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More than 8 million Ghanaians gets access to medical care

Denmark supports Ghana in developing a healthcare system that can ensure good and free medical health care to the poorest people in the country, to pregnant women, children and the elderly. Until now, over 8 million people have received health insurance, and for more than 5 million of them it is free of charge, around 4 million of which are children.

Lægehjælp i Ghana

Health clinic in the village of Kpasenkpe in the Northern Ghana. Infants are measured, weighed and vaccinated against yellow fever, measles and cholera. Infants are also given drops against polio and pregnant women are examined during their pregnancy.

Photo: Klaus Holsting/Danida

In Ghana, the poorest people, pregnant women, people over 70 and everyone under 18 have now been given the right to free medical care. This is a result of the country having introduced the National Health Insurance Scheme (NHIS), which Danida has helped support for over 10 years.

The health insurance scheme is run by the Ghanaian government and is unique in Africa. The results are so promising that many other countries are now visiting Ghana to see how the health insurance scheme works. Denmark supports Ghana’s health authority financially and by providing experts who advise the Ghanaian health authority.

Access to free medical care has had a great impact on the people and has created a number of important results. For example, far fewer children die now than previously. In 2003, 111 out of every 1000 children died before the age of five – in 2012, the number had fallen to 82 out of a 1000. This is still far too many, but a great improvement nonetheless. The reduction in child mortality is due to, among other things, increased access to health services such as free medical care and vaccinations. Through a child vaccination programme, which Denmark also has supported, the percentage of infants under the age of one who have been vaccinated for measles increased from 61% in 1998 to almost 90% in 2012.

The rich pay for the poor

Ghana’s health insurance scheme is built on the same principles as the Danish healthcare system. Everyone helps pay for the welfare services and those who have the most contribute the most to the community as a whole. In Ghana, this means that the price for taking part in the health insurance scheme varies depending on how much money you earn. The richest people in the country pay approx. DKK 100 a year, while those people who have less money only pay around DKK 15 a year. The poorest people in the country are covered by the health insurance scheme free of charge.

Besides paying a membership charge, as we know it from the health insurance scheme Sygeforsikring “danmark” in Denmark, Ghana has also introduced a VAT on goods, where 2.5% of the price of all transactions goes to Ghana’s health insurance scheme. In this way, once again it is those who can afford to spend the most money that contribute the most to the health insurance scheme.

2/3 of the approx. 8.6 million active members of the health insurance scheme are covered free of charge – this corresponds to around 5.3 million Ghanaians who receive free medical care. In total, approx. 34% of the Ghanaian people are members of the health insurance scheme and have received a membership card – somewhat like the Danish NHS medical card.

There continue to be major challenges in rural areas

The opportunity to receive free medical care has helped a lot of people, but the health insurance scheme is not, in itself, the answer to everyone’s problems. One of the greatest challenges is to get people, especially the poor, to even seek medical attention when they fall ill. Many people just stay at home because they do not know that the medical care is free of charge.

There are also other major challenges, such as the fact there is still a long distance between health clinics, especially in rural areas; that Ghana lacks trained doctors, nurses and midwives; and that transport options are limited. In Ghana, there is only one doctor per 10,500 people. In addition, when the closest doctor is many kilometres away and you live in a country where many of the roads get washed away during the rainy season and where there is a general lack of transport options, then it is still be difficult for many sick people and pregnant women to get to a doctor in time.

There is a great amount of inequality in Ghana, and it is especially in the rural areas that there are many holes in the healthcare sector. But the rural areas are also where many of the poor people of the country live. That is why it is still quite a risk for women to give birth out in the rural districts, and it is not unusual for a woman to die during labour. A number of them bleed to death after giving birth if, for example, the placenta has not come out completely. The lives of many women could be saved if there were more trained healthcare staff, a blood bank, or simply a means of transport and a road that could be driven on. Women in labour are just one example of the challenges in rural districts when it comes to the healthcare sector.

Healthcare is coming closer

It is therefore important to bring the healthcare sector closer to the rural population. It is a long, tough haul, but Ghana’s health authority has been working on it for many years now with support from, among others, Danida. Since 2000 the development has been picking up speed, and Ghana is now fully underway in setting up small health clinics in rural districts. Up until now, 2,200 health clinics have been established in Ghana and 20% of the people now have access to them. At the same time, Ghana is in the process of training a corps of local healthcare staff who lives in the local communities close to the clinics. This means that healthcare has come closer to many poor Ghanaians. Some villages are, though, so remote that there is not a health clinic nearby. In order to be able to reach these areas, a number of the Ghanaian healthcare staff has now been equipped with motorcycles that can access bridges and dirt roads too small or too difficult for cars to travel on. Driving these roads is however, not without danger.

Partnership ensures healthcare in the most desolate areas

The lack of resources also means that it is impossible to have public hospitals or health clinics in all areas. Therefore, public-private partnerships have been set up between the state and private healthcare providers in the country. For example, the Ghanaian government has an agreement with the Christian Health Association of Ghana (CHAG) to treat patients and receive payment through the national health insurance scheme. As such, healthcare reaches the country’s remote and inaccessible areas. The Christian organisations run 180 clinics and church-led hospitals in Ghana, and it is estimated that they deliver approx. 25-30% of all health services in Ghana. At the same time, the Ghanaian Ministry of Health saves the large amount of money it would cost to build new clinics. Denmark supports CHAG both financially and with capacity building provided by a long-term adviser.

Many years of Danish support

Denmark has supported the health sector in Ghana since 1998 and has helped to ensure significant improvements in health in the country. Already in 2002, Danida chose to support the government’s own five-year plan by contributing directly to the national healthcare budget. In 2008 the support shifted to sector budget support, and in 2012 Danida began the fifth phase of sector budget support to healthcare in Ghana. The sector budget support is provided through the Ghanaian Ministry of Finance and is given untied to the Ghanaian health authority. As such the funds support the government’s own plans for improving the delivery of healthcare to Ghanaians. This provides the Ministry of Health with the opportunity for more holistic and effective planning, and makes it easier to build up a sustainable health sector with strong Ghanaian ownership, driven by Ghana itself and which will also function when Denmark is no longer providing support.

A crucial element is that Denmark and other donors have jointly decided to support the government’s health plan and thus made it easier for the Ghanaian Ministry of Health to be able to plan for both the short and the long term. This has made the efforts much more effective, and the Ghanaian government has reciprocated by working on reforming the healthcare system in the country and on ensuring basic healthcare services for everyone.

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