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