Transcript Document

La couverture sanitaire des pauvres,
quelles leçons tirées des expériences
internationales pour le RAMED?
Expérience de Ghana
M. Anthony Gingoung
Socio-Economic Factors
World’s second
largest producer of
cocoa
African’s biggest gold
miner after SA
Oil production at
Ghana's offshore
Jubilee field began in
mid-December, 2010,
and is boosting
economic growth
One of African’s
fastest growing
economies
National Health Insurance Scheme
Pro-poor Policy Programme aimed at providing financial access to basic healthcare to
all persons resident in Ghana, especially the poor and the most vulnerable in society
Covers about 95% of
reported disease
conditions in Ghana

In-patients
services
 Out-patient
services
 Maternal health
services
 Emergencies
Membership Category
Category
Membership % of total
3,408,999
33.6%
360,860
3.6%
24,540
0.2%
Informal sector
Informal
SSNIT
Contributors
Under 18 years
SSNIT Pensioners
70 years and above
4,713,894
46.5%
SSNIT contributors
Under 18 years
70 years and
above
381,511
3.8%
SSNIT pensioners
Indigents
1,230,410
12.1%
Pregnant women
Police Service
7,790
0.1%
Indigents
Military
16,261
0.2%
262
0.003%
10,144,527
38.3%
Category
Premium
Proc. Fee
LEAP beneficiaries
Paying
Other Security
Services
Non-Paying
Total
NHIS Timeline and Financing
• The NHIS was
established by an Act
of Parliament in 2003
(Act 650)
•National Health Ins. Levy
(NHIL) – 2.5% Consumption tax
•
•Premiums from subscribers
(ranges from GH¢7.20 to
GH¢48.00 )
In 2004, L.I 1809 was
promulgated to
provide regulations
for its operations.
• Revised Law (Act 852)
was passed in
November 2012
establishing one
unitary scheme
•SSNIT – 2.5 percentage points
of Social Security
Contributions.
•Funds from Government of
Ghana (GoG) allocated by
Parliament
•Returns on investment
•Sector Budget Support
Identifying the poor
Community-based targeting is employed using community members to identify the poor and
vulnerable:
1.
2.
District Staff liaise with Department of Social Welfare, opinion leaders, and others within
their respective areas of operations for list of poor persons in their communities
Relying on existing pro-poor social intervention programmes, namely:
- Livelihood Empowerment Against Poverty (LEAP)
- Orphanages
- Leprosaria and inmates in mental homes
- Prison inmates (reported to be poor and vulnerable)
- Children in government school feeding programme
- Children in government school uniform programme
6
Strategies to increase enrollment of poor (1)
• Enroll all LEAP beneficiaries under the NHIS
• Livelihood Empowerment Against Poverty (LEAP)
• Ongoing across the country
• About 90% enrolled under the NHIS
• Support the implementation of Common Targeting Mechanism (CTM)
• Piloted in 10 districts (One per region)
• Plans are far advanced to increase the number to 50 in 2015
• Funding constraint
Strategies to increase enrollment of poor (2)
• Undertake special registration exercise for the following:
• Psychiatrict Hospitals
• Beneficiaries of School Feeding Programmes
• Beneficiaries of School Uniform
• Indigent
- Mother of twins begging on the street
- TB patients
- Inmate in Leprosaria who are poor and have no source of income
- Persons with no identifiable source of income
- Orphans with no support
- Differently-able Persons
- Prison Inmates
- Children in orphanages
Evidence on enrollment
Current targeting mechanism for reaching the poor has resulted in significant increase in
the number of indigents enrolled from 393,453 in 2012 to 1.23m in 2013 representing
about 238% increase over the previous year.
1200000
1,124,438
1000000
800000
600000
341,725
400000
380,144
304,835
200000
159,991
128,313
23,238
144,960
48,955
0
2005
2006
2007
2008
2009
2010
2011
2012
2013
Challenges in effective coverage of poor
• Difficulty reaching out to the poor
• Hard to reach areas
• Identification constraints
• Poor road network
• Unavailable national database of the poor
• Difficulty determining the actual population of the poor
• Unsustainable funding and operational strategy
Way Forward
• Deepen collaboration with all stakeholders (Department of social
welfare, local government, opinion leaders etc) to:
• Develop guidelines and proxies for targeting and enrolment of the poor
and vulnerable under the NHIS
• Develop register of the poor and vulnerable under the NHIS
• Ensure consistent funding for identification and registration of
the poor and vulnerable
Adaptable Lessons from Ghana’s NHIS
Innovative funding:
o Earmarked fund – NHIL (2.5% VAT)
o 2.5 percentage points of 18.5% Social Security Contributions
o Informal sector contributions
Promotion of acceptability through community ownership using district based
sub-schemes
Non-partisan political will of Government and entire population
Comprehensive Accreditation system
o Public, Private & Mission facilities
o Assess staffing, management systems (including quality and safety)
o Health care delivery systems and processes
o Well accepted due to participation by all stakeholders
Involvement of both public and private health care providers
Adaptable Lessons from Ghana’s NHIS (2)
A mix of provider payment mechanisms
(i) Fee for Service (ii)The Ghana DRG system (iii) Capitation (Pilot state)
NHIS medicine List derived from Ministry of Health (MOH) Essential Medicines
List
Clinical audit for the promotion of quality and cost containment
Broad involvement of providers in the development of NHIS systems
Call Centre
Annual stakeholder meetings