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NPP flagbearer lays out health policy; read it here - NHIS CAPITATION

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The chaos that followed the decision by this NDC government to introduce the capitation method of payment in the Ashanti Region has been well documented and is fresh in all our minds. This most populous region was a poor choice for a pilot program, and it shows in the results. Subscriber confidence has been reduced. There is reduction in active membership in all schemes and in some schemes, as much as 80% in the first 3 months of implementation. Premiums collected from subscribers were reduced by as much as 35.5% for the period January –July 2012 as compared to the same period for 2011.

The private health providers, who form the bulk of the health service delivery in the region, withdrew from the scheme. Some re-joined in April when some of their concerns were addressed, making it clear that there had not been enough stakeholder consultation and education throughout the process. This brought unnecessary hardship and confusion to the subscribers and providers. It impacted the health of the people of the region. Most health institutions in the Ashanti Region have been forced to introduce what is called a Co-Payment -- or to call it by its real name, Cash & Carry -- through the back door.

Capitation, as the pilot project in the Ashanti Region has shown clearly to all Ghanaians, has failed. But we discover the NDC is not quite finished- they are promising more chaos and more suffering for subscribers to the scheme instead of quietly withdrawing capitation. The NDC Manifesto calls for the expansion of capitation! Yes, you heard right. At page 23 of their 2012 Manifesto, they are threatening to bring it back in a big way. It reads “In the next four years, the NDC government will… roll out capitation nationwide.” Yes, that is what the NDC is promising. Fellow citizens, the NDC intends to spread the ills of capitation to every corner of the country if re-elected into office. Call it a timely warning because we cannot claim we have not been warned. The ruling party is sending out a clear message to the Ghanaian voter: ‘The NDC Can Be Dangerous to Your Health’. Vote for NDC and pray you don’t fall sick for another 4 years. Ladies and gentlemen, this is too high a risk to take, if you ask me. The NHIS is not safe in NDC hands.

The NDC either does not believe in national health insurance, or they are incapable of operating the scheme successfully. Both of them are unacceptable. Today, the scheme is to all intents and purposes bankrupt. In 2008, under the NPP, the NHIS was a net lender to Ghanaian banks. Now it is a net borrower; and as at December 31, 2011, the scheme owed the banks GHC105 million.

They have had four years to operate the one-time premium policy, and have been unable to implement it. The Capitation system of payment has been shown to be a disaster and will collapse the scheme. Ladies and Gentlemen, when the NPP is voted into office on December 7, God willing, we will inject new life into the scheme and rebuild the confidence of the service providers and the clients. We believe in it and we will make it work. We must save our health system to keep our people healthy.


But, in order for the NHIS to deliver, we must have well trained nurses, midwives, health technicians, pharmacists, doctors and other allied health workers in sufficient numbers serving with job satisfaction. We shall increase the capacity of the institutions that train health workers; we have done it before. Under President J A Kufour, all the existing health training institutions were expanded and new ones established across the country. Some private health training institutions were also established. Intake for Diploma Nurses, for example, was increased from 968 in 2000 to 7,068 in 2008. Community Health Nursing intake increased from 500 to 2,214 in 2008. To improve skills in the nursing profession, the health care assistant training program was established and a number of Health Assistant Training Institutions were also put up across the country. Intake into such institutions increased from 477 in 2006 to 2,541 in 2008. This did not happen by accident. We will expand health facilities and train more of our health workers to attend to the sick. There are lots and lots of young people who want to become nurses, we need lots and lots of nurses, we will make it possible for them to train as nurses. Our priority will be to train our doctors locally. We will expand existing medical schools and establish a National Institute for Biomedical Sciences, where medical students will have their basic sciences and this will make it possible to increase the intake of the medical schools.

At a time when Ghanaian students on government scholarships across the world are crying for their fees and allowances to be paid, and at a time when students at our nursing training colleges are crying against the sudden 100% hikes in fees, the NDC government, under an opaque scheme, operated by then Vice President Mahama, found GH¢160 million to send people to Cuba to be trained as doctors. The Cubans still insist it was a scholarship scheme. If so, then it is most expensive. The cost of this translates into GH¢106,000 per year for each of the 250 Ghanaians sent to Cuba. On the other hand, the cost of training a Ghanaian doctor in Ghana is a fraction of that, at just GH¢30,000 annually, according to the Ghana Medical Association. Can you imagine what the UDS Medical School, for example, would have done with just a third of this GH¢160 million investment over the next five years? We shall invest in our own medical schools to train more doctors locally.


In line with our primary healthcare policy, the NPP will ensure that every village or deprived community has access to a Community Nurse to provide the primary healthcare that often makes the difference between life and death. These Community Nurses, with a small and basic surgery, will be responsible for basic public health education and primary healthcare.


There are simply not enough specialists and facilities to serve patients, especially in rural and remote communities. To solve this problem, we need to think outside the box. The next NPP government will, therefore, revolutionise the concept of taking healthcare closer to patients’ homes with the use of mobile theatres and mobile clinics. The use of mobile units will mean we can, through a shift system, send the best of our medical personnel and the state-of-the-art facilities to patients in a way that mitigates the need for capital spending, whilst allowing the best of medical care, including surgical operations, to be deployed across the nation in a way that is responsive to local needs. With mobile theatres, the next NPP government will seek to deliver thousands of cataract operations and other such treatments nationwide.


It is time that we took the bold step of establishing a number of world-class referral hospitals and medical centres of excellence in our country. Prof Frimpong Boateng, with the successful Cardio-Thoracic Centre in Korle Bu, has taught us that these can become income-generation ventures, as well. The next NPP government will introduce policies to promote Ghana as a centre of medical tourism in Africa. We will assist those already doing so in the private sector to do more. This would not only help to provide a satisfactory working atmosphere for our specialist doctors, it would attract many doctors to come and work in Ghana, and would help turn our country into an attractive health tourism destination.


Ghana has a successful local pharmaceutical industry, which deserves special attention from government. My government would help them to serve our people well and become more competitive in the international market. We will borrow from the experiences of India and elsewhere to become the masters of this lucrative industry. Under the NDC, what we have seen in recent years are measures that are counterproductive to the growth of the local industry, with Facility Audit Fees, for example, going up from $7,000 in 2008 to $15,000. At the same time, the Food & Drugs Board has seen its share of the national budget decreasing in real terms. We will change this as part of our policy to focus more on preventive and primary health care.


In our efforts to enhance the quality of care, the NPP will create an ombudsman with the power to investigate and support complaints from patients in both public and private hospitals.


As part of our efforts to build a society of opportunities for all, we shall actively promote the provision of facilities for persons with disabilities and invest more public funds to ensure their proper integration to enable them achieve their potential in life. I will ensure that the provisions in the Persons With Disability Act, 2006, Act 715 are implemented. I must here declare a personal interest; this is one of the laws that I feel a personal attachment to, having started work on it as Attorney General. Ghana cannot afford to ignore the contributions of the many talented people in the society simply because they are disabled. The likes of Prof Bashirudeen Koray of the Ministry of Justice, a blind lawyer, whose appointment I had the honour of approving as Attorney General, bear testimony to what persons with disability can do in a society where all have an equal opportunity of exploiting existing opportunities and contributing to the creation of new, exciting ones.


One of the greatest challenges we have in the health sector is in the area of mental health. There is an alarming shortage of psychiatrists and mental health practitioners in general. There are said to be only five specialist psychiatrists in the public health system and this means that every mental health problem rapidly deteriorates into a full scale crisis. We shall offer incentives to make it attractive for young doctors to specialize in psychiatry and we shall tackle the long standing problem of the disgraceful state of the Psychiatric Hospital in the middle of Accra.


Ladies and gentlemen, we all continue to tell ourselves that we have a society in which the elderly are respected and taken care of. The truth, the reality, ladies and gentlemen, is very far from this. In villages and cities around the country, we are leaving our elders in pitiful conditions. There are many elderly people who have been left by themselves, who have no one to care for them.

We will introduce policies that will compel District Assemblies to take a more responsible role in catering for the needs of the elderly in our communities. Beyond that, my government will offer incentives to the private sector to provide the elderly with proper care homes. I know this will require a major cultural jump but I believe it is time we brought this silent and hidden problem out into the open and find solutions. Those who have served their families and Ghana deserve some dignity at the end of their lives.

Some of the other measures the next NPP government will introduce to improve healthcare delivery in Ghana will include:-

• Making dental care accessible to the poor and vulnerable

• Cutting down on red tape at both the NHIA and our hospitals to invest the millions saved in frontline health service delivery

• Refocusing capital investment on primary and community services

• Increasing health spending in real terms every year

• Making sure the Public Procurement Act works in the supply of pharmaceuticals and other health facilities

• Introducing eHealth policy to make access to healthcare and health tips easily accessible to consumers via the internet and mobile phones

We need to move away from management by crisis. The health sector needs a management culture that is proactive and not reactive. The Ghana Health Service will be helped to acquire a more efficient Medical Information Management Systems designed to better track performance across the delivery chain, and provide the data needed to make excellent health care decisions and save lives and keep Ghanaians healthy.

We will sit down with the private providers of health services to work out how to attract greater investments and offer lucrative incentives with the objective of creating a competitive, consumer-driven healthcare service delivery system.

Ladies and Gentlemen, we have it in our power to transform our country and its economy. We will do it with the support of people like you. Every day nurses and health workers around this country perform little miracles. They bring care and comfort to the sick and the distressed, they do it under trying conditions. Under an NPP government, you will have support from the top and together we will build a healthy and prosperous Ghana. We shall not go back to a failed government that is failing you, failing your health, failing your jobs, failing your education, failing your future. Let us move forward with the NPP.

God bless you

God bless Ghana.

From: NPP Communications Directorate



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