Consolidated Premium Account for Eastern Region 44 29. Workshop on Consolidated Premium Account for Volta Region 36 30. Fire Management 90 31. NHIA ID Card Mgt. Training 84 32. Enterprise Risk Management 25 33. Sensitization on Gate Keeper & MOH Policy & Guidelines 347 34. M & E Tool Training 23 35. Effective Customer care a s Tool for Successful Businesses 25
60 2011 ANNUAL REPORT
36. Performance Management System (PMS) Training 26 Sub Total 834 EXTERNAL TRAINING 37. Drafting & Implementing Commercial Contracts 2 38. Leadership Course on Frontiers for Development 1 39. Health Leadership Forum 7 40. Conf. Meeting the Challenges Faced by Emerging Countries in The Provision of Quality Primary Health Care. 4 41. Board Chairmen, Chief Executives, Directors & Board Secretaries Programme 4 42. Learning’s from Kaiser Permanente Model 1 43. Annual Health Conference 2 44. Towards Universal Health Coverage in Africa 3 45. Follow Up meets to: Challenges Faced by Emerging Countries in The Provision of Quality Primary Health Care. 1 46. IT Governance: Principles, Tools and International Standards 2 47. ILO Conference 1 48. Workshop: Expanding Coverage of the Informal Sector 2 49. Investment Appraisal & Risk Analysis 1 50. International Health Economics Association: 8th Congress 4 51. 2nd Annual Strategic HR Forum 2 52. Health Insurance Portability Act (HIPAA) 1 53. Public Sector Financial Management 3 54. Industrial Relations – Cornell 2 55. Improving the Quality of Health Service 4 56. Management Development Skills for Secretaries & Office Administrators 2 57. Risk Based Internal Auditing 2 58. Forces of Change & Process Improvement in Health Care 2
Sub Total 67 SUMMARY Nuffic Funded Training 134 Other Local Training A 116 Other Local Training B 834 External Training 67 GRAND TOTAL 1146
61 2011 ANNUAL REPORT