Health insurance a lifesaver in Ghana
[] 6/23/2005
Janet Asare with her baby shows her healthcard.Janet Asare wipes her baby's mouth with one hand, clutching her national health insurance card with the other. She sits on a bench outside her house, a small wooden shack. A string of goats and chickens trails across the dirt yard.
For her first child, she had a traditional birth in her village, so didn't have to visit a hospital. But things were different this time.
'The doctor told me there were some complications and that I would need surgery,' she says. 'After everything was done, they told me the bill would be three million cedis [about $400]. But they assured me I wouldn't have to pay,' she says smiling, 'that the NHIS would pay for everything.'
Asare shows her new health card. On the plastic card is her photo, physical and economic profile, and identification number. Because so many Ghanaians don't have actual addresses, officials have come up with a system. They walk, bike or drive through communities assigning ID numbers, which consist of codes for the community, street, building, household, and household status.
Having national health insurance is revolutionary in this small developing country. It was launched last March by President John Kufuor, designed to offer affordable health care to Ghanaians, especially to the poor and vulnerable.
Since 1985, the country has had a 'cash-and-carry' system where patients pay directly for medical services at government medical facilities. The problem was the average Ghanaian couldn't afford proper health care and people were dying needlessly.
Here's how the scheme works. Ghanaians pay an annual fee according to their income keeping in mind the minimum wage is about $1.50 per day. As a vendor, Janet Asare is classified as very poor, so she pays about $10 annually.
Workers in the formal sector pay 2.5 per cent of their social security contribution. The government covers the aged, indigent and children whose parents pay into the scheme. Financing comes through a 2.5 per cent National Health Insurance Levy on selected goods and services. It's also funded by the Heavily Indebted Poor Countries Index.
The government estimates the new health insurance scheme will cost between $10 million and $17 million annually. In Canada, governments spent just under $70 billion delivering public health care in 2004.
The NHIS covers the main reasons Ghanaians go to the doctor: for child and maternal care, nutritional needs and treatment for conditions such as malaria and diabetes. But it won't cover some types of specialized health care, including treatment of chronic renal failure, heart and brain surgery.
It also won't help 28-year-old Gifty Torto who needs to use the neo-natal intensive care unit at Accra's Korle-Bu, a tertiary care hospital. Her baby was born premature, but nursed back to health, and discharged three weeks ago. This mother, however, can't take her baby home. She owes the hospital more than $400 and can't pay the bill.
'It makes me uncomfortable. I feel very sad that l have to leave my baby here and sleep elsewhere,' she says. 'My husband is travelling, but when he returns he will pay for me to leave. In the meantime, my brother says he can deposit some money for me.'
Dozens of other parents are in the same position as Torto. About 25 babies have been discharged and are staying in a makeshift waiting room. Their tiny brown bodies lie next to each other at every which angle on mattresses on the floor.
Miniature white identification bands are wrapped around their wrists. One baby throws out her arms to the side, wailing for her mother. There isn't enough space in the unit's equipped rooms for these newborns. Babies there are already two to an incubator, two to a crib.
Workers here estimate as many as 60 per cent of parents have problems paying their hospital bills. That concerns the hospital's director of nursing, Grace Barnes.
'It means that there will always be congestion,' she says. 'Some babies are likely not to get the facility if perpetually we keep people there who should have gone so that others could have their place.'
She sighs. 'You keep hearing: I can't pay, I can't pay, I can't pay. Sometimes you wonder whether you should let the child go, whether you're being callous if you don't let the child go. The mothers suffer, and the workers and the staff also suffer.'
Because the NHIS doesn't cover this unit, the hospital is looking after itself it has recently set up a fund for needy patients. The head of the NHIS Secretariat, Sam Akor, sympathizes, but says Ghana's new health insurance must be sustainable. He says if the fund covered everyone who went to a tertiary institution such as Korle-Bu, it would run dry within six months.
While Canada grapples with whether to allow private institutions to administer health care already provided publicly to ensure faster delivery, Ghana and just recently, Nigeria is trying to do what Canada did back in 1967: simply give people access to affordable health care. Ghana's NHIS is slowly being implemented across the country and expected to be fully operational by the end of this year.
Singing her baby to sleep, Janet Asare is just grateful she didn't have to pay for her caesarean section. She says if they hadn't had health insurance, her husband would have had to spend a lot of time combing the neighbourhood for loans.
'The NHIS people made me very, very happy,' she says. 'So much so the hospital experience was actually better than giving birth.'
Source: CBC News, Canada
[your comment] | [
0
comments]
|
|
