NHIS to receive $27.7m from World Bank Group
The World Bank Group is offering $27.7 million to the National Health Insurance Authority (NHIA) to increase the National Health Insurance Scheme (NHIS) annual active membership and facilitate claims processing and payments for primary healthcare providers, including Community-based Health Planning Services (CHPS), health centers, and maternity homes, under the Primary Health Care Improvement Program for Results (PforR).
The program is financed through a World Bank facility with co-financing grants from the Global Financing Facility (GFF), Canada, the UK Foreign, Commonwealth and Development Office (FCDO), and the Gavi Alliance.
The program will be implemented for four years, spanning from 2022 to 2025.
The funding is allocated based on the Disbursement Linked Result (DLR) achieved per the Disbursement Linked Indicators (DLIs) of the program.
The DL is under the program include increase in the membership of the NHIS, increase in the enrollment of vulnerable populations in the Scheme and improvement in claims processing and payment for the primary health care facilities.
The NHIA and the Social Protection Directorate of the Ministry of Gender, Children, and Social Protection (MoGCSP) will collaborate to boost the enrollment of indigent populations, such as the disabled, orphans, widows, women, and children, in the Scheme.
This will be done through linkage with the National Household Registry, which is also supported by the World Bank.
New NHIS Leadership Vision
The new NHIA leadership’s ultimate goal is to build a more resilient health insurance scheme that responds to the needs of all by providing access to quality and affordable healthcare services on a sustainable basis.
The Executive Management’s strategy towards achieving Universal Health Coverage (UHC) is the adoption of “pro-poor pathway” interventions, coupled with the legal framework that requires all Ghanaians to register with the NHIS.
The Chief Executive, Dr. Bernard Okoe Boye, his deputies, and some directors have completed a national tour of all 16 regions as a way of connecting with staff and the citizenry and discussing how to strengthen the NHIA and its role in helping Ghana achieve UHC.
The leadership is determined to open more offices in strategic locations to make the NHIS more accessible to all. Some additional offices that have been recently commissioned are the Western North Regional Office, Bono East Regional Office, Ahafo Regional Office, Dormaa East, Jaman North, Asunafo North, Asutifi North, Obuasi, Asawase, Atwima Kwanwoma, Ejisu, Komenda Edina Eguafo Abirem (KEEA), Mion, Kumbungu, and Nanton. Bono East, Sunyani Municipal, Jaman South, Kintampo Municipal, and Techiman Municipal have received newly branded operational vehicles.
Relevance
The NHIS has grown to become a major instrument for financing healthcare delivery in Ghana and is the financial mainstay of over 4,600 credentialed healthcare service providers. Over 80% of the internally generated funds of most healthcare providers are from the NHIS.
The NHIS continues to provide financial access to many people who would otherwise not be able to afford the cost of their healthcare services.
Many are now seeking medical attention early and avoiding unnecessary deterioration in their medical conditions, and possibly death, as a result.
Digitalization Drive
The NHIA is leveraging the national digitization drive to improve efficiency. Some of the recent innovations include the MyNHIS App, the Claim-it Application, and online credentialing capability.
MyNHIS App
As the most recent innovation, the MyNHIS App empowers individuals and groups to use their Ghana Cards to register, renew, and link to the NHIS without having to visit any of the NHIA district offices for the same service.
The app can be downloaded from the Google Play Store or Apple Store, and it operates on both Android and iOS smartphones.
It issues digitized NHIS cards and provides a mechanism for the NHIA to fulfill its statutory obligations. The new app also enables NHIS members to securely pay registration and membership renewal fees from their mobile money wallets and bank cards.
The app delivers a vastly improved renewal experience to NHIS members, as it saves time and money, making the scheme more accessible to all.
Electronic Claims Management
The NHIA is determined to attain nearly 100% electronic claims management (submission, vetting, and payment) by the end of the year 2023. The essence is to eliminate waste and ensure prudent use of available resources to provide the best healthcare services to NHIS active members. The introduction of electronic claims processing in 2013 has greatly improved efficiency in NHIS claims management over the years, decreasing claims processing time from months to 1-7 days for vetting of provider claims.
Claim-it
The Claim-it system was introduced to restrict fraudulent activities such as the submission of escalated claims. Claims submitted via Claim-it make it easy for vetting at the Claims Processing Centres (CPCs) in Accra, Kumasi, Tamale, and Cape Coast.
The pragmatic nationwide rollout of the Claim-IT application to nearly 95% of providers in the year 2022 saw an increase in the number of providers submitting electronic claims from about 40% in 2021 to 60.3% by December 2022 and 86% by March 2023. The NHIA Claims Directorate and its Claims Processing Centres are actively assisting providers with challenges in electronic claims submission to ensure near 100% implementation of electronic claims processing.
Online Credentialing
Healthcare service providers typically apply for credentials from the NHIA to enable them to serve Ghanaians under the NHIS. In creating efficiency, the NHIA introduced an online application system on its official web portal, making it possible for service providers and prospective applicants to submit and renew applications electronically.
Development Partners’ Support
The NHIA has recently received support from development partners including the World Bank Group, World Health Organization (WHO), United States Agency for International Development (USAID), United Nations International Children’s Emergency Fund (UNICEF), and the Korea Foundation for International Health Care (KOFIH), among others. The support has positioned Ghana’s NHIS as a remarkable social protection model in Africa and this is evidenced by the number of foreign delegations who have so far visited the NHIA to understudy the NHIS operations.
The World Bank Group’s recent financial support is therefore key and timely in the National Health Insurance Authority’s (NHIA) quest to achieve universal health coverage by the year 2030.