Agnes M. Kotoh


The government’s vision for introducing the National Health Insurance Scheme (NHIS) in 2004 was to provide a more equitable quality healthcare to all residents in Ghana without the need of out-of-pocket payment at the point of service utilisation. The premium is heavily subsidised with the subsidy financed by a 2.5% value added tax and formal sector workers’ Social Security and National Insurance Trust (SSNIT) contributions.

The cost of premium for non-SSNIT contributors is GH₵18.00-GH₵48.00 per annum and GH₵4.00 as registration fee and GH₵1.00 administrative fee to renew membership. Exemptions are provided for vulnerable groups (children below 18 years, those aged 70 years and above, SSNIT pensioners, indigents and pregnant women). Except pregnant women, all exempt categories pay registration and administrative fees.

The NHIS was thus expected to reach the poor first and achieve universal coverage within five years. However, alongside NHIS’ success story of improving healthcare access, enrolment is low and dropout high (National Health Insurance Authority, 2011) and the poor, the target of the policy enrol less (Asante and Aikins 2008, Sarpong, 2010) making the dream of achieving universal coverage a mirage. 

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