2010 ANNUAL REPORT TABLE OF CONTENTS TABLE OF CONTENTS ..................................................................................................................... i LIST OF ACRONYMS ...................................................................................................................... iii VISION, MISSION AND CORE VALUES ....................................................................................... 1 PROFILE OF DIRECTORS ............................................................................................................... 6 CHAIRMAN’S ACKNOWLEDGEMENT ........................................................................................ 9 REPORT OF CHIEF EXECUTIVE.................................................................................................. 10 1.0 INTRODUCTION ....................................................................................................................... 13 1.1 GOVERNANCE ..................................................................................................................... 13 1.2 MANAGEMENT .................................................................................................................... 13 1.3 NHIS VALUE CHAIN ........................................................................................................... 13 2.0 CORPORATE GOALS AND OBJECTIVES ............................................................................. 15 2.1 CORPORATE GOALS ........................................................................................................... 15 2.2 CORPORATE OBJECTIVES FOR 2010-2014...................................................................... 15 3.0 OPERATIONAL ACTIVITIES .................................................................................................. 15 3.1 SUSTAINABILITY AND COST CONTAINMENT ............................................................. 15 3.2 MEMBERSHIP AND ID CARD MANAGEMENT .............................................................. 16 3.2.1 Membership trend ............................................................................................................. 16 3.2.2 Special registration exercise ............................................................................................. 18 3.2.3 Free maternal health care ................................................................................................. 19 3.2.4 ID cards production and distribution ................................................................................ 20 3.3 CLAIMS MANAGEMENT .................................................................................................. 21 3.3.1 Outpatient utilization ........................................................................................................ 21 3.3.2 Inpatient utilization ........................................................................................................... 21 3.3.3 Claims payment trend ....................................................................................................... 22 3.4 ICT AND DATA MANAGEMENT ....................................................................................... 23 3.5 PROVIDER ACCREDITATION AND QUALITY ASSURANCE ...................................... 23 3.5.1 Collaboration .................................................................................................................... 24 3.6 ADMINISTRATION AND HUMAN RESOURCE ............................................................... 25 3.7 PLANNING, MONITORING, EVALUATION, RESEARCH AND DEVELOPMENT ...... 25 3.8 PROJECTS AND PROCUREMENTS ................................................................................... 25 3.9 COMMUNICATION AND STAKEHOLDER ENGAGEMENT .......................................... 26 3.9.1 Stakeholder engagement ................................................................................................... 26 3.9.2 Policy fair ......................................................................................................................... 26 3.9.3 End of year get-together and awards night ....................................................................... 26 3.9.4 Media engagement ........................................................................................................... 27 4.0 ACHIEVEMENTS ...................................................................................................................... 29 4.1 INCREASED COVERAGE .................................................................................................... 29 4.2 UNDP/WHO EXCELLENCE AWARD ................................................................................. 29 4.3 FINANCIAL AND CLINICAL AUDITS .............................................................................. 29 4.4 REVIEW OF MEDICINES LIST ........................................................................................... 30 4.5 ACCREDITATION OF HEALTH FACILITIES ................................................................... 30 4.6 IMPROVED REIMBURSEMENT TO PROVIDERS ........................................................... 31 4.7 GATE-KEEPER SYSTEM AND FREE MATERNAL CARE PROGRAMME ................... 31 4.8 RISK ASSESSMENT ............................................................................................................. 31 5.0 CHALLENGES ........................................................................................................................... 32 5.1 FINANCIAL SUSTAINABILITY OF THE SCHEME ......................................................... 32 5.2 IDENTIFICATION OF THE POOR IN THE INFORMAL SECTOR .................................. 32 5.3 ID CARD MANAGEMENT ................................................................................................... 32 5.4 ICT ........................................................................................................................................... 32 5.5 CLAIMS MANAGEMENT .................................................................................................... 32 i 2010 ANNUAL REPORT 6.0 OUTLOOK FOR 2011 ................................................................................................................ 33 6.1 ENHANCE FINANCIAL SUSTAINABILITY OF THE NHIS ............................................ 33 6.1.1 Defensive Strategy: .......................................................................................................... 33 6.1.2 Prudent fund management: ............................................................................................... 33 6.1.3 Sourcing Strategy: ............................................................................................................ 34 6.2 STRENGTHEN THE NHIS ICT ............................................................................................ 34 6.2.1 ICT deployment ................................................................................................................ 34 6.2.2 ICT governance ................................................................................................................ 34 6.2.3 Data integrity .................................................................................................................... 34 6.3 PROMOTE QUALITY IMPROVEMENT IN SERVICE PROVIDER FACILITIES ........... 35 6.4 STRENGTHEN CLAIMS MANAGEMENT ......................................................................... 35 6.5 IMPROVE ID CARD MANAGEMENT ................................................................................ 35 6.6 HUMAN RESOURCE CAPACITY AND ORGANISATIONAL REFORMS ..................... 35 6.6.1 Attracting, developing and retaining relevant human resource ........................................ 35 6.6.2 Organizational reforms ..................................................................................................... 36 6.6.3 Ghana Health Insurance Institute ..................................................................................... 36 6.7 Communication and marketing strategies ............................................................................... 36 6.7.1 Internal and external communication ............................................................................... 36 6.7.2 Communication with service providers ............................................................................ 37 7.0 CONCLUSION ........................................................................................................................... 38 ANNEXES ............................................................................................................................................ 39 ANNEX 1: Financial Statement .................................................................................................... 40 ANNEX 2: Minimum health care package under NHIS ............................................................... 43 ANNEX 3: Unit heads and managers ............................................................................................ 45 ANNEX 4: Regional Managers ..................................................................................................... 46 ANNEX 5: Directory of district mutual health insurance schemes .............................................. 47 ANNEX 6: Training programs organised in 2010 ........................................................................ 54 List of Figures Figure 1: NHIS Value chain .............................................................................................................